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Musculoskeletal
FA complete review
| Question | Answer |
|---|---|
| Which are the anti-inflammatory type of drugs that inhibit Phospholipase A2 in the Arachidonic acid pathway? | Glucocorticoids (corticosteroids) |
| Which enzyme is inhibited by glucocorticoids in the AA pathway? | Phospholipase A2 |
| Membrane phospholipids are converted into Arachidonic acid via which enzyme? | Phospholipase A2 |
| Leukotriene synthesis stopped by inhibiting which enzyme? | 5-Lipoxygenase |
| Inhibition of 5-lipoxygenase causes the inhibition what type product synthesis? | Leukotrienes |
| What is a common drug that works by inhibiting 5-Lipoxygenase? | Zileuton |
| Which enzyme is inhibited by Zileuton? | 5-Lipoxygenase |
| What process is inhibited with the use of Zileuton? | Leukotriene synthesis |
| Which leukotrienes are inhibited ty Leukotriene receptor antagonists? | LTC-4, LTD-4, and LTE-4 |
| What are some common Leukotriene Receptor antagonists? | Montelukast and Zafirlukast |
| LTC4, LTD4, LTE4 cause: | Increased bronchial tone |
| What is the function of LTB4? | Incrase neutrophil chemotaxis |
| Which is precursor of leukotrienes from Arachidonic acid? | 5-HPETE |
| What enzyme converts Arachidonic acid into 5-HPETE? | 5-Lipoxygenase |
| Which Leukotriene (LT) subtype is NOT inhibited by Leukotriene receptor antagonists? | LTB-4 |
| What is a common COX-2 only inhibitor? | Celecoxib |
| What is the irreversible COX-1 & COX-2 inhibitors? | Aspirin |
| Which COX is inhibited by Celecoxib? | COX-2 |
| List of reversible NSAIDs: | - Diclofenac - Ibuprofen - Indomethacin - Ketorolac - Naproxen |
| What process is inhibited by inhibiting COX? | Endoperoxidase synthesis |
| What are the roles of PGI2? | - Decreased platelet aggregation - Decreased vascular tone |
| Which prostaglandin decreases vascular tone? | PGE-1 |
| What are the products of Cyclic endoperoxides? | Prostacyclin, Prostaglandins, and Thromboxane |
| Which prostaglandins work by increased uterine tone? | PGE2 and PGF-2 alpha |
| What is the functions of TXA2? | - Increased platelet aggregation - Increased vascular tone |
| What is the mechanism of action of Acetaminophen? | Reversibly inhibits cyclooxygenase, mostly in CNS |
| Where does acetaminophen has the most efficacy? | CNS |
| What are clinical uses for Acetaminophen? | Antipyretic, analgesic, but not anti-inflammatory |
| True or False. Acetaminophen has no anti-inflammatory properties. | True. Acetaminophen is not an anti-inflammatory |
| What medication should be used instead to aspirin in children to avoid Reye syndrome? | Acetaminophen |
| What does OD on acetaminophen causes? | Hepatic necrosis |
| What is the acetaminophen metabolite? | NAPQI |
| What causes NAPQI? | Depletes glutathione and foresm toxic tissue byproducts in liver |
| What is used to treat acetaminophen overdose? | N-acetylcysteine |
| How does N-acetylcysteine works to treat acetaminophen overdose? | Regenerates glutathione |
| What is MOA of Aspirin? | Irreversibly inhibits cyclooxygenase-1/-2, by covalent acetylation leading to decreased synthesis of TXA2 and prostaglandins |
| What hematologic lab result in increased by the use of Aspirin? | Bleeding time |
| How long do the effects of Aspirin last? | Until new platelets are produced |
| What is the clinical cause for a low dose of Aspirin? | Decrease platelet aggregation |
| What is considered a low dose of aspirin? | < 300 mg/day |
| What is a intermediate dose of aspirin? | 300-2,400 mg/day |
| What is the clinical use of intermediate aspirin dose? | Antipyretic and analgesic |
| What is consider a high dose of Aspirin? | 2,400-4,000 mg/day |
| What is the clinical use of high-dose of Aspirin? | Anti-inflammatory |
| What does toxic doses of Aspirin can provoke? | Respiratory alkalosis early, but transition to mixed metabolic acidosis-respiratory alkalosis |
| What reh the acute adverse effects of Aspirin? | Gastric ulceration, tinnitus (CN VII),and allergic reactions |
| What are some adverse effects of chronic aspirin administration? | Acute renal failure, interstitial nephritis, and GI bleeding |
| What is a severe adverse effect of treating a child's fever with Aspirin? | Reye syndrome |
| Which conditions lead to higher risk to develop allergic reaction to aspirin? | Asthma and/or nasal polyps |
| What is used to treat Aspirin overdose? | NaHCO3 (sodium bicarbonate) |
| What is the acid base profile of Aspirin toxicity? | 1st: Respiratory alkalosis (early) 2nd: Transitions to mixed metabolic acidosis <--> Respiratory alkalosis |
| MOA of Celecoxib | Reversibly and selectively inhibits the cyclooxygenase (COX) isoform 2 |
| COX-2 receptors are found in: | Inflammatory cells and vascular endothelium and mediates inflammation and pain |
| Why is Celecoxib used to treat pain in PUD patients? | Spares COX-1, which helps maintains gastric mucosa, thus not affect PUD patients |
| Spares platelet function as TXA2 productions is dependent on COX-1. Drug? | Celecoxib |
| What conditions are often treated with Celecoxib? | Rheumatoid arthitirts and Osteoarthritis |
| What are the significant adverse effects associated with Celecoxib? | 1. Increase risk of thrombosis 2. Sulfa allergy |
| What are some examples of NSAIDs? | Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac, meloxicam, and piroxicam. |
| What is the MOA of NSAIDs? | Reversibly inhibit COX-1 and COX-2; blocking prostaglandin synthesis. |
| What is the clinical use for NSAIDs? | Antipyretic, analgesic, anti-inflammatory |
| What is an specific use for Indomethacin? | Close a PDA |
| Which NSAID is used to close a PDA? | Indomethacin |
| What are the associated adverse effects of NSAIDs? | 1. Interstitial nephritis 2. Gastric ulcer 3. Renal ischemia 4. Aplastic anemia |
| How does usage of NSAIDs for a prolonged time cause a Gastric ulcer? | Prostaglandins protect gastric mucosa |
| Which type of analgesics are contraindicated in persons with PUD or risk of any gastric ulcer? | NSAIDs |
| How does NSAID therapy may cause renal ischemia? | Prostaglandin vasodilation afferent arteriole of the nephron |
| MOA of Leflunomide: | Reversibly inhibits dihydroorotate dehydrogenase, preventing pyrimidine synthesis |
| What are the common uses for Leflunomide? | Rheumatoid arthritis and Psoriatic arthritis |
| Associated adverse effects of Leflunomide: | Diarrhea, HTN, Hepatotoxicity, and Teratogenicity |
| Which enzyme is inhibited by Leflunomide? | Dihydroorotate dehydrogenase |
| Common Bisphosphonates: | Alendronate, Ibandronate, Risedronate, and Zoledronate |
| Pyrophosphate analogs used in bone diseases? | Bisphosphonates |
| MOA of Bisphosphonates: | Bind hydroxyapatite in bone, inhibiting osteoclast activity |
| What are common clinical uses of Bisphosphonates? | Osteoporosis, hypercalcemia, Paget disease of bone, metastatic bone disease, and osteogenesis imperfecta |
| What are the associated adverse effects of Bisphosphonates? | 1. Esophagitis 2. Osteonecrosis of jaw 3. Atypical femoral stress fractures |
| How is Esophagitis due to bisphosphonates intended to prevented? | Patients are advised to take with water and remain upright for 30 minutes |
| What is the mode of action of Teriparatide? | Increase osteoblastic activity when administered in pulsatile fashion |
| Important Recombinant PTH analog used for Osteoporosis. | Teriparatide |
| What is the clinical use of Teriparatide? | Osteoporosis; causes increase bone growth compared to antiresorptive therapies |
| What is the adverse effect of Teriparatide? | Increase risk of Osteosarcoma and transient hypercalcemia |
| What are the chronic gout drugs (preventive)? | Probenecid, Allopurinol, Pegloticase, and Febuxostat |
| List of Acute Gout drugs: | 1. NSAIDs 2. Glucocorticoids 3. Colchicine |
| MOA of Probenecid: | Inhibits reabsorption of uric acid in PCT |
| What is a common adverse of Probenecid? | Precipitate uric acid calculi |
| What are two common Gout (preventive) drugs that inhibit XO? | Allopurinol and Febuxostat |
| What is the mode of action of Allopurinol | Competitive inhibitor of XO leading to a decrease conversion of hypoxanthine and xanthine to urate |
| Other than in Gout, Allopurinol, is also a preventive measure for: | Tumor lysis-associated urate nephropathy in Leukemia and lymphoma patients |
| The use of Allopurinol leads to increase concentrations of: | Xanthine oxidase active metabolites, azathioprine, and 6-MP. |
| High levels of 6-MP and Azathioprine are often seen in patient with long Hx of Gout, because: | Allopurinol use |
| MOA of Febuxostat: | Inhibits xanthine oxidase |
| What is the MOA of Pegloticase? | Recombinant uricase catalyzing uric acid to allantoin |
| What is more water soluble, uric acid or allantoin? | Allantoin |
| Which Gout-treating medication is known to convert uric acid into allantoin? | Pegloticase |
| In which part of the nephron does Probenecid act upon? | PCT |
| What is an added effect of Probenecid? | Inhibition of the secretion of penicillin |
| Which drugs can inhibit (decrease) uric acid excretion/secretion? | Diuretics and low-dose salicylates |
| How does high-dose salicylates help in treating acute gout flares? | Inhibit tubular reabsorption of Uric acid |
| Does high-dose or Low-dose salicylates, help in treating acute gout events? | High-dose salicylates |
| What is the MOA of Colchicine? | Binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation |
| To what protein does Colchicine bind in order to work in acute gout? | Tubulin |
| What is the result of Colchicine--Tubulin binding? | Microtubule polymerization which leads to impairing neutrophil chemotaxis and degranulation |
| What type of side effects are associated with Colchicine? | GI and Neuromyopathic side effects |
| List of common TNF-alpha inhibitors: | 1. Etanercept 2. Infliximab, 3. Adalimumab, 4. Certolizumab, 5. Golimumab |
| What is the mechanism of action of Etanercept? | TNF-alpha inhibitor |
| Fusion protein, produced by recombinant DNA | Etanercept |
| What drug is a decoy receptor for TNF-alpha + IgGi Fc? | Etanercept |
| What conditions are often treated with Etanercept? | Rheumatoid arthritis, psoriasis, and ankylosing spondylitis |
| List of Anti-TNF-alpha monoclonal antibody medications: | Infliximab, Adalimumab, Certolizumab, and Golimumab |
| Which conditions are treated with infliximab? | Inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, and psoriasis |
| What are the most significant adverse effect of TNF-alpha inhibitors? | Predisposition to infection, including reactivation of latent TB and drug-induced lupus. |
| What are the 3 layers of the skin? | - Epidermis - Dermis - Subcutaneous fat (hypodermis, subcutis) |
| What are the divisions of subcutaneous fat? | Hypodermis and subcutis |
| What are epidermis layers form surface to base? | Stratum Corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basale |
| With lather of the epidermis is "keratin" found? | Stratum Corneum |
| What protein is associated with Strum Corneum? | Keratin |
| Which areas of body have the most prominent Stratum Lucidum? | Palms and soles |
| Which layer of the epidermis are desmosomes found in? | Stratum Spinosum |
| Which epidermis layer is the stem cell site? | Stratum Basale |
| Which the innermost layer of the Epidermis? | Stratum Basale |
| Which is the outermost (top; closest to surface) layer of the Epidermis? | Stratum Corneum |
| Which epidermis layers is most prominent in the palms of hands and soles of feet? | Stratum Lucidum |
| What protein/structures are found in the Stratum spinosum? | Desmosomes |
| Any condition with a deficiency or alteration to the Desmosomes, would be evident in which layer of the epidermis? | Stratum Spinosum |
| What is a common mnemonic used to remember the order (surface to base) of all layers of the epidermis? | Californians Like Girls in String Bikinis Corneum Lucidum Granulosum Spinosum Basale |
| List of Epithelial cell junctions: | 1. Tight junction 2. Adherens junction 3. Desmosome 4. Gap junction 5. Hemidesmosome |
| What is another name for Tight junction? | Zonula occludens |
| The zonula occludens is the same as: | Tight junctions |
| What are other ways to refer to Adherens junctions? | Belt desmosome and zonula adherens |
| What other ways to refer to Desmosomes? | Spot desmosome, and macula adherens |
| What is the common name for macula adherens? | Desmosomes |
| What is the purpose of Tight junctions? | Prevents paracellular movement of solutes |
| The Tight junctions are composed of which proteins? | Claudins and occludins |
| Claudins and Occludins compose with epithelial cell junction? | Tight junctions |
| Prevention of paracellular movement of solutes is the role of the: | Tight junctions |
| Below tight junction, forms a "belt" connecting actin cytoskeleton adjacent cells with Cadherins. | Adherens junctions |
| What is the protein or "glue" used in adherens junctions to attach adjacent cells? | Cadherins |
| The Cadherins (proteins) are involved in which Epithelial cell junction? | Adherens junctions |
| What is promoted by the loss of E-cadherin? | Metastasis |
| What is a way, involving epithelial cell junctions, that promote metastasis? | The loss of E-cadherin |
| What is the overall role of the Adherens junctions? | To form a connection among adjacent actin cytoskeletons of adjacent cells |
| Why is the Adherens junction often referred as Belt desmosome? | Forms a 'belt' connects actin cytoskeletons of adjacent cells with cadherins |
| What are Cadherins? | Ca2+ - dependent adhesion proteins |
| What is the main role of Desmosomes? | Structural support via intermediate filament interaction |
| What disease or condition is associated with Desmosomes? | Pemphigus vulgaris |
| Pemphigus vulgaris involves which type of Epithelial cell junction? | Desmosomes |
| Autoantibodies to Desmoglein ----> | Pemphigus vulgaris |
| What protein is attacked by the autoantibodies which then cause Pemphigus vulgaris? | Desmoglein |
| Autoimmune disease involving the Macula adherens? | Pemphigus vulgaris |
| Gap junction are: | Channel proteins called connexons permit electrical an chemical communication between cells |
| What epithelial cell junction allow for eltictial and chemicla commnction among cells? | Gap junctions |
| What are the channel proteins used by Gap junctions? | Connexons |
| Connexons are associated in which Epithelial cell junction? | Gap junctions |
| What is the role of Connexons? | Permit electrical and chemical communication between cells |
| Hemidesmosomes are on the Apical or Basolateral side(surface) of the epithelial cell? | Basolateral |
| Tight junctions are close to the Apical or Basolateral surface of the epithelial cells? | Apical |
| What is the purpose of Hemidesmosomes? | Connects keratin in basal cells to underlying basement membrane |
| Which epithelial cell junction is known to connect keratin to the basement membrane? | Hemidesmosomes |
| What condition is produced by attacking the Hemidesmosomes by autoantibodies? | Bullous pemphigoid |
| In Bullous pemphigoid, which is the affected epithelial cell junction? | Hemidesmosome |
| Which condition is due to antibodies affecting the keratin connection in basal cells to the underlying basement membrane? | Bullous pemphigoid |
| What are integrins? | Membrane proteins that maintain integrity of balateral membrane by binding o collagen, laminin, and fibronectin in basement membrane |
| Where are integrins found in the epithelial cell, apical o basolateral surface? | Basolateral |
| To which structure (proteins) are integrins attached to in the basement membrane? | Collagen, laminin, and fibronectin |
| Laminin is a protein in the basement membrane of epithelial cells that is often used by which structural protein? | Integrins |
| What are the characteristics of a Macule/ | Flat lesion with well-circumscribed change in skin color < 1 cm |
| Flat lesion, well circumscribed change in skin color, < 1 cm | Macule |
| What are examples of Macules? | Frecke, and labial macule |
| A freckle is an example of a ______________. | Macule |
| What is the lesion (or term) for a macule > 1 cm? | Patch |
| 3 cm macule is referred as a _____________. | Patch |
| What is a common example of a Patch? | Large birthmark (congenital nevus) |
| A large birthmark, such as a congenital nevus, is an example of what dermatologic lesion? | Patch |
| WHat are the characteristic of Papule? | Elevated solid skin lesion < 1 cm |
| Elevated solid skin lesion of < 1 cm in size | Papule |
| What are common examples of Papules? | Mole (nevus) and Acne |
| Acne is a common example of a _______________________. | Papule |
| A mole is an example of which dermatologic lesion? | Papule |
| Papule > 1 cm. | Plaque |
| Is a plaque, larger or smaller, than a Papule? | Larger |
| What is a Plaque? | Papule > 1 cm |
| What is the most common example of a Plaque? | Psoriasis |
| Psoriasis is a example of which dermatologic lesion? | Plaque |
| What is a vesicle? | Small fluid-containing blister < 1 cm |
| Is a vesicle size of extend, larger or smaller than 1 cm? | Smaller |
| What conditions are associated with vesicle dermatologic lesions? | Chickenpox (varicella), and shingles (zoster) |
| Shingles is associated with what type of dermatologic lesion? | Vesicle |
| Large fluid-containing blister > 1 cm | Bulla |
| A large vesicle is known as a ___________________. | Bulla |
| What condition is seen with Bullae? | Bullous pemphigoid |
| What is the name of a vesicle that if fulled with pus? | Pustule |
| What is a pustule? | Vesicle contains pus |
| What is a common condition associated with Pustules? | Pustular psoriasis |
| What is a Wheal? | Transient smooth papule or plaque |
| Transient smooth papule or plque | Wheal |
| What condition is seen with Wheals? | Hives (urticaria) |
| What is a Scale? | Flaking off of stratum corneum |
| Which layer of epidermis gives rise to scales? | Stratum Corneum |
| What are common examples of scales? | Eczema, psoriasis, and SCC |
| Eczema is an example of what type of macroscopic dermatologic lesion? | Scale |
| Squamous cell carcinoma of the skin is an example of what type of dermatologic lesion? | Scale |
| What is the definition of Crust? | Dry exudate |
| Dry exudate is referred as ________________. | Crust |
| What is the most common example of a crust? | Impetigo |
| What type of dermatologic lesion is impetigo? | Crust |
| What are the characteristics of hyperkeratosis? | Increased thickness of stratum corneum |
| Increased thickness of the Stratum corneum. | Hyperkeratosis |
| What are examples of Hyperkeratosis? | Psoriasis and calluses |
| Calluses are an example of what kind of microscopic dermatologic condition? | Hyperkeratosis |
| What is Parakeratosis? | Retention of nuclei in stratum corneum |
| What important condition is seen with Parakeratosis? | Psoriasis |
| Which layer of the epidermis involves Parakeratosis? | Stratum Corneum |
| What is the definition of Hypergranulosis? | Increased thickness of stratum granulosum |
| Increased thickness of epidermal Stratum granulosum. | Hypergranulosis |
| What condition is associated with Hypergranulosis? | Lichen planus |
| Lichen planus is characterized by what dermatologic condition? | Hypergranulosis |
| Which epidermal layer is increased in thickness in Lichen planus? | Stratum granulosum |
| What is Spongiosis? | Epidermal accumulation of edematous fluid in intercellular spaces |
| What is a condition seen with Spongiosis? | Eczematous dermatitis |
| Term used for epidermal accumulation of edematous fluid in intercellular spaces. | Spongiosis |
| What is the definition of Acantholysis? | Separation of epidermal cells |
| What is an example condition associated with Acantholysis? | Pemphigus vulgaris |
| Autoantibody condition that is closely associated with Acantholysis? | Pemphigus vulgaris |
| Separation of epidermal cells. | Acantholysis |
| What is Acanthosis? | Epidermal hyperplasia (increased spinsum) |
| What is an example disease or condition seen with Acanthosis? | Acanthosis nigricans |
| Epidermal hyperplasia of the Stratum spinosum | Acanthosis |
| Which epidermal layer is affected by Acanthosis? | Stratum Spinosum |
| What are common Pigmented Skin disorders? | 1. Albinism 2. Melasma (chloasma) 3. Vitiligo 4. Seborrheic dermatitis |
| What pathogenesis of Albinism? | Normal melanocyte number with decreased melanin production due to a decreased tyrosinase activity or defective tyrosine transport. |
| What are the two causes of decreased melanin production in Albinism? | 1. Decreased tyrosinase activity or, 2. Defective tyrosine transport |
| Albinism represents an increased risk for: | Skin cancer |
| Hyperpigmentation associated with pregnancy or OCP use. | Melasma |
| What is another term used for Melasma? | Chloasma |
| What is Melasma? | Hyperpigmentation associated with pregnancy or OCP use |
| A pregnant woman notices a darkening of the skin patches. Dx? | Melasma |
| What is Vitiligo? | Irregular patches of complete depigmentation |
| What is the cause of Vitiligo? | Autoimmune destruction of melanocytes |
| Skin pigmentation condition due to autoimmune destruction of melanocytes. | Vitiligo |
| What is a Seborrheic dermatitis? | Erythematous, well-demarcated plaques with greasy yellow scales in areas rich in sebaceous glands, such as scalp, face, and periocular region. |
| What areas of the body are often affected in Seborrheic dermatitis? | Areas rich in sebaceous glands, such as scalp, face, and periocular region. |
| Which neurodegenerative condition is associated with Seborrheic dermatitis? | Parkinson disease |
| A person with Parkinson disease is often affected by which dermatological condition? | Seborrheic dermatitis |
| What pathogen is possibly associated in development with Seborrheic dermatitis? | Malassezia spp |
| What are common treatment options for Seborrheic dermatitis? | Topical antifungals and corticosteroids |
| What are some common causes of Acne? | 1. Increased sebum/androgen production, 2. Abnormal keratinocyte desquamation, 3. Cutibacterium acnes colonization of the pilosebaceous unit, and, 4 .Inflammation of papules/pustules |
| What are treatment options of acne? | Retinoids, benzoyl peroxide, and antibiotics |
| Which bacteria is often causative of acne development? | Cutibacterium acnes |
| What is a comedone? | Pilosebaceous unit |
| What is the former name of Cutibacterium acnes? | Propionibacterium |
| Common skin disorder of multifactorial etiology, often involving sebum? | Acne |
| What is another name of Atopic dermatitis? | Eczema |
| Eczema is also known as: | Atopic dermatitis |
| What is Atopic dermatitis? | Pruritic eruption, commonly on skin flexures |
| What are common associations of Atopic dermatitis? | 1. Atopic disease (asthma, allergic rhinitis, and food allergies) 2. Increased serum IgE |
| What gene is often mutated in Eczema? | Filaggrin |
| What condition is highly associated with mutations in filaggrin gene? | Atopic dermatitis |
| What function is interrupted by a filaggrin mutation? | Skin barrier dysfunction |
| Atopic dermatitis in infants is present most commonly in: | Face |
| Eczema in children and adults is often seen in what body area? | Antecubital fossa |
| Type IV hypersensitivity reaction that follows exposure to allergen. | Allergic contact dermatitis |
| What type of hypersensitive is Allergic contact dermatitis? | Type IV |
| What common skin disorder is characterised by lesions that occur at site upon contact with the material? | Allergic contact dermatitis |
| What are common examples of material that develop Allergic contact dermatitis? | Nickel, poison ivy, neomycin |
| What is the medical term of a common mole? | Melanocytic nevus |
| Intradermal nevus are ________________. | Papular |
| What is the term used for flat macules? | Junctional nevi |
| What is Pseudofolliculitis barbae? | Foreign body inflammatory facial skin disorder characterized by firm, hyperpigmented papules and pustules that are painful and pruritic. |
| What are common sites of Pseudofolliculitis barbae? | Cheeks, jawline, and neck |
| What is a common skin disorder that is associated of shaving ("razor bumps")? | Pseudofolliculitis barbae |
| Which population is most often affected by Pseudofolliculitis barbae? | African-American males |
| Papules and plaques with silvery scaling, especially on knees and elbows. Dx? | Psoriasis |
| What is the definition of Psoriasis? | Papules and plaques with silvery scaling, especially on knees and elbows |
| What are microscopic dermatologic conditions associated with Psoriasis? | Acanthosis with Parakeratotic scaling. |
| What are clinical features/signs of Psoriasis? | 1. Acanthosis with Parakeratotic scaling 2. Munro microabscesses 3. Increased stratum spinosum 4. Decreased stratum granulosum 5. (+) Auspitz sign |
| What non-dermatologic features are associated with Psoriasis? | Nail pitting and psoriatic arthritis |
| What is Auspitz sign? | Pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off |
| A (+) Auspitz sign. Dx? | Psoriasis |
| What is the definition of Rosacea? | Inflammatory facial skin disorder characterized by erythematous papules and pustules, but no comedones. |
| What is rhinophyma? | Bulbous deformation of nose |
| What is a possible adverse result of Phymatous rosacea? | Rhinophyma |
| Associated with facial flushing in response to external stimuli, such as alcohol or heat. Dx? | Rosacea |
| What is Seborrheic keratosis? | Flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts). |
| "stuck on" looking keratin-filled cysts. Dx? | Seborrheic keratosis |
| What are common places with Seborrheic keratosis occur? | Head, trunk, and extremities |
| Common skin benign neoplasm of older people. | Seborrheic keratosis |
| Seborrheic keratosis is (+) for what clinical sign? | Leser-Trélat sign |
| WHat is the Leser-Trelat sign? | Sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy. |
| (+) Leser-Trélat sign. Dx? | Seborrheic keratosis |
| Common name for Verrucae? | Warts |
| What pathogen causes verrucae (warts)? | Low-risk HPV strains |
| What is the description of verrucae? | Soft, tan-colored, cauliflower-like papules |
| Soft, tan-colored, cauliflower-like papules. | Verrucae |
| What is the result of epidermal hyperplasia, hyperkeratosis, and koilocytosis? | Verrucae |
| What verrucae condition is associated with warts in the anus or genital? | Condyloma acumintum |
| Which part of body does Condyloma acuminatum appear on? | Anus and genitals |
| Common name of Urticaria | Hives |
| What is urticaria? | Pruritic wheals that form after mast cell degranulation |
| How urticaria characterized by? | Superficial dermal edema and lymphatic channel dilation |
| Which skin condition is characterized with superficial dermal edema and lymphatic channel dilation? | Urticaria |
| What skin condition is formed after mast cell degranulation? | Urticaria |
| List of Vascular tumors of the skin: | 1. Angiosarcoma 2. Bacillary angiomatosis 3. Cherry hemangioma 4. Cystic hygroma 5. Glomus tumor 6. Kaposi sarcoma 7. Pyogenic granuloma 8. Strawberry hemangioma |
| Rare blood vessel malignancy typically occurring in the head, neck, and breast areas, in elderly, on sun-exposed areas. Dx? | Angiosarcoma |
| Angiosarcoma is: | A rare blood vessel malignancy (vascular tumor of skin) that occurs in the head, neck, and breast aras of elderly in sun-exposed areas. |
| What are common associations to the development of Angiosarcomas? | Radiation therapy and chronic postmastectomy lymphedema |
| Which vascular tumor of skin is highly associated with vinyl chloride and arsenic exposures? | Hepatic angiosarcoma |
| A person with Hepatic angiosarcoma, is likely to have been exposed to what material? | Vinyl chloride and arsenic |
| Hx of postmastectomy lymphedema and radiation therapy, raises suspicion of which vascular tumor of skin? | Angiosarcoma |
| Which patients are often seen with Bacillary angiomatosis? | AIDS patients |
| What is Bacillary angiomatosis? | Benign capillary skin papules found in AIDS patients |
| Pathogen causative of Bacillary angiomatosis in AIDS patient? | Bartonella spp |
| Bacillary angiomatosis is often mistaken by which other vascular skin tumor? | Kaposi sarcoma |
| What is the distinguish infiltrate of Bacillary angiomatosis from Kaposi sarcoma? | Bacillary angiomatosis has a NEUTROPHILIC infiltrate |
| What type of infiltrate is seen in Bacillary angiomatosis? | Neutrophilic |
| Neutrophilic or Lymphocytic infiltrate in Bacillary angiomatosis? | Neutrophilic |
| Neutrophils or Lymphocytic infiltrate in Kaposi sarcoma? | Lymphocytic |
| Cherry hemangioma is: | Benign capillary hemangioma of the elderly. Does not regress. Increase frequency with age |
| Benign capillary hemangioma of the elderly. Dx? | Cherry hemangioma |
| Bening capillary hemangioma of infancy. Dx? | Strawberry hemangioma |
| What is a Cystic hygroma? | Cavernous lymphangioma of the neck |
| Cystic hygroma is highly associated with which condition? | Turner syndrome |
| A patient with Turner syndrome is at high risk of developing which Vascular tumor of the skin? | Cystic hygroma |
| Cavernous lymphangioma of the neck. | Cystic hygroma |
| What is a Glomus tumor? | Bening, painful, red-blue vascular skin tumor, commonly found under the fingernails |
| How does a Glomus tumor aries? | From modified smooth muscle cells of the thermoregulatory glomus body |
| Benign, painful, red-blue tumor, commonly found under fingernails. | Glomus tumor |
| Painful or Painless. Glomus tumor? | Painful |
| What is Kaposi sarcoma? | Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and respiratory tract. |
| What are the viral associations of Kaposi sarcoma? | HHV-8 and HIV |
| Other than the skin, what other areas may be affected, rarely, by Kaposi sarcoma? | Mouth, GI tract, and respiratory tract |
| What condition may be mistaken instead of Kaposi sarcoma? | Bacillary angiomatosis |
| Polypoid lobulated hemangioma that can ulcerate and bleed. Dx? | Pyogenic granuloma |
| What are associations of Pyogenic granuloma development? | Trauma and pregnancy |
| What is Pyogenic granuloma? | Polypoid lobulated capillary hemangioma that can ulcerate and bleed. |
| What age is associated with Strawberry hemangioma? | Infancy |
| Strawberry hemangioma features: | 1. Appears in infancy 2. Grows rapidly 3. Spontaneous regression by 5-8 years old |
| At what is a Strawberry hemangioma commonly spontaneously regressed? | 5-8 years old |
| List of BACTERIAL skin infections: | 1. Impetigo 2. Erysipelas 3. Cellulitis 4. Abscess 5. Necrotizing fasciitis 6. Staphylococcal Scalded Skin Syndrome |
| What are the most common bacteria that cause Impetigo? | S. aureus and S. pyogenes |
| What is impetigo? | A very superficial skin infection; highly contagious, and honey-colored crusting, caused by S. aureus and/or S. pyogenes |
| Bullous impetigo: | Impetigo + bullae caused by S. aureus |
| What structures of the skin are involved in the development of Erysipelas? | Upper dermis and superficial lymphatics |
| What is the organism that causes Erysipelas? | S. pyogenes |
| Infection involving the upper dermis and superficial lymphatics, due to a S. pyogenes infection. | Erysipelas |
| How is Erysipela (infection) presented? | Well-defined, raised demarcation between infected and normal skin |
| What is cellulitis? | Acute, painful, spreading infection of deeper dermis and subcutaneous tissues |
| Which organism are often associated with Cellulitis development? | S. aureus and S. pyogenes |
| How is the most common way that Cellulitis develops? | Starts with skin from trauma or another infection |
| What is an abscess? | Collection of pus from a walled-off infection within deeper layer of skin. |
| What is the most common organism that causes an skin abscess? | S. aureus |
| What layers or parts of the skin are affected in Cellulitis? | Deeper dermis and subcutaneous tissues |
| Deeper tissue injury, usually from anaerobic bacteria or S. pyogenes, which shows pain out of proportion to exam findings. | Necrotizing fasciitis |
| What is the key finding or feature to identify and diagnose Necrotizing fasciitis? | Pain may be out of proportion ito exam findings |
| Necrotizing fasciitis result in ----> | Crepitus from methane and CO2 production |
| What gases are developed or associated in Necrotizing fasciitis? | Methane and CO2 production |
| What important Necrotizing fasciitis feature is due to the production of Methane and CO2 gases? | Crepitus |
| Bacterial skin conditions associated with "Flesh-eating bacteria" | Necrotizing fasciitis |
| Clinical exam findings of Necrotizing fasciitis: | 1. Pain out of proportion to exam 2. Crepitus 3. Bullae and a purple color to the skin |
| What is a skin infection that is considered a surgical emergency? | Necrotizing fasciitis |
| What skin bacterial condition is due to an Exotoxin that destroys keratinocyte attachments in the S. granulosum only? | Staphylococcal Scalded Skin syndrome |
| Which epidermal layer is affected in Staph Scalded Skin syndrome? | Stratum Granulosum |
| How is Staphylococcal SS syndrome clinical presented? | Fever and generalized erythematous rash with sloughing of the upper layer of epidermis that heals completely. |
| What sign is associated with Staphylococcal Scalded skin syndrome? | (+) Nikolsky sign |
| What is the Nikolsky sign? | Separation of epidermis upon manual stroking of skin |
| SSSS is seen in adults often with ___________________ ________________. | Renal insufficiency |
| What is destroyed by Toxic epidermal necrolysis? | Epidermal-dermal junction |
| List of Viral skin infections: | 1. Herpes 2. Molluscum contagiosum 3. Varicella zoster virus 4. Hairy Leukoplakia |
| Which strains of herpes virus cause skin infection? | HSV-1 and HSV-2 |
| Common presentations of herpes skin infections: | Herpes labialis, Herpes genitalis, and, Herpes whitlow |
| Herpes whitlow infection affects the _____________. | Fingers |
| What is Molluscum contagiosum? | Umbilicated papules caused by Poxvirus |
| Cna Molluscum contagiosum be sexually transmitted? | Yes, although is mostly seen in children |
| What conditions are caused by Varicella zoster virus? | Chickenpox and Shingles |
| How does Varicella present clinically? | Multiple crops of lesions in various stages from vesicles to crusts |
| What is Zoster? | Reactivation of the virus in dermatomal distribution |
| Reactivation of VZV in dermatomal distribution. | Zoster |
| What is the key or classic rash distribution of reactivation of VZV? | Dermatomal |
| Irregular, white, painless plaques on lateral tongue that cannot be scrapped off. | Hairy leukoplakia |
| What virus is associated with Hairy leukoplakia? | EBV |
| Which type of patients are most seen with Hairy leukoplakia? | HIV-(+) and organ transplant patients |
| Unscrapable and precancerous white plaques on tongue? | Hairy leukoplakia |
| List of Blistering skin disorders: | 1. Pemphigus vulgaris 2. Bullous pemphigoid 3. Dermatitis herpetiformis 4. Erythema multiforme 5. Stevens-Johnson syndrome |
| What is Pemphigus vulgaris? | Potentially fatal autoimmune skin disorder with IgG antibody against desmoglein. |
| What is desmoglein? | Component of desmosomes, which connect keratinocytes in the stratum spinosum |
| What are findings of the immunofluorescence of Pemphigus vulgaris? | Antibodies around epidermal cells in a reticular (net-like) pattern |
| Clinical features of Pemphigus vulgaris: | Flaccid intraepidermal bullae caused by acantholysis; Oral mucosa is involved Type II hypersensitivity reaction |
| What type of hypersensitivity reaction is seen in Pemphigus vulgaris? | Type II |
| Is Pemphigus vulgaris positive or negative for Nikolsky sign? | (+) Nikolsky sign |
| How is the acantholysis described in Pemphigus vulgaris? | Separation of keratinocytes, resembling a "row of tombstones". |
| Histological description of acantholysis in Pemphigus vulgaris | "row of tombstones" |
| IM net-like (reticular) pattern. Pemphigus vulgaris or Bullous pemphigoid? | Pemphigus vulgaris |
| What is more severe, Bullous pemphigoid or Pemphigus vulgaris? | Pemphigus vulgaris |
| What is the cause of Bullous pemphigoid? | Type II hypersensitivity reaction: involves IgG antibody against hemidesmosomes |
| What is the clinical profile of Bullous pemphigoid? | Tense blisters containing eosinophils affect skin but space oral mucosa |
| Which, Bullous pemphigoid and Pemphigus vulgaris, spares oral mucosa? | Bullous pemphigoid |
| What are the immunofluorescence findings in Bullous pemphigoid? | Linear pattern at epidermal -dermal junction |
| Which blistering skin disorder is an autoimmune disorder that attacks the hemidesmosomes? | Bullous pemphigoid |
| Tense blisters + no oral involvement + (-) Nikolsky sign | Bullous pemphigoid |
| Immunoforce reveals a linear pattern at epidermal-dermal junction. Dx? | Bullous pemphigoid |
| What causes Dermatitis herpetiformis? | Deposits of IgA at tips of dermal papillae |
| What dermatological conditions are seen with Dermatitis herpetiformis? | Pruritic papules, vesicles, and bullae, most often in the elbows |
| What autoimmune disease is associated with Dermatitis herpetiformis? | Celiac disease |
| What is the common treatment for Dermatitis Herpetiformis? | Dapsone and gluten-free diet |
| A kid gets severe stomach aches when consumes gluten-containing foods. What skin condition may be also present in the patient? | Dermatitis herpetiformis |
| Deposits of IgA at tips of dermal papillae + Celiac disease. Dx of skin? | Dermatitis herpetiformis |
| How is Erythema multiforme presented? | Multiple types of lesions, such as macules, papules, vesicles, target lesions due to infection, drugs or autoimmune diseases. |
| What are some causative associations of Erythema multiforme? | - Infeactions - Drugs - Cancers - Autoimmune disease |
| What infections are associated with Erythema multiforme? | Mycoplasma pneumoniae and HSV |
| What drugs are associated with developing Erythema multiforme? | Sulfa drugs, B-lactams, and Phenytoin |
| What are characteristics of Stevens-Johnson syndrome? | Fever, bullae formation and necrosis, sloughing of skin at dermal-epidermal junction, and high mortality rate. |
| What is a more severe form of Stevens-Johnson syndrome (SJS)? | Toxic epidermal necrolysis (TEN) |
| What is the most common causative association for Stevens-Johnson syndrome? | Adverse drug reaction |
| What is Acanthosis nigricans? | Epidermal hyperplasia causing symmetric, hyperpigmented thickening of skin, especially in axilla and/or neck. |
| What areas of body are most affected by Acanthosis nigricans? | Axilla and/or neck |
| What are associations with Acanthosis nigricans? | 1. Insulin resistance 2. Visceral malignancy |
| Epidermal hyperplasia causing symmetric, hyperpigmented thickening of skin. | Acanthosis nigricans |
| What is Actinic keratosis? | Pre-malignant lesions caused by sun exposure. |
| How is Actinic keratosis presented? | Small, rough, erythematous or brownish papules or plaques |
| Actinic keratosis raises risk for: | Squamous cell carcinoma of the skin |
| What is Erythema nodosum? | Painful, raised inflammatory lesions of subcutaneous fat (panniculitis), usually on anterior shins. |
| What are associated conditions of Erythema nodosum? | Sarcoidosis, Coccidioidomycosis, histoplasmosis, TB, streptococcal infections, leprosy, and inflammatory bowel disease. |
| What part of the body is most likely to be affected by Erythema nodosum? | Anterior shins |
| Painful, raised inflammatory lesions of subcutaneous fat on the anterior shins. Dx? | Erythema nodosum |
| What are the 6 P's of Lichen Planus? | Pruritic Purple Polygonal Planar Papules lichen Planus |
| What virus is associated with Lichen planus? | Hepatitis C |
| How is mucosal involvement in Lichen Planus presented clinically? | Wickham striae (reticular white lines) and hypergranulosis |
| What is a key finding at the dermal-epidermal junction in Lichen Planus? | Sawtooth infiltrate of lymphocytes |
| What are Wickham striae associated skin disorder? | Lichen planus |
| "Herald patch" followed days later by other scaly erythematous plaques, often in a "Christmas tree" distribution on trunk. Dx? | Pityriasis rosea |
| What skin condition is seen with pink plaques with collarette scale? | Pityriasis rosea |
| "Christmas tree" distribution on trunk or erythematous plaques. Dx? | Pityriasis rosea |
| Self-resolving in 6-8 weeks epidermal rash with "festive" distribution. Dx? | Pityriasis rosea |
| What condition is first seen with a "Herald patch" and later with a very unique erythematous rash distribution? | Pityriasis rosea |
| Acute cutaneous inflammatory reaction due to excessive UV radiation | Sunburn |
| What is caused by a sunburn? | DNA mutations, inducting apoptosis of keratinocytes |
| What is the result of the DNA mutations caused by Sunburns? | Induction of apoptosis of keratinocytes |
| What are the two types of UV radiation? | UVB and UVA |
| UVB is dominant in: | Sunburn |
| UVA is dominant in : | Tanning and photoaging |
| Increased exposure to UVA and UVB increase risk for: | 1. Skin cancer 2. Impetigo |
| What is the most common example of a first degree burn? | Sunburn |
| Which burn classification are: Painful, erythematous, and blanching? | First- and Second-degree burns |
| What is the burn classification of a burn that is superficial, though epidermis only? | First-degree burn |
| Second-degree burn is described as: | Partial-thickness burn though epidermis and dermis |
| In a second-degree burn the skin is: | Blistered and usually heals without scarring |
| Description of the a Third-degree burn: | Full-thickness burn thought epidermis, dermis, and hypodermis |
| If the burn goes through all 3 main layers of the skin, it si a: | Third-degree burn |
| Description of the skin in a Third-degree burn? | Skin scars with wound healing |
| How is a Third-degree burn described clinically? | Painless, waxy or leathery appearance, non-blanching |
| What is the most common type of skin cancer? | Basal cell carcinoma |
| What are common physical features of Basal cell carcinoma? | Waxy, pink, pearly nodules, commonly with telangiectasias, rolled borders, and central crusting or ulceration |
| Which type of skin cancer appears at times with non-healing ulcers with infiltrating or as a scaling plaque | Basal cell carcinoma |
| What is the key characteristic of the nuclei of Basal cell carcinoma? | Palisading |
| Which type of skin cancer is seen with "palisading" nuclei? | Basal cell carcinoma |
| Which skin cancer is seen with telangiectasias? | Basal cell carcinoma |
| Waxy, pink, pearly nodules, commonly with telangiectasias, rolled borders, and central crusting or ulceration. Dx? | Basal cell carcinoma |
| Which areas of body are often found with BCC? | Sun-exposed areas |
| Which skin cancer is locally invasive, rarely metastasis, and palisading nuclei? | Basal cell carcinoma |
| What is the second most common skin cancer? | Squamous cell carcinoma |
| How is Squamous cell carcinoma of the skin development associated with? | Excessive exposure to sunlight, immunosuppression, chronically draining sinuses and occasionally arsenic exposure. |
| What body areas are most often seen with SCC of skin? | Face, lower lop, ears, and hands |
| Which lip, lower or upper, is often affected by SCC of skin? | Lower lip |
| What is a common clinical characteristic of SCC of skin? | Ulcerative red lesion with frequent scale |
| Which skin cancer is seen with ulcerative red lesions with frequent scale? | Squamous cell carcinoma |
| What are the key histologic findings of Squamous cell carcinoma of the skin? | Keratin "pearls" |
| Which skin cancer is often seen with histological finding of keratin "pearls"? | Squamous cell carcinoma |
| What are two conditions of the skin often seen in SCC of skin? | 1. Actinic keratosis 2. Keratoacanthoma |
| What is Actinic keratosis? | A scaly plaque, is a precursor to squamous cell carcinoma |
| What is Keratoacanthoma? | Variant of SCC of skin, that grows rapidly (4-6 weeks) and may regress spontaneously over months |
| What is a common skin tumor with a significant risk of metastasis? | Melanoma |
| What are the main three types of skin cancer? | 1. Basal cell carcinoma 2. Squamous cell carcinoma 3. Melanoma |
| What is the main tumor maker for melanoma? | S-100 |
| (+) S-100. Dx? | Melanoma |
| What condition of Melanoma correlates with risk of metastasis? | Depth of tumor (Breslow thickness) |
| What is the name given of depth of tumor of Melanoma? | Breslow thickness |
| What are the ABCDE of Melanoma? | Asymmetry Border irregularity Color variation Diameter > 6mm Evolution over time |
| What are the 4 types of Melanoma? | - Superficial spreading - Nodular - Lentigo maligna - Acral lentiginous |
| Melanoma acral lentiginous is most common among which populations? | African-Americans and Asian |
| What is the common mutation associated with Melanoma development? | BRAF kinase |
| What is the primary treatment of Melanoma? | Excision with appropriately wide margins |
| Which type of Melanoma is benefited with treatment with Vemurafenib? | Melanoma with a BRAF V600E mutation |
| What is the MOA of Vemurafenib? | BRAF kinase inhibitor |
| What is the pathogenesis of Osteoarthritis? | Mechanical- wear and tear destroys articular cartilage leading to inflammation with inadequate repair |
| What cell mediate the pathogenesis of Osteoarthritis? | Chondrocytes |
| What is the role of Chondrocytes in Osteoarthritis pathogenesis? | Mediate degradation an inadequate repair of the articular cartilage |
| Is the pathogenesis of Osteoarthritis, mechanical or autoimmune? | Mechanical |
| What are common predisposing factors of Osteoarthritis? | Age, female, obesity, and joint trauma |
| What is the clinical presentation of Osteoarthritis? | 1. Pain in weight-bearing joints after use, improving with rest 2. Asymmetric joint involvement 3. Knee cartilage loss beings mediall 4. NO SYSTEMIC symptoms |
| Which condition, rheumatoid arthritis or osteoarthritis, presents with "bowlegged" deformity? | Osteoarthritis |
| Joint involvement in osteoarthritis, is symmetric or asymmetric? | Asymmetric |
| True or False. Osteoarthritis present with systemic symptoms. | FALSE. Osteoarthritis has NO systemic symptoms |
| What are the joint finding of osteoarthritis? | 1. Osteophytes, 2. Joint space narrowing, 3. Subchondral sclerosis ans cysts 4. Synovial fluid noninflammatory 5. Involves DIP, PIP, and 1st CMC |
| Is the MCP involved in Osteoarthritis? | No |
| Which joint involvement in osteoarthritis produces the Heberden nodes? | DIP |
| The "nodes" of joint deformities are involved in Osteoarthritis or Rheumatoid arthritis? | Osteoarthritis |
| Which are joint deformities caused by DIP and PIP in osteoarthritis? | Heberden nodes (DIP) and Bouchard nodes (PIP) |
| Besides the PIP and DIP, which other joint is involved in Osteoarthritis? | 1st CMC |
| It the arthritic condition does NOT involve the MCP, it most likely is, osteoarthritis or RA? | Osteoarthritis |
| List of treatment options for Osteoarthritis: | Acetaminophen, NSAIDs, intra-articular glucocorticoids |
| What is the pathogenesis of Rheumatoid arthritis? | Autoimmune- inflammation induces formation of pannus which erodes articular cartilage and bone |
| What is Pannus? | Proliferative granulation tissue |
| What common articular condition is associated with pannus? | Rheumatoid arthritis |
| What are risk factors of Rheumatoid arthritis? | Female, HLA-DR4, smoking, (+) rheumatoid factor, anti-cyclic citrullinated peptide antibody |
| What is most specific antibody for Rheumatoid arthritis? | Anti-cyclic citrullinated peptide antibody |
| What is the clinical presentation of Rheumatoid arthritis? | Pain, swelling, and morning stiffness lasting > 1 hour, improving with use. Symmetric joint involvement and, Systemic symptoms such as fever, weight loss, and fatigue Extraarticular manifestations are common |
| Which RA or Osteoarthritis presents with symmetrical joint involvement? | Rheumatoid arthritis |
| Which, RA or osteoarthritis, is presented with systemic symptoms? | Rheumatoid arthritis |
| How is the pain in joint in RA in the morning? | Morning stiffness lasting > 1 hour, but improves with use |
| What are the extra-articular manifestation presented in RA? | 1. Rheumatoid nodules in subcutaneous tissue and lung 2. Interstitial lung disease 3. Pleuritis 4. Pericarditis 5. Anemia of chronic disease 6 .Neutropenia + splenomegaly 7. AA amyloidosis 8. Sjogren syndrome 9. Scleritis 10. Carpal tunnel syndrome |
| What are some joint findings in Rheumatoid arthritis? | Erosions, juxta-articular osteopenia, soft tissue swelling, subchondral cysts, joint space narrowing |
| What are the classical joint deformities in RA? | 1. Cervical subluxation 2. Ulnar finger deviation 3. Swan neck, 4 Boutonniere |
| Which joints are involved in Rheumatoid arthritis? | MCP, PIP, and wrist |
| Which joint is involved in RA but not in Osteoarthritis? | DIP or 1st CMC |
| Articular condition with synovial fluid inflammatory | Rheumatoid arthritis |
| What are the lung conditions associated with Rheumatoid arthritis? | Pneumoconiosis leading to Caplan syndrome |
| What are the treatment options for Rheumatoid arthritis? | NSAIDs, glucocorticoids, disease-modifying agents, and biologic agents. |
| What are common Disease-Modifying agents used in treatment of Rheumatoid arthritis? | Methotrexate, sulfasalazine, hydroxychloroquine, and Leflunomide. |
| What is Gout? | Acute inflammatory monoarthritis caused by precipitation of monosodium urate crystal in joints. |
| What risk factors associated with developing of Gout? | Male sex, hypertension, obesity, diabetes, and dyslipidemia |
| What is the strongest risk factor for Gout? | Hyperuricemia |
| Acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in joints. Dx? | Gout |
| What type of crystals are seen in joints of Gout patients? | Monosodium urate crystals |
| What are the two causes of hyperuricemia? | 1. Underexcretion of uric acid 2. Overproduction of uric acid |
| Which cause of hyperuricemia, underexcretion or overproduction of uric acid, is most common in causation? | Underexcretion of uric acid |
| What are some condition that lead to the underexcretion of uric acid leading to Gout? | Idiopathic but potentiated by renal failure |
| What type of diuretic are often associated with precipitating gout by underexcretion of uric acid? | Thiazide diuretics |
| What conditions cause the overproduction of uric acid leading to Gout? | Lesch-Nyhan syndrome, PRPP excess, increase cell turnover, and von Gierke disease |
| Description of Gout crystals | Needle shaped and (-) birefringence under polarized light |
| Crystal are needle-shaped and with a negative birefringent. Dx? | Gout |
| How are the crystals of Gout under polarized light? | Yellow under parallel light, and blue under perpendicular light |
| Needle-shaped crystal (-) birefringence under polarized light | Gout |
| How is the birefringent of Gout crystals? | Negative |
| What is the shape of crystal in gout? | Needle-shaped |
| What is a common condition that causes a elevated cell turnover? | Tumor lysis syndrome |
| What type or hyperuricemia is produced by Tumor lysis syndrome, that later develops into Gout? | Overproduction of uric acid |
| Is the joint affection in Gout, asymmetric or symmetric? | Asymmetric |
| Clinical description of affected joint in Gout? | Joint is swollen, red, and painful |
| What is the classical manifestation of Gout? | Painful MTP joint of big toe (podagra) |
| What is Tophus formation associated with? | Gout |
| Where in Gout is Tophus formation visible? | External ear, olecranon bursa, or Achilles tendon |
| What are events or actions that precipitate Gout? | 1. After large meal with foods rich in purines (red meat, seafood), 2. Trauma 3. Dehydration 4. Diuresis 5. Alcohol consumption |
| How does alcohol consumption precipitate acute Gout attacks? | Alcohol metabolites compete for same excretion sites in kidney as uric acid lead to decrease uric acid secretion and subsequent buildup in blood. |
| What are medications are used for acute flare of gout? | NSAIDs, glucocorticoids and colchicine |
| What are the chronic (preventive) medications of Gout? | Xanthine oxidase inhibitors |
| What are tow commonly used xanthine oxidase inhibitors used in gout? | Allopurinol and Febuxostat |
| MOA of Allopurinol and Febuxostat | Xanthine oxidase inhibitors |
| What was the old nomenclature for Calcium pyrophosphate deposition disease? | Pseudogout |
| What is the pathogenesis of Pseudogout? | Deposition of calcium pyrophosphate crystals within the joint space. |
| What are some associations causative of Calcium Pyrophosphate deposition disease (Pseudogout)? | Hemochromatosis, hyperparathyroidism, and joint trauma |
| What is the most commonly involved joint in Pseudogout? | Knee |
| Pain and swelling with acute inflammation and/or chronic degeneration (pseudo-osteoarthritis). | Clinical presentation of Pseudogout |
| What is the key feature of x-ray of Calcium Pyrophosphate deposition disease? | Chondrocalcinosis |
| What is chondrocalcinosis? | Cartilage calcification |
| How are the crystals in Calcium Pyrophosphate deposition disease? | Rhomboid and weakly (+) birefringent under polarized light |
| What is the treatment for Pseudogout? | NSAIDs, colchicine, and glucocorticoids |
| What medication is often used as prophylaxis for Pseudogout? | Colchicine |
| Rhomboid calcium crystal in the knee joint. Dx? | Pseudogout |
| Birefringent of crystal in Pseudogout | Weakly (+) birefringent |
| What is Systemic juvenile idiopathic arthritis? | Childhood arthritis seen in < 12 year olds. |
| What is the clinical presentation Systemic Juvenile Idiopathic arthritis? | 1. Daily spiking fevers 2. Salmon-pink macular rash 3. UveÃtis 4. Arthritis (2+ joints) |
| What are accompanying lab results in Systemic Juvenile idiopathic arthritis? | Leukocytosis, Thrombocytosis, Anemia Increased ESR, Increased CRP |
| What are the treatment options of Juvenile arthritis? | NSAIDs, steroids, methotrexate, TNF inhibitors |
| What is the key cutaneous (skin) feature of Juvenile Arthritis? | Salmon-pink macular rash |
| A 9 year old complains of joint pain, and PE is (+) for a salmon-pink macular rash. Dx? | Systemic Juvenile Idiopathic Arthritis |
| What is Sjogren syndrome? | Autoimmune disorder characterized by destruction of exocrine glands by lymphocytic infiltrates. |
| Which exocrine glands are commonly destroyed n Sjogren's syndrome? | Lacrimal and salivary glands |
| Autoimmune disorder that is featured by the destruction of lacrimal and salivary glands by lymphocytic infiltrates, most commonly in women. Dx? | Sjogren syndrome |
| What is the epidemiology of Sjogren's syndrome? | Women of 40-60 years old |
| What are the findings in Sjogren syndrome? | 1. Inflammatory joint pain 2. Keratoconjunctivitis sicca 3. Xerostomia 4. Presence of several antibodies |
| What is Keratoconjunctivitis sicca? | Decreased tear production and subsequent corneal damage |
| What is XerostomÃa? | Decreased saliva production |
| What autoimmune disorder is associated with Xerostomia? | Sjogren syndrome |
| What occular (eye) condition is associated with Sjogren syndrome? | Keratoconjunctivitis sicca |
| What are the antibodies associated with Sjogren syndrome? | - Antinuclear antibodies - Rheumatoid factor - Anti-ribonucleoprotein antibodies - Bilateral parotid enlargement |
| What are the anti-ribonucleoprotein antibodies associated with Sjogren syndrome? | SS-A (anti-Ro) and/or SS-B (anti-La) |
| Other than Sjogren syndrome, which other condition has (+) anti-SSA and anti-SSB? | SLE |
| What is the risk of (+) anti-SSA in pregnant women with SLE? | Congenital heart block in the newborn |
| What is a common primary or secondary syndrome assocaited with other automimmune disorders such as RA, SLE, and systemic sclerosis? | Sjogren syndrome |
| What are common complications of Sjogren syndrome? | Dental caries, mucosoa-associated lumphoid tissue (MALT) lymphoma, . |
| What is the key finding of Sjogren syndrome in a biopsy? | Focal lymphocytic sialadenitis on labial salivary gland |
| Focal lymphocytic sialadenitis on labial salivary gland biopsy. Dx? | Sjogren syndrome |
| What are the common pathogens that cause Septic arthritis? | S. aureus, Streptococcus, and Neisseria gonorrhoeae. |
| How is the synovial fluid in Septic arthritis? | Purulent with WBC > 50, 000/mm3 |
| What is the common triad of Gonococcal arthritis? | Polyarthralgia, tenosynovitis (hand), and dermatitis. |
| STI that presents as either purulent arthritis (knee) with a triad of polyarthritis, tenosynovitis, and dermatitis. Dx? | Gonococcal arthritis |
| Which part is Gonococcal arthritis tenosynovitis present? | Hand |
| What type of arthritic conditions are without rheumatoid factor? | Seronegative Spondyloarthtirtis |
| What is the MHC class serotype is associated Seronegative spondyloarthritis? | MHC class I |
| List of Seronegative Spondyloarthritis: | 1. Psoriatic arthritis 2. Ankylosing spondylitis 3. Inflammatory bowel disease 4. Reactive arthritis |
| What are general clinical signs of Seronegative spondyloarthritis? | 1. Inflammatory back pain 2. Peripheral arthritis 3. Enthesitis 4. Dactylitis 5. Uveitis |
| What is Enthesitis? | Inflamed insertion sites of tendons |
| What is a common way to refer to Dactylitis? | "sausage fingers" |
| What is the HLA association with all Seronegative spondyloarthritis? | HLA-B27 |
| Description of inflammatory back pain associated with HLA-B27 arthritic conditions | Morning stiffness, that improves with exercise |
| What are common associations of Psoriatic arthritis? | Skin psoriasis and nail lesions |
| What are clinical signs of Psoriatic arthritis? | - Asymmetric and patchy involvement. - Dactylitis and "pencil-in-cup" deformity of DIP on x-ray |
| What is a classic finding of DIP x-ray in Psoriatic arthritis? | "pencil-in-cup" deformity of DIP |
| "Pencil-in-cup" deformity of DIP on x-ray. Dx? | Psoriatic arthrtitis |
| Which arthritic condition is characterized by symmetric involvement of spine and sacroiliac joints? | Ankylosing spondylitis |
| What are the results of the joint inflammation in Ankylosing spondylitis? | Ankylosis (joint fusion), uveitis, and aortic regurgitation |
| Which heart condition is associated with Ankylosing spondylitis? | Aortic regurgitation |
| Bamboo spine. Dx? | Ankylosing spondylitis |
| What is a possible respiratory complication in Ankylosing spondylitis? | Costovertebral and costosternal ankylosis may cause restrictive lung disease |
| What is the cause of a respiratory lung disease in Ankylosing spondylitis? | Costovertebral and costosternal ankylosis |
| Which inflammatory bowel diseases are associated with Spondyloarthritis? | Crohn disease and Ulcerative colitis |
| What was the former name of Reactive arthritis? | Reiter syndrome |
| What is the classic triad of Reactive arthritis? | 1. Conjunctivitis 2. Urethritis 3. Arthritis |
| A person complains of conjunctivitis, inability to urinate, and peripheral arthritis. Dx? | Reactive arthritis |
| What are the pathogens associated with causing Reactive arthritis? | Shigella, Yersinia, Chlamydia, Campylobacter, and Salmonella |
| Systemic Lupus Erythematosus (SLE) is a : | Systemic, remitting, and relapsing autoimmune disease |
| What causes organ damage in SLE? | Primarily due to a type III hypersensitivity reaction and, to a lesser degree, a type II hypersensitivity reaction. |
| What is the cause of a decrease in clearance of immune complexes in SLE? | Deficiency of early complement proteins (C1q, C4, and C2) |
| What is the classic clinical presentation of SLE? | Rash, joint pain, and fever in a female of reproductive age |
| Which ethnicities are more common to develop SLE? | African-American and Hispanic descent |
| Which are the early complement proteins associated with the pathogenesis of SLE? | C1q, C4 and, C2 |
| What is Libman-Sacks Endocarditis? | Nonbacterial, verrucous thrombi usually on mitral or aortic valve and can be present on either surface of the valve |
| What subtype of endocarditis is associated with SLE? | Libman-Sacks Endocarditis |
| SLE endocarditis (name) | Libman-Sacks Endocarditis |
| Glomerular deposition of DNA-anti-DNA immune complexes. | Lupus nephritis |
| What is Lupus nephritis cause? | Glomerular deposition of DNA-anti-DNA immune complexes |
| What is the common and severe type of Lupus nephritis? | Diffuse proliferative |
| What are the common causes of death in SLE? | 1. Renal disease 2. Infections 3. Cardiovascular disease |
| What is the MCC of death in SLE? | Renal disease |
| In a anti-SSA (+) pregnant woman ---> | Increased risk of newborn developing neonatal lupus |
| What are the clinical features of Neonatal lupus? | Congenital heart block, Periorbital/diffuse rash, Transaminitis and, Cytopenias |
| What is the common mnemonic used to summarize SLE? | RASH OR PAIN |
| RASH OR PAIN: | Rash (malar or discoid) Arthritis (nonerosive) Serositis Hematologic disorders Oral/nasopharyngeal ulcers Renal disease Photosensitivity Antinuclear antibodies Immunologic disorder Neurological disorders |
| What is the type of rash seen in SLE? | Malar or discoid rash |
| How is the arthritis in SLE described as? | Nonerosive |
| What are the anti-antibodies associated with SLE immunologic disorders? | anti-dsDNA, anti-Sm, and antiphospholipid |
| Mixed connective tissue disease has features of: | SLE, Systemic sclerosis, and/or polymyositis |
| What is the associated antibody of Mixed CT disease? | anti-U1 RNP antibodies |
| (+) anti-U1 RNP antibodies. Dx? | Mixed connective tissue disease |
| Antiphospholipid syndrome is: | A primary or secondary disorder, most commonly in SLE |
| What is the criteria for diagnosis of Antiphospholipid syndrome? | 1. Hx of thrombosis 2. Hx of Spontaneous abortion 3. (+) antibodies: lupus anticoagulant, anticardiolipin, and anti-B2 glycoprotein I antibodies |
| What is the treatment for antiphospholipid syndrome? | Systemic anticoagulation |
| Anticardiolipin antibodies can cause: | False-positive VDRL/RPR |
| What can produce false-positive VDRL/RPR? | Anticardiolipin antibodies |
| What is a adverse effect of Lupus anticoagulant? | Prolonged PTT that cannot be corrected by the addition of normal platelet-free plasma. |
| What condition is closely associated with Polymyalgia rheumatica? | Giant cell (temporal) arteritis |
| What are the symptoms of Polymyalgia rheumatica? | Pain and stiffness in proximal muscles, often with fever, malaise, and weight loss. |
| What is the population most commonly affected by Polymyalgia rheumatica? | Women > 50 years old |
| A person with Giant cell (temporal) arteritis, is often also found with what muscle condition? | Polymyalgia rheumatica |
| What are the lab findings of Polymyalgia rheumatica? | Elevated ESR and CRP, and normal CK |
| Lab findings: - Increased ESR - Increased CRP - Normal CK Dx? | Polymyalgia rheumatica |
| The treatment of Polymyalgia rheumatica has a -----> | Rapid response to low-dose corticosteroids |
| What is Fibromyalgia? | Chronic, widespread musculoskeletal pain associated with "tender points," stiffness, paraesthesias, poor sleep, fatigue, cognitive disturbance. |
| What is the etiology of Fibromyalgia? | Women 20-50 years old |
| What is the treatment for Fibromyalgia? | Regular exercise, antidepressants, and neuropathic pain agents |
| What neuropathic pain agent is often use in Fibromyalgia treatment? | Gabapentin |
| What type of antidepressants are used in the treatment of Fibromyalgia? | TCAs and SNRIs |
| What are the non-specific lab findings of Polymyositis/Dermatomyositis? | (+) ANA and elevated CK |
| What are the SPECIFIC lab findings of Polymyositis/ Dermatomyositis? | 1. (+) anti-Jo-1 (histidyl-tRNA synthetase) 2. (+) anti-SRP (signal recognition particle), 3. (+) anti-Mi-2 (helicase) |
| Anti-Jo-1 antibody = | Histidyl-tRNA synthetase |
| What is Polymyositis? | Progressive symmetric proximal muscle weakness, characterized by endomysial inflammation with CD8+ T cells |
| Endomysial or Perimysial inflammation is seen with Polymyositis? | Endomysial inflammation |
| Endomysial or Perimysial inflammation is seen with Dermatomyositis? | Perimysial inflammation |
| What are the distinguishing features of dermatomyositis, that separate it from Polymyositis? | Gottron papules, photo disturbed facial erythema, "shawl and face" rash, darkening and thickening of fingertips and sides resulting in irregular, "dirty"-appearing marks |
| Polymyositis + cutaneous involvement. Dx? | Dermatomyositis |
| Perimysial inflammation and atrophy with CD4+ T cells. | Dermatomyositis |
| What CD + T cells are involved in Dermatomyositis? | CD4+ T cells |
| Which CD+ T cells are involved in Polymyositis? | CD8+ T cells |
| What is the facial rash/erythema seen with Dermatomyositis? | Heliotrope (violaceus) edema of the eyelids |
| What part of the body is most often involved in Polymyositis? | Shoulders |
| Helicase antibody = | anti-Mi-2 antibody |
| What are the two most common Neuromuscular junction diseases? | Myasthenia gravis and Lambert-Eaton myasthenic syndrome |
| What is the most common NMJ disorder? | Myasthenia gravis |
| What is the pathophysiology of Myasthenia gravis? | Autoantibodies to postsynaptic ACh receptor |
| What condition is due to autoantibodies to postsynaptic ACh receptor? | Myasthenia gravis |
| What are the clinical fatigable muscle weakness features of Myasthenia gravis? | Ptosis; Diplopia; Proximal weakness; Respiratory muscle involvement --> dyspnea Bulbar muscle involvement --> dysphagia, difficulty chewing |
| What is the result of bulbar muscle involvement in Myasthenia gravis? | Dysphagia and difficulty chewing |
| Myasthenia gravis or Lambert-Eaton myasthenic gravis syndrome, worsens with muscle use? | Myasthenia gravis |
| Myasthenia gravis or Lambert-Eaton myasthenic gravis syndrome, improves with muscle use? | Lambert-Eaton myasthenic syndrome |
| What associated conditions with Myasthenia gravis? | Thymoma and Thymic hyperplasia |
| AChE inhibitor administration in Myasthenia gravis? | Reverses symptoms |
| What is a common medication used in Myasthenia gravis to reverse symptoms? | Pyridostigmine |
| Pyridostigmine is used to reverse ________________________ symptoms. | Myasthenia gravis |
| What is the pathophysiology of Lambert-Eaton myasthenic syndrome? | Antibodies to presynaptic Ca2+ channel leading to a decrease in ACh release |
| Myasthenia gravis involves pre- or postsynaptic receptors in NMJ? | Postsynaptic ACh receptors |
| Lambert-Eaton myasthenic syndrome, involves pre- or postsynaptic receptors? | Presynaptic Ca2+ channels |
| The antibodies in LEMS that attach the presynaptic Ca2+ channels cause ---> | Decrease in ACh release |
| What are clinical characteristics of LEMS? | Proximal muscle weakness, autonomic symptoms (dry mouth, constipation, and impotence) Hyporeflexia Improves with muscle use |
| What condition is associated with Lambert-Eaton myasthenic syndrome (LEMS)? | Small cell lung cancer |
| Which NMJ condition is often associated with Small cell lung cancer? | Lambert-Eaton myasthenic syndrome |
| Which NMJ condition is associated with minimal effect when treated with AChE inhibitors? | Lambert-Eaton myasthenic syndrome |
| What is the color change seen in Raynaud phenomenon? | From white to blue to red |
| What does the color white in Raynaud phenomenon represent? | Ischemia |
| What causes the change in color into blue form white in Raynaud phenomenon? | Hypoxia |
| What does the change from blue to red in Raynaud phenomenon? | Reperfusion |
| What is the cause of Raynaud phenomenon? | Decrease blood flow to skin due to arteriolar (small vessel) vasospasm in response to cold or stress |
| What areas of the body are most often seen with Raynaud phenomenon? | Fingers and toes |
| When is Raynaud phenomenon called Raynaud disease? | Only when it is idiopathic |
| When does Raynaud syndrome occur? | Secondary to a disease process such as mixed connective tissue disease, SLE, or CREST syndrome. |
| Digital ulceration is seen in Raynaud phenomenon, disease, or syndrome? | In secondary Raynaud's syndrome |
| What is a key feature of Raynaud syndrome? | Digital ulceration |
| What is the common treatment of Raynaud phenomenon? | Ca2+ channel blockers |
| What is another form to refer to Scleroderma? | Systemic sclerosis |
| What is the triad that defines Scleroderma? | 1. Autoimmunity 2. Non-inflammatory vasculopathy 3. Collagen deposition with fibrosis |
| What common features of Systemic sclerosis? | Sclerosis of skin manifested as puffy, taut skin without wrinkles, fingertip pitting. |
| Which other organ systems, besides skin, are often associated or involved in Scleroderma? | Renal, pulmonary, gastrointestinal, and cardiovascular systems. |
| What is the feature of renal involvement in Scleroderma? | Renal crisis treated with ACE inhibitors |
| What are pulmonary conditions seen with Scleroderma? | Interstitial fibrosis and Pulmonary HTN |
| What GI conditions are associated with Scleroderma? | Esophageal dysmotility and reflux |
| What are the 2 major types of Scleroderma? | 1. Diffuse scleroderma 2. Limited scleroderma |
| What is Diffuse scleroderma? | Widespread skin involvement, rapid progression, ealy visceral involvement. |
| What is the antibody associated with Diffuse Scleroderma? | anti-Scl-70 antibody |
| What is another name for anti-Scl-70 antibody? | anti-DNA topoisomerase I antibody |
| (+) anti-DNA topoisomerase I antibody. Dx? | Diffuse scleroderma |
| The extend of Limited Scleroderma involves which areas? | LImited skin involvement confined to fingers and face |
| What syndrome is associated with Limited Scleroderma? | CREST syndrome |
| What are the characteristics of CREST syndrome? | Calcinosis cutis anti-Centromere antibody Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia |
| What is the antibody seen with CREST syndrome? | anti-Centromere antibody |
| What muscles make up the Rotator Cuff? | 1. Supraspinatus 2. Infraspinatus 3. Teres minor 4. Subscapularis |
| What nerve innervates the Supraspinatus muscle? | Suprascapular nerve |
| What is the function of the Supraspinatus muscle? | Abducts arm initially (before the action of deltoid) |
| What muscle abducts arm before the deltoid takes over? | Supraspinatus |
| Which Rotator cuff muscle is most likely injured? | Supraspinatus |
| What test is done to diagnose a Rotator cuff injury of the Supraspinatus muscle? | "empty/full can" test |
| What are the common conditions due to Supraspinatus injury? | Tendinopathy or tear of the muscle |
| What nerve innervates the infraspinatus muscle? | Suprascapular nerve |
| What is the function of the Infraspinatus muscle? | Externally rotates arm |
| What muscle is injured in a "pitching injury"? | Infraspinatus |
| A professional baseball pitcher will likely to injured which rotator cuff muscle? | Infraspinatus |
| Teres minor muscle is innervated by which nerve? | Axillary nerve |
| The Axillary nerve innervates which rotator cuff muscle? | Teres minor |
| What is the function of the Teres minor muscle? | Adducts and Externally rotates arm |
| Which rotator cuff muscle helps in adduction and external rotation of the arm? | Teres minor |
| What is the innervation for the the Subscapularis muscle? | Upper and lower subscapular nerves |
| The Upper and Lower Subscapular nerves innervate which rotator cuff muscle? | Subscapularis |
| What are the functions performed by the Subscapularis muscle? | 1. Internally rotates arm 2. Adducts arm |
| Which rotator cuff muscle(s) adduct the arm? | Teres minor and Subscapularis muscles |
| Which rotator cuff muscle externally rotates the arm? | Teres minor |
| Which rotator cuff muscle internally rotates the arm? | Subscapularis |
| Internally rotates and adducts the arm. Muscle? | Subscapularis |
| What nerve roots primarily innervate the rotator cuff? | C5-C6 |
| Which muscles are involved in arm ABDUCTION? | Supraspinatus, Deltoid, Trapezius, and Serratus anterior |
| Which nerve innervates the Deltoid muscle? | Axillary |
| The Trapezius muscle is innervated by the _________________ nerve. | Accessory |
| The Long Thoracic nerve innervates which arm abduction muscle? | Serratus anterior |
| Which muscle abducts arm form 0-15 degrees? | Supraspinatus |
| What is the angle range of abduction performed by the deltoid muscle? | 15-100 degrees |
| Which muscle abducts arm in degrees greater than 90 *, besides the Deltoid? | Trapezius |
| At what point (degree) does the Serratus anterior help in abduction of arm? | > 100 degrees |
| List of upper extremity nerves: | 1. Axillary 2. Musculocutaneous 3. Radial 4. Median 5. Ulnar 6. Recurrent branch of Median nerve |
| What are the nerve roots of the Axillary nerve? | C5-C6 |
| Which upper extremity nerve has nerve roots C5-C6? | Axillary |
| What are the nerve roots of the Musculocutaneous nerve? | C5-C7 |
| Which upper extremity nerve has roots C5-C7? | Musculocutaneous |
| What are the nerve roots of the Radial nerve? | C5-T1 |
| Which upper extremity nerve has roots C5-T1? | Radial |
| What are the nerve roots of the Median nerve in the upper extremities? | C5-T1 |
| Which upper extremity nerves have both the nerve roots C5-T1? | Radial and Median |
| What are the nerve roots of the Ulnar nerve? | C8 - T1 |
| Nerve roots C8-T1 . Upper extremity nerve? | Ulnar |
| What are the MCC of injury to the Axillary nerve? | 1. Fractured surgical neck of humerus 2. Anterior dislocation of humerus |
| What nerve is likely to be injured in a fracture of the surgical neck of humerus? | Axillary |
| Which nerve is injured by an anterior dislocation of the humerus? | Axillary |
| How a an axillary nerve injured clinically presented? | - Flattened deltoid - Loss of arm abduction at shoulder (>15 degrees) - Loss of sensation over deltoid and lateral arm |
| Which areas lose sensation in an axillary nerve injury? | Area over the deltoid and lateral arm |
| Which part of the arm, losses sensation when there is a axillary injury? | Lateral arm |
| A flattened deltoid, very likely indicates what type of nerve injury? | Injury to the Axillary nerve |
| What causes injury to the Musculocutaneous nerve? | Upper trunk compression |
| An Upper trunk compression may injure which upper extremity nerve? | Musculocutaneous |
| What reflex is loss or decreased by an injured Musculocutaneous nerve? | Biceps reflex |
| C5-C6 reflex = | Biceps reflex |
| A decreased or diminished Biceps reflex, very likely indicates? | Injury to the Musculocutaneous nerve |
| What is the clinical presentation of a Musculocutaneous nerve injury? | 1. Decreased biceps reflex 2. Weakness of forearm flexion and supination 3. Loss of sensation over lateral forearm |
| Loss of sensation in the lateral forearm is due to injury to the ________________ nerve. | Musculocutaneous |
| A person indicates weakness of forearm to flex and supinate. What is a possible cause? | Injury to the Musculocutaneous nerve |
| What three common ways in which the Radial nerve is injured? | 1. Compression of axilla 2. Midshaft fracture of humerus 3. Repetitive pronation/supination of forearm |
| What is a common way the Radial nerve is injured by compression of the axilla? | Due to crutches or sleeping with arm over chair |
| What causes "Saturday night palsy"? | Compression of axilla, commonly due to crutches, causing Radial nerve damage |
| Which nerve is damaged causes Wrist drop? | Radial |
| Loss of elbow, wrist, and finger extension. | Wrist drop |
| What causes "finger drop"? | Repetitive pronation/supination of forearm |
| What is a possible condition due to prolonged use of a screwdriver? | "Finger drop" due to radial nerve damage |
| What are clinical features of Radial nerve damage? | 1. Wrist drop 2. Decrease grip strength 3. Loss of sensation over posterior arm/forearm and dorsal hand |
| What arm or forearm sensation losses sensation due to Radial nerve? | Posterior arm/forearm and dorsal hand |
| Nerve damaged with a midshaft humeral fracture | Radial |
| What conditions cause Median nerve damage? | 1. Supracondylar fracture of humerus 2. Carpal tunnel syndrome 3. Wrist lacerations |
| Which is the proximal cause of lesion to the Median nerve? | Supracondylar fracture of humerus |
| Which are the distal lesions that cause Median nerve damage? | Carpal tunnel syndrome and wrist laceration |
| Which hand gestures or abnormalities are associated with Median nerve damage? | "Ape hand" and "Pope's blessing" |
| Carpal tunnel syndrome causes what type of nerve damage? | Distal Median nerve damage |
| What type of nerve injury is due to Supracondylar fracture of the humerus? | Proximal Median nerve damage |
| What are the clinical features of Median nerve damage? | 1. "Ape hand" and "Pope's blessing" 2. Loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of 2nd and 3rd digits 3. Loss of sensation over thenar eminence and dorsal and palmar aspect of lateral 3 1/2 fingers with proximal lesion |
| "Pope's blessing" is due to injury to the ________________ nerve. | Median |
| What are the hand and finger deficits in Medina nerve damage? | Loss of: - Wrist flexion - Flexion of lateral fingers - Thumb opposition - Lumbricals of 2nd and 3rd digits |
| Loss of thumb opposition may be due to ______________nerve damage. | Median |
| Which area, thenar or hypothenar eminence, losses sensation with Medina nerve damage? | Thenar |
| What are common causes of Ulnar nerve damage? | 1. Fracture of medial epicondyle of humerus "funny bone" 2. Fracture hook of hamate from fall on outstretched hand |
| What is the common proximal lesion that causes ulnar damage? | Fracture of medial epicondyle of humerus "funny bone" |
| Fractured "funny bone" may cause ____________ nerve damage. | Ulnar |
| What is the distal lesion that causes Ulnar nerve damage? | Fractured hook of hamate form fall on outstretched hand |
| What is formed or seen upon digit extension in a person with Ulnar nerve damage? | "Ulnar claw" |
| If the Ulnar nerve suffers damage, it is very likely that the wrist will present with __________________ deviation. | Radial |
| Radial deviation of wrist upon flexion. Incidentes? | Proximal Ulnar nerve damage |
| What are the fingers and hand deficits seen with Ulnar nerve damage or lesion? | Loss of : 1. Wrist flexion 2. Flexion of medial fingers 3. Abduction and adduction of fingers (interossei), 4. Actions of medial 2 lumbrical muscles |
| What is the sensory loss due to Ulnar nerve lesion? | Loss sensation over medial 1 1/2 fingers including hypothenar eminence. |
| The hypothenar eminence has _____________ nerve innervation. | Ulnar |
| Which nerve damage cause loss of sensation over the Hypothenar eminence? | Ulnar |
| The Ulnar nerve damage, cause loss of sensation over the Thenar or Hypothenar eminence? | Hypothenar eminence |
| What nerve is commonly damaged or suffers lesion with a Superficial laceration of palm? | Recurrent branch of Median nerve |
| How is the Recurrent branch of the Median nerve often damaged? | Superficial laceration of palm |
| What type of hand deformity is seen with an Recurrent branch of Median nerve lesion? | "Ape hand" |
| What are the common clinical features of Recurrent branch of Median nerve damage? | 1. Ape and 2. Loss of thenar group: opposition, abduction, and flexion of thumb 3. No loss of sensation |
| Is there loss of sensation with a lesion to the recurrent branch of the Median nerve? | No loss of sensation |
| What actions of the thumb are diminished or absent upon lesion to the recurrent branch of median nerve? | Opposition, abduction, and flexion |
| Humerus fractures, proximally to distally, follow sith simple mnemonic? | ARM Axillary --> Radial --> Median |
| What are the overuse injuries of the elbow? | 1. Medial epicondylitis (golfer's elbow) 2. Lateral epicondylitis (tennis elbow) |
| Which overuse elbow injury has pain near the medial epicondyle? | Medial epicondylitis |
| What is the common name for Medial epicondylitis? | Golfer's elbow |
| Golfer's elbow = | Medial epicondylitis |
| What is the cause of Golfer's elbow? | Repetitive flexion (forehand shots) of elbow |
| What is the cause of Tennis elbow? | Repetitive extension (backhand shots) of elbow |
| Which overuse elbow injury experience pain near lateral epicondyle? | Lateral epicondylitis |
| What is the common name for Lateral epicondylitis? | Tennis elbow |
| Tennis elbow = | Lateral epicondylitis |
| List of all wrist bones: | 1. Scaphoid 2. Lunate 3. Triquetrum 4. Pisiform 5. Hamate 6. Capitate 7. Trapezoid 8. Trapezium |
| Name for the group of wrist bones? | Carpal bones |
| Which carpal bone is palpable in the anatomic snuff box? | Scaphoid |
| Which the the MC fractured carpal bone? | Scaphoid |
| The Scaphoid bone is : | 1. Palpable in the anatomic snuff box 2. Most commonly fractured carpal bone |
| What is the most common way the Scaphoid bone is fractured? | Fall on an outstretched hand |
| Falling on an outstretched hand most likely will fracture with carpal bone? | Scaphoid |
| What are common complication of proximal Scaphoid fractures? | 1. Avascular necrosis and , 2. Nonunion due to retrograde blood supply |
| What type of wrist fracture is commonly not seen in the initial x-ray? | Scaphoid fracture |
| What is caused by dislocation of the LUnate? | Acute carpal tunnel syndrome |
| Sudden, quick onset Carpal tunnel syndrome, may be due to: | Lunate dislocation |
| What is a "boxer's fracture? | Metacarpal neck fracture |
| What is the common cause of a "boxer's fracture"? | Direct blow with a closed fist |
| Which metacarpal are most likely to be injured in a "boxer's fracture"? | 4th and 5th |
| An amateur boxer practices punching repeatedly and hard a concrete wall. What is a possible injury in case of doing it too much or with no supervision? | Metacarpal neck fracture ("Boxer's fracture") |
| Entrapment of the median nerve in the region of the wrist. Dx? | Carpal tunnel syndrome |
| What causes Carpal tunnel syndrome? | Entrapment of median nerve in carpal tunnel |
| The entrapment of the median nerve causing Carpal tunnel syndrome is between which two structure? | Transverse carpal ligament and carpal bones |
| What are the clinical results of the entrapment of the median nerve? | Paresthesia, pain , and numbness in distribution of median nerve |
| Carpal tunnel syndrome produces thenar or hypothenar eminence atrophy? | Thenar eminence atrophy |
| Why is the sensation to the thenar eminence spared in Carpal tunnel syndrome? | Dut the fact that Palmar cutaneous branch enters hand EXTERNAL to carpal tunnel |
| What are common signs/maneuvers that suggests Carpal tunnel syndrome? | (+) Tinel sign and Phalen maneuver |
| What is the Tinel sign? | Percussion of wrist causing tingling |
| What is the Phalen maneuver? | A 90 degree flexion of wrist causing tingling. |
| (+) Tinel sign and (+) Phalen manuever. Dx? | Carpal tunnel syndrome |
| Which wrist condition is associated with repetitive use? | Carpal tunnel syndrome |
| What is Guyon canal syndrome? | Compression of ulnar nerve at wrist |
| The compression of the ulnar nerve at the wrist. Dx? | Guyon canal syndrome |
| Which athletes often develop Guyon canal syndrome? | Cyclists |
| Why do cyclists are often found with Guyon canal syndrome? | Due to pressure from handlebars |
| What are two common pediatric fractures? | 1. Greenstick fracture 2. Torus (buckle) fracture |
| Incomplete fracture extending part way through with of bone following bending stress. | Greenstick fracture |
| Which pediatric fracture has an intact compression side? | Greenstick fracture |
| Definition of a Greenstick fracture: | Incomplete fracture extending partway through width of bone following bending stress. |
| Torus (buckle) fracture? | Axial force applied to immature bone causing cortex buckle on compression side and fractures |
| Which pediatric fracture has a incontact Tension side? | Torus (buckle) fracture |
| List of Hand muscles: | 1. Thenar (median) 2. Hypothenar (ulnar) 3. Dorsal interossei (ulnar) 4. Palmar interossei (ulnar) 5. Lumbricals (1st/2nd, median; 3rd/4th, ulnar) |
| What are the Thenar muscles? | Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis, Superficial head |
| What are the Hypothenar muscles? | Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi brevis |
| What are the functions that perform the hypothenar and thenar muscle groups? | Oppose, Abduct, and Flex |
| The interossei muscles, both Dorsal and Palmar, are innervated by which nerve? | Ulnar |
| What function of fingers are performed by the Dorsal interossei? | Abduct fingers |
| What function of fingers is performed by the Palmar interossei muscles? | Adduct fingers |
| The mnemonic DAB, is used for: | Indicate that Dorsal interossei muscles ABduct fingers |
| PAD, is used to remember: | Palmar interossei muscles ADduct fingers |
| The first and second lumbricals are innervated by which nerve? | Median |
| Thenar muscle group is innervated by what nerve? | Median |
| Which upper extremity nerve innervates the Hypothenar muscle group? | Ulnar |
| Nerve innervating the 3rd and 4th lumbricals? | Ulnar |
| What are the function of the lumbricals? | - Flex at the MCP joint - Extend PIP and DIP joints |
| Which hand muscles are in charge of flexing finger at MCP joint, and extension at PIP and DIP joints? | Lumbricals |
| Which part of the brachial plexus is involved in Erb's palsy? | Upper trunk, involving roots C5-C6 |
| Which part of the brachial plexus is involved in Klumpke's palsy? | Lower trunk, involving roots C8-T1 |
| A wrist drop due to a brachial plexus lesion, is likely located at which level of the brachial plexus? | Posterior chord |
| What are the nerve roots that comprise the Brachial plexus? | C5-T1 |
| What are the divisions of the brachial plexus? | Roots > Trunks > Divisions > Cords > Branches |
| What are important lesions of the brachial plexus that involve the Trunks? | Erb palsy and Klumpke palsy |
| Which is the only relevant brachial plexus lesion involving the proximal part of the posterior cord of brachial plexus? | Wrist drop |
| Which nerve is lesioned in a Winged Scapula? | Long thoracic nerve |
| Axillary nerve lesion at the proximal axillary nerve? | Deltoid paralysis |
| At what point of the brachial plexus does a person develop "Saturday night palsy"? | Proximal part of the Radial nerve (not the Poerterio cord) |
| What is the difference between the Wrist drop and Saturday night palsy wrist drop? | In normal wrist drop, the lesion is at the level of the posterior division, which affect the radial and axillary nerves, which in Saturday night palsy, it only involves the Radial nerve. |
| Which brachial plexus branch is affected in a person has difficulty flexing elbow? | Musculocutáneos |
| What are the deficits seen in lesion at the Median nerve brachial plexus branch? | Decreased thumb function, and "Pope's blessing" |
| Which brachial plexus branch lesion is featured with a Claw hand? | Ulnar |
| What is another way to refer to Erb palsy? | "Waiter's tip" |
| Traction or tear of upper trunk (C5-C6). Dx? | Erb palsy |
| What is the most common cause of infant Erb palsy? | Lateral traction on neck during delivery |
| What is the MCC of adult Erb palsy? | Trauma |
| What muscles are affected in Erb palsy? | 1. Deltoid, 2. Supraspinatus 3. Infraspinatus 4. Biceps brachii |
| What is the functional deficit in Erb palsy due to deltoid and supraspinatus involvement? | Lack of abduction, presenting with arm hanging by the side |
| What muscle deficit causes the lateral rotation seen in Erb palsy? | Infraspinatus |
| In Erb palsy, the Biceps brachii is affected causing --> | Deficit in flexion, supination , presenting with arm extended and pronated |
| What muscle deficit in Erb palsy causes the patient to present clinically with arm extended and pronated? | Biceps brachii |
| What is the injury that causes Klumpke palsy? | Traction or tear of lower trunk: C8-T1 root |
| What is the most common cause of infantile Klumpke palsy? | Upward force on arm during delivery |
| What is the MCC of adult Klumpke palsy? | Trauma, such as grabbing a tree branch to break a fall |
| What are the main muscles affected in Klumpke palsy? | Intrinsic hand muscles: lumbricals, interossei, thenar, and hypothenar |
| What are the intrinsic hand muscles? | Lumbricals, interossei, thenar, and hypothenar |
| Which brachial plexus conditions affect the Intrinsic hand muscles? | Klumpke palsy and Thoracic outlet syndrome |
| What are the clinical features of Klumpke palsy? | Total Claw hand |
| What functional deficits causes Total Claw hand? | Lumbricals normally flex MCP joints and extend DIP and PIP joints |
| Which brachial plexus condition is seen with Total Claw hand? | Klumpke palsy |
| What type of injury causes Thoracic outlet syndrome? | Compression of lower trunk and subclavian vessels |
| Which vessels are compressed or affected in Thoracic outlet syndrome? | Subclavian vessels |
| What are common causes of Thoracic outlet syndrome? | Cervical rib adn Pancoast tumor |
| Which muscles are affected in Thoracic outlet syndrome? | Intrinsic hand muscles |
| What are the functional deficits of Thoracic outlet syndrome? | Atrophy of intrinsic hand muscles; Ischemia, pain, and edema due to vascular compression |
| Which nerve roots are affected in Winged scapula? | C5-C7 |
| Lesion of Long Thoracic nerve, roots C5-C7. Dx? | Winged scapula |
| What are common causes of Winged scapula? | 1. Axillary node dissection after mastectomy 2. Stab wounds |
| Which muscle is affected in Winged scapula? | Serratus anterior |
| Which condition affects the Serratus anterior muscle? | Winged scapula |
| What are the functional deficits of Winged scapula? | Inability to anchor scapula to thoracic cage ---> cannot abduct arm above horizontal position |
| Which brachial plexus condition is seen with the inability to abduct arm above horizontal position? | Winged scapula |
| When is hand "clawing" most likely seen? | In distal lesions of median or ulnar nerves |
| Which distortion of hand are less pronounced, proximal or distal, lesions? | Proximal |
| How are proximal lesions that cause distortion sign of the hand are presented? | Present during voluntary flexion of the digits |
| What is the sign of a distal ulnar nerve lesion? | Ulnar claw |
| What is the hand dostorion sign of Proximal median nerve lesion? | Pope's blessing |
| What is the hand distortion sign of Distal Median nerve lesion? | Median claw |
| What is the hand distortion sign of Proximal Ulnar nerve lesion? | OK gesture |
| Atrophy of the Thenar eminence causes: | Ape hand |
| Which nerve lesion causes Thenar eminence atrophy? | Median |
| Hypothenar eminence atrophy is seen with ________ nerve lesions. | Ulnar |
| Which ligament connects the Lateral femoral condyle to the anterior tibia? | ACL |
| Which knee ligament connects the Medial femoral condyle to the posterior tibia? | PCL |
| LAMP: | Lateral femoral condyle to anterior tibia: ACL Medial femoral condyle to posterior tibia: PCL |
| List of knee exam tests: | 1. Anterior drawer sign 2. Posterior drawer sign 3. Abnormal passive abduction 4. Abnormal passive adduction 5. McMurray test |
| A (+) anterior drawer sign indicates what injury? | ACL injury |
| Which are two test performed to diagnose ACL injury? | 1. Anterior drawer sign 2. Lachman test |
| Bending knee at 90 degree angle, and "pull" knee forward, to check for anterior sliding relative to femur. | Anterior drawer sign |
| Bending knee at 90 degree angle, increase posterior gliding of tibia due to PCL injury. | (+) Posterior drawer sign |
| Which test is more sensitive, Lachman test or Anterior drawer test? | Lachman test |
| (+) Posterior drawer sign indicates what type of injury? | PCL injury |
| A (+) abnormal passive abduction (valgus) test, indicates what type of knee injury? | MCL injury |
| A suspected MCL injury athlete, must have a which knee test (+)? | Abnormal passive abduction test |
| Which test, if (+), shows lateral space widening of tibia? | Abnormal passive adduction test |
| In a MCL injury, what is the result fo applying latrea (valgus) force to the extended knee? | Medial widening of tibia |
| Which knee test is (+) in LCL injury? | Abnormal passive adduction test |
| What is another way to refer to the medial force applied on an extended knee while performing test fro LCL injury? | Varus force |
| Valgus force, refers to abnormal passive adduction or abduction test? | Abduction |
| Varus force, refers to abnormal passive adduction or abduction test? | Adduction |
| Which knee test is performed in suspected meniscus injury? | McMurray test |
| What dictates a (+) McMurray test? | Pain, "popping" on external/or internal rotation of knee |
| What is extended or flex, in a McMurray test? | Knee is either extended or flexed |
| What is rotated in a McMurray test? | Tibia/foot |
| (+) McMurray test on external rotation. Dx? | Medial meniscal tear |
| McMurray test shows pain and popping on internal rotation of foot while knee is flex and/or extended. Dx? | Lateral meniscal tear |
| List of hip and knee conditons: | 1. Trochanteric bursitis 2. "Unhappy triad" 3. Prepatellar bursitis 4. Baker cyst |
| What is Trochanteric bursitis? | Inflammation of the gluteal tendon and bursa lateral to greater trochanter of femur |
| Inflammation of the gluteal tendon and bursa lateral to greater trochanter of femur. | Trochanteric bursitis |
| Common injury in contact sports due to lateral force applied to a planted lag. Dx? | Unhappy triad |
| Which ligaments are affected in the "Unhappy triad"? | ACL, MCL, and medial meniscus |
| Even though the medial meniscus is the one that is part of the Unhappy triad, but which is most commonly affected? | Lateral meniscus |
| Quarterback gets tackled by the left side while he's throwing the ball with a planted left foot. Falls immediately the knee shoes pain and instability. Dx? | "Unhappy triad" with Lateral meniscus damage |
| What is prepatellar bursitis? | Inflammation of the prepatellar bursa in front of the kneecap |
| What is another name for prepatellar bursitis? | "Housemaid's knee" |
| What are some common causes to prepatellar bursitis? | Repeated trauma or pressure from excessive kneeling |
| What is a Baker cyst? | Popliteal fluid collection in gastrocnemius-semimembranosus bursa commonly communicating with synovial space and related to chronic joint disease |
| What chronic joint diseases are often associated with Baker cysts? | Osteoarthritis and Rheumatoid arthritis |
| Popliteal fluid collection in the back of the knee. | Baker cyst |
| Which area is the one collecting popliteal fluid in a Baker cyst? | Gastrocnemius-semimembranosus bursa |
| Which ankle ligament is the most commonly sprained? | Anterior Talofibular ligament |
| What is a low ankle sprain? | Anterior Talofibular ligament sprain |
| What movements cause a Anterior Talofibular ligament sprain? | Overinversion/ supination of foot |
| A soccer player overinverts foot while playing a match. What is the most likely sprain suffered by the player? | Anterior Talofibular ligament sprain |
| Anterior Talofibular ligament sprain is also known as: | Low ankle sprain |
| What is the most commonly injured ligament in a high ankle sprain? | Anterior inferior tibiofibular ligament |
| What is most common, a low ankle or high ankle sprain? | Low ankle sprain |
| Which ankle sprain involves the anterior inferior tibiofibular ligament? | High ankle sprain |
| What are Muscle proprioceptors? | Specialized sensory receptors that relay information about muscle dynamics. |
| What are two types of muscle proprioceptors? | Muscle spindle and Golgi tendon organ |
| What is the location of Muscle spindles? | Body of muscle/type Ia and II sensory axons |
| Which muscle proprioceptors are found in type Ia and II sensory axons? | Muscle spindles |
| Which type of muscle proprioceptors are seen in the body of the muscle? | Muscle spindles |
| How are muscle proprioceptors activated? | Increased muscle stretch |
| Increase in muscle stretch will activate which muscle proprioceptors? | Muscle spindles |
| Muscle spindle pathway: | 1. Increase length and speed of stretch --> 2. via dorsal root ganglion (DRG) --> 3. Activation of inhibitory interneuron and alpha-motor neuron-> 4. Simultaneous inhibition of antagonist muscle and activation of agonist muscle |
| What action of muscle spindle pathway prevents overstretching? | Simultaneous inhibition of antagonist muscle |
| What action is produced by activation of agonist muscle by muscle spindle proprioceptors? | Contraction |
| Which muscle proprioceptors would be activated if there is an increase in tension on the muscle? | Golgi tendon organs |
| Where are Golgi tendon organ proprioceptors located? | Tendons/ type Ib sensory axons |
| What type of muscle proprioceptors are found in tendons? | Golgi tendon organs |
| Which sensory axons type are associated with Golgi tendon organ? | Type Ib sensory axons |
| Associated muscle proprioceptor in Increased muscle TENSION. | Golgi tendon organs |
| What is Achondroplasia? | Failure of longitudinal bone growth leading to short limbs |
| What type of ossification is failed in Achondroplasia? | Endochondral ossification |
| The affectation of membranous ossification in Achondroplasia, leads to: | Large head relative to limbs |
| What gene is affected in Achondroplasia? | Fibroblast growth factor receptors 3 (FGFR3) |
| What is the role of FGFR3 when activated? | Inhibition of chondrocyte proliferation |
| What is mode of inheritance of Achondroplasia? | Autosomal dominant with full penetrance |
| What is the most common cause of dwarfism? | Achondroplasia |
| Achondroplasia is the most common cause of: | Dwarfism |
| What is associated with increased risk of Achondroplasia? | Advanced paternal age |
| What pathology is associated with advanced paternal age? | Achondroplasia |
| Is Achondroplasia associated with maternal or paternal advance age? | Paternal |
| Definition of Osteoporosis: | Trabecular (spongy) and cortical bone lose mass and interconnection despite normal bone mineralization and lab values |
| How are serum Ca2+ and PO4 -3 in Osteoporosis? | Normal leves |
| Another way to refer to trabecular bone? | Spongy bone |
| Trabecular and cortical bone loss as well interconnections, despite normal serum levels of calcium and phosphate. Dx? | Osteoporosis |
| What are the MCC of Osteoporosis? | Increased bone resorption related to decreased estrogen levels and old age |
| Osteoporosis is commonly secondary to which medications? | Steroids, alcohol, anticonvulsants, anticoagulants, thyroid replacement therapy |
| What are medical conditions that may cause Osteoporosis eventually? | Hyperparathyroidism, Hyperthyroidism, Multiple myeloma, and malabsorption syndromes. |
| How is Osteoporosis diagnosed? | 1. DEXA test check for bone density at lumbar spine, total hip, and femoral neck, with T-score of less or equal to 2.5 or, 2. Fragility fracture at hip or vertebra |
| At what age are women recommended to to SOteporiss screening? | 65 or older |
| What is the recommended prophylaxis for Osteoporosis? | Regular weight-bearing exercise and adequate Ca2+ and Vitamin D intake throughout adulthood |
| What are common treatment medications for Osteoporosis? | Bisphosphonates, teriparatide, SERMs, and rarely calcitonin; Denosumab |
| What condition is treated with Denosumab? | Osteoporosis |
| What is the MOA of Denosumab? | Monoclonal antibody against RANKL |
| Why does DEnosumab attack RANKL secreted by osteoblasts? | RANKL interacts with RANK receptors on osteoclasts and increase their activity |
| Common complication of Osteoporosis | Vertebral compression fractures |
| What is the clinical presentation of vertebral compression fractures? | Acute back pain, loss of height, and kyphosis |
| What other, rarely, fractures may be seen along with Vertebral compression fractures, in osteoporotic patients? | Femoral neck fracture and Distal Radius (Colles) fracture |
| What is the name given to a Distal Radius fracture? | Colles fracture |
| What is Osteopetrosis? | Failure of normal bone resorption due to defective osteoclasts |
| Which bone cells are defective in Osteopetrosis? | Osteoclasts |
| Description of bones in Osteopetrosis? | Thickened, dense bones that are prone to fracture |
| How can certain mutations lead to development of Osteopetrosis? | Impair ability of osteoclast to generate acidic environment necessary for boner resorption |
| What is the result of the overgrowth of cortical bone that fills marrow space in Osteopetrosis? | Pancytopenia and extramedullary hematopoiesis |
| Why are palsies commonly seen in Osteopetrosis? | Due to narrowed foramina |
| What are some consequences of the narrowed foramen in Osteopetrosis? | Cranial nerve impingement and palsies |
| What is the X-ray description of bones in Osteopetrosis? | Diffuse symmetric sclerosis |
| What are terms commonly used in X-ray findings of Osteopetrosis? | Bone-in-bone, "stone bone" |
| What is the potential treatment option for Osteopetrosis? | Bone marrow transplant |
| Defective mineralization of osteoid or cartilaginous growth plates in adults. | Osteomalacia |
| What is denomination of osteomalacia in children? | Rickets |
| What is the most common cause of Osteomalacia/rickets? | Vitamin D deficiency |
| What X-rays findings of Osteomalacia? | 1. Osteopenia 2. "Looser zones" 3. Epiphyseal widening and, 4. Metaphyseal cupping/fraying in rickets |
| What is a pathologic finding or feature of Rickets? | Bow legs (genu varum), bead-like costochondral junctions (rachitic rosary), and craniotabes (soft skull). |
| What is another name for Paget disease of bone? | Osteitis deformans |
| Definition of Paget disease of bone: | Localized disorder of bone remodeling caused by increased osteoclastic activity followed by increased osteoblastic activity that forms poor-quality bone. |
| Osteoclastic activity --> Osteoblastic activity ===> Dx? | Paget disease of bone |
| What serum level is increased in Paget disease of bone? | ALP |
| What is the most common reason for the elevation of ALP in blood levels? | Hyperactivity of osteoblasts |
| - Mosaic pattern of woven and lamellar bone - Long bone chalk-stick fractures - High-output heart failure | Features of Paget disease of bone |
| What causes the high-output heart failure in Osteitis deformans? | Increased blood flow from increased arteriovenous shunts |
| What is an important elevated risk of Paget disease of bone? | Increased risk of Osteogenic sarcoma |
| Which malignancy is commonly a higher risk of development in Paget disease of bone (osteitis deformans)? | Osteogenic sarcoma |
| What are two common complaints or patient indications that may lead to diagnosis of Paget disease of bone? | 1. Increased hat size 2. Hearing loss |
| Why is there hearing loss in Paget's disease of bone? | Due to Auditory foramen narrowing |
| What are the 4 stages of Paget disease of bone? | 1. Lytic -- OsteoClast 2. Mixed -- Osteoclast + osteoblast 3. Sclerotic -- OsteoBlast 4. Quiescent-- minical osteoclast/osteoblast activity |
| Which Paget disease of bone stage is purely osteoclast driven? | Lytic |
| What is the the 1st stage of Paget disease of bone? | Lytic |
| What cells are involved in the Sclerotic stage of Paget disease of bone? | Osteoblast |
| Minimal osteoclast/osteoblast activity describes which Paget disease of bone stage? | Quiescent |
| What is the treatment of Paget disease of bone? | Bisphosphonates |
| What is Osteonecrosis? | Infarction of bone and marrow, usually very painful |
| What is the most common site for Osteonecrosis? | Femoral head |
| Why the Femoral head the most common site for avascular necrosis? | Due to insufficiency of medial circumflex femoral artery |
| What is another way to refer to osteonecrosis? | Avascular necrosis |
| List of common causes for Osteonecrosis: | 1. Corticosteroids 2. Alcoholism 3. Sickle cell disease 4. Trauma 5. "the Bends" (Caisson/Decompression disease), 6. Gaucher disease 7. Slipped capital femoral epiphysis 8. Legg-Calve-Perthes disease |
| Is osteonecrosis a painful or painless condition? | Painful |
| Which disorder has normal lab values, only with a decreased bone mass? | Osteoporosis |
| Which is the only lab value that may be decreased in Osteopetrosis? | +/- slight decrease in serum Ca2+ |
| Dense, brittle bones. Ca2+ decrease in severe, malignant disease. Dx? | Osteopetrosis |
| Abnormal "mosaic" bone architecture. Dx? | Paget disease of the bone |
| Which serum lab value(s) are abnormal in Paget disease of bone? | Elevated ALP |
| Which are the lab values measured in common bone disorders? | Serum Ca2+, Phosphate, ALP, and PTH |
| "Brown tumors" due to fibrous replacement bone, subperiosteal thinning. | Osteitis fibrosa cystica |
| Idiopathic or PTH hyperplasia, adenoma, carcinoma. Associated with Osteitis fibrosa cystica. | Primary hyperparathyroidism |
| What is the primary lab value abnormality in Osteitis fibrosa cystica/Primary HyperPTH? | Elevated PTH |
| Which bone disorder main lab value change is an elevated/increased PTH ? | Osteitis fibrosa cystica |
| What are the changes in lab values of Osteitis fibrosa cystica/ Primary hyperPTH? | Elevated PTH, ALP, and serum Ca2+, and decreased phosphate |
| Which is the only lab value decreased in Osteitis fibrosa cystica? | Phosphate |
| Often as compensation of CKD (decreased phosphate excretion and products of activated Vitamin D). Dx? | Secondary hyperparathyroidism |
| What is the main lab value change in Secondary hyper-PTH? | Decreased serum Ca2+ |
| Which bone disorder is indicated by an decreased serum Ca2+ level as its primary change? | Secondary hyperparathyroidism |
| In Secondary hyper-PTH, which levels are elevated? | Phosphate, ALP, and PTH |
| Elevated Phosphate, ALP, and PTH + decreased serum Ca2+ + Hx of CDK. Dx? | Secondary hyperparathyroidism |
| Soft bones; vitamin D deficiency also causes secondary hyperparathyroidism. Dx? | Osteomalacia/Rickets |
| Which is the only lab value that is increased in Osteomalacia or Rickets (children)? | ALP |
| Which condition of the bones is seen with elevated ALP and decreased serum Ca2+, phosphate, and PTH? | Osteomalacia/Rickets |
| Which important lab value is normalin Hypervitaminosis D? | ALP |
| Caused by over-supplementation or granulomatous disease (sarcoidosis). | Hypervitaminosis D |
| Which lab values are elevated in Hypervitaminosis D? | Serum Ca2+ and phosphate |
| Is PTH elevated or decreased in hypervitaminosis D? | Decreased |
| What is more common, Metastatic disease to the bone or Primary bone tumors? | Metastatic disease to bone |
| List of BENIGN Primary bone tumors: | 1. Osteochondroma 2. Osteoma 3. Osteoid osteoma 4. Osteoblastoma 5. Chondroma 6. Giant cell tumor |
| What is the most common benign bone tumor? | Osteochondroma |
| What is the epidemiology of Osteochondromas? | Males < 25 years old |
| What is the location for a Osteochondroma? | Metaphysis of long bones |
| Which benign primary bone tumor is located at the metaphysis of long bones? | Osteochondroma |
| What are features or characteristics of Osteochondroma? | 1. Lateral bony projection of growth plate covered by cartilaginous cap 2. Rarely transforms to chondrosarcoma |
| An x-ray of the femoral bone shows lateral bony projections of growth plate covered by a cartilage cap in a 22 year old male patient. Dx? | Osteochondroma |
| What is the epidemiology of Osteomas? | Middle age |
| What is the common location for an Osteoma? | Surface of facial bones |
| Which benign primary tumor is found in the surface of facial bones? | Osteoma |
| What is the common associated condition with Osteoma? | Gardner syndrome |
| A person with Gardner syndrome is often seen with what primary bone tumor? | Osteoma |
| What is the approximate age in which Osteoid osteoma develop? | In adults < 25 years old |
| Are males or females, most affected with Osteoid osteoma? | Males |
| Osteoid osteoma affects mostly: | Adult male of < 25 years of age |
| What is the location for an Osteoid osteoma? | Cortex of long bones |
| Which type of primary bone tumor is found in the cortex of long bones? | Osteoid osteoma |
| What are features and clinical signs of Osteoid Osteoma? | 1. Presens as bone pain (worse at pm) that is relieved with NSAIDs 2. Bony mass (<2 cm) with radiolucent osteoid core |
| Bony mass on X-ray of a 19 year old male, that visits physician office due to severe pain at night located in the right humerus. Dx? | Osteoid osteoma |
| What medications are used to relieve or control the pain in patients with Osteoid osteoma? | NSAIDs |
| What is the location for an Osteoblastoma? | Vertebrae |
| Which primary benign bone tumor is found in the vertebrae? | Osteoblastoma |
| Osteoblastoma is malignant or benign? | Benign |
| Malignant or benign. Osteochondroma? | Benign |
| Malignant or benign. Osteoma? | Benign |
| Malignant or benign. Osteoid osteoma? | Benign |
| Malignant or benign. Chondroma? | Benign |
| Malignant or benign. Giant cell tumor? | Benign |
| Which two benign primary bone tumors have very similar histology? | Osteoid sarcoma and Osteoblastoma |
| How does Osteoblastoma differ from Osteoid osteoma? | Osteoblastoma is larger in size (> 2 cm), pain is non-responsive to NSAIDS, and located at the vertebrae. |
| Patient complains of severe pain in the "spinal column" that is not responding to ibuprofen. X-ray showed a 3 cm mass in the base of L2. Dx? | Osteoblastoma |
| What is the location of a Chondroma? | Medulla of small bones of hand and feet |
| Which primary (benign) bone tumor is found in the medulla of small bones of hand and feet? | Chondroma |
| Benign tumor of cartilage in hands and feet. | Chondroma |
| What is the epidemiology of Giant cell tumor? | 20-40 years old |
| What is the location of Giant cell tumor? | Epiphysis of long bones |
| What is the most common region in which a Giant cell tumor develops? | Knee region |
| What are features and characteristics of Giant cell tumor ? | - Locally aggressive benign tumor - Neoplati mononuclear cells that express RANKL and reactive multinucleated giant cells. "Osteoclastoma" - "Soap bubble" appearance on x-ray |
| x-ray finding. "Soap bubble" appearance in the epiphysis of a long bone (femur) near the knee? | Giant cell tumor |
| Why is Giant cell tumor often referred as "Osteoclastoma"? | Due to neoplastic mononuclear cells that express RANKL and reactive multinucleated giant (osteoclast-like) cells. |
| List of MALIGNANT Primary bone tumors: | 1. Osteosarcoma (osteogenic carcinoma) 2. Chondrosarcoma 3. Ewing sarcoma |
| What is the epidemiology of Ewing Sarcoma? | Boys < 15 years old |
| Among which ethnicity is Ewing sarcoma is most common? | Caucasian |
| What is the most common location of a Ewing Sarcoma? | Diaphysis of long bones, and pelvic flat bones |
| Which long bone is especially or more consistently affected by Ewing sarcoma? | Femur |
| What malignant bone tumor is often found in the diaphysis of long bones, especially the femur? | Ewing sarcoma |
| What other bones, besides the diaphysis of long bones, are affected by Ewing sarcoma? | Pelvic flat bones |
| Histology of Ewing sarcoma: | Anaplastic small blue cells of neuroectodermal origin (resemble lymphocytes) |
| Anaplastic small blue cells of neuroectodermal origin, that have certain resemblance to lymphocytes. Dx? | Ewing sarcoma |
| What translocation is associated with Ewing sarcoma? | t(11;22) |
| t(11;22). Dx? | Ewing sarcoma |
| What is t(11;22) ? | Fusion protein EWS-FLII |
| "Onion skin" periosteal reaction in bone | Ewing sarcoma |
| What is an important gross feature of Ewing sarcoma that is view in x-ray? | "Onion skin" periosteal reaction in bone |
| What is another name for Osteosarcoma? | Osteogenic sarcoma |
| Osteosarcoma is peak incidence of primary tumor in: | Males < 20 years |
| Osteosarcoma can be secondary to which disease or conditions? | Paget disease of bone, bone infarcts, radiation, familial retinoblastoma, and Li-Fraumeni syndrome |
| What is the location of Osteosarcoma? | Metaphysis of long bones |
| Which malignant primary tumor is often found in the metaphysis of long bones , especially in the knee region? | Osteosarcoma |
| What are features and characteristics of Osteosarcoma? | - Painful enlarging mass or pathologic fractures - Codman triangle - Pleomorphic osteoid-producing cells (malignant osteoblasts) |
| Which malignant bone tumor is associated with "malignant osteoblasts"? | Osteosarcoma |
| Histology of Osteosarcoma: | Pleomorphic osteoid-producing cells (malignant osteoblasts) |
| (+) Codman triangle. Dx? | Osteosarcoma |
| What is the Codman triangle? | Elevation of the periosteum under x-ray in Osteosarcoma |
| What feature in Osteosarcoma has a description of a "sunburst" pattern? | Codman triangle |
| What is the location of a Chondrosarcoma? | Medulla of pelvis and central skeleton |
| Which malignant primary bone tumor is located at the medulla of pelvis and central skeleton? | Chondrosarcoma |
| Tumor of malignant chondrocytes? | Chondrosarcoma |
| What is a Chondrosarcoma? | Primary tumor of malignant chondrocytes |
| List of childhood musculoskeletal conditions: | 1. Developmental dysplasia of the hip 2. Legg-Calve-Perthes disease 3. Osgood-Schlatter disease 4. Patellofemoral syndrome 5. Radial head subluxation 6. Slipped capital femoral epiphysis |
| What is Developmental dysplasia of the hip? | Abnormal acetabulum development in newborns. |
| What is the major risk for development Dysplasia of the hip? | Breech presentation |
| What are tests or maneuvers to assess developmental dysplasia of the hip? | Ortolani and Barlow maneuvers |
| Idiopathic avascular necrosis of femoral head. | Legg-Calve-Perthes disease |
| What is the presentation of Legg-Calve-Perthes disease? | Presentas between 5-7 years wit insidious onset of hip pain that may cause child to limp. |
| Is Legg-Calve-Perthes disease more common in males or females? | Males |
| What is another name for Osgood-Schlatter disease? | Traction apophysitis |
| What is Osgood-Schlatter disease? | Overuse injury caused by repetitive strain and chronic avulsion of the secondary ossification center of proximal tibial tubercle |
| Which condition of a child involves the Proximal Tibial tubercle injury due to repetitive strain and chronic avulsion? | Osgood-Schlatter disease |
| What type of athletes or exercise training lead to Osgood-Schlatter disease? | Running and jumping athletes |
| What is the most common age for Osgood-Schlatter disease? | Adolescents after growth spur |
| What is the clinical presentation of Osgood-Schlatter disease? | Progressive anterior knee pain |
| What is Patellofemoral syndrome? | Overuse injury that commonly presents in young, female athletes as anterior knee pain. |
| What is the common action for exacerbation of Patellofemoral syndrome? | Prolonged sitting or weight-bearing on a flexed knee |
| What is the treatment used for Patellofemoral syndrome? | NSAIDs and thigh muscle training |
| What is another way to refer to Radial head subluxation? | Nursemaid's elbow |
| What is a common elbow injury in children < 5 years? | Radial head subluxation |
| What is the MCC of Radial head subluxation? | Sudden pull on the arm leading to immature annular ligament slips over head of radius. |
| Injured arm held in extended/slightly flexed and pronated position. Dx? | Radial head subluxation |
| Which ligament is involved in Nursemaid's elbow? | Immature annular ligament |
| What is a classical presentation of Slipped capital femoral epiphysis? | Obese young adolescent with hip/knee pain and altered gait. |
| What is the cause of Slipped capital femoral epiphysis? | Increased axial force on femoral head leading to epiphysis displaces relative to femoral to femoral neck. |
| List of Lower Extremity nerves: | 1. Iliohypogastric 2. Genitofemoral 3. Lateral femoral cutaneous 4. Obturator 5. Femoral 6. Sciatic 7. Common peroneal 8. Tibial 9. Superior gluteal 10. Inferior gluteal 11. Pudendal |
| What are the nerve roots of the Iliohypogastric nerve? | T12-L1 |
| Which lower extremity nerve has roots T12-L1? | Iliohypogastric |
| What is the sensory innervation of the Iliohypogastric nerve? | Suprapubic region |
| What nerve provides sensory innervation to the Suprapubic region? | Iliohypogastric |
| What is the motor innervation of the Iliohypogastric nerve? | Transversus abdominis and Internal oblique |
| What lower extremity nerve provide motor innervation to the Transversus abdominis and internal oblique? | Iliohypogastric |
| Which muscles are innervated by the motor part of the Iliohypogastric nerve? | Transversus abdominis and Internal oblique |
| What is a common cause of injury to the Iliohypogastric nerve? | Abdominal surgery |
| A patient undergoing abdominal surgery may have lesion to which lower extremity nerve? | Iliohypogastric |
| What is the common clinical presentation of Iliohypogastric nerve lesion? | Burning or tingling pain in surgical incision site radiation to inguinal and suprapubic region |
| Burning/tingling pain in abdominal surgical incision radiating to inguinal and suprapubic region. What nerve is likely damaged? | Iliohypogastric |
| What are the nerves roots of Genitofemoral nerve? | L1-L2 |
| Which lower extremity nerve has roots L1-L2? | Genitofemoral |
| What is the sensory innervation of the Genitofemoral nerve? | Scrotum/labia majora, medial thigh |
| The medial thigh, scrotum(males) and labia major (females) is sensory innervated by the ________________ nerve. | Genitofemoral |
| What is the motor (muscle) innervation of the Genitofemoral nerve? | Cremaster |
| The Cremaster muscle is innervated by the ________________ nerve. | Genitofemoral |
| What type of surgery may result in Genitofemoral nerve lesion? | Laparoscopic surgery |
| What is the common presentation of Genitofemoral nerve damage or injury? | - Decreased anterior thigh sensation beneath inguinal ligament - Absent cremasteric reflex |
| An absent Cremasteric reflex may be due to what nerve injury? | Genitofemoral |
| Diminished anterior thigh sensation beneath the inguinal ligament is often presented in cases of: | Genitofemoral nerve injury |
| Does the Lateral femoral cutaneous nerve has sensory, motor, or both, innervation? | Only sensory |
| What is the sensory innervation of ht Lateral Femoral cutaneous nerve? | Anterior and lateral thigh |
| Which nerve provides cutaneous sensory information to the anterior and lateral thigh? | Lateral Femoral Cutaneous |
| What are the nerve roots of the Lateral Femoral Cutaneous nerve? | L2-L3 |
| Damage to roots L2-L3 will cause what type of sensory deficits? | Decreased anterior and lateral thigh sensation |
| What are examples or conditions that cause an injury or deficit in Lateral femoral cutaneous sensory functioning? | Thigh clothing, Obesity, Pregnancy, and pelvic procedures |
| What are the nerve roots of the Obturator nerve? | L2-L4 |
| Which nerve has nerve roots L2-L4? | Obturator |
| What is the sensory innervation of the Obturator nerve? | Medial thigh |
| What part of the thigh does the Obturator nerve provide sensory innervation? | Medial thigh |
| List of motor (muscle) innervation of the Obturator nerve: | 1. Obturator externus 2. Adductor longus 3. Adductor brevis 4. Gracilis 5. Pectineus 6. Adductor magnus |
| The adductor longus and Adductor brevis, both have motor innervation from which lower extremity nerve? | Obturator |
| Which are the nerve roots of the nerve that provides innervation to the Gracilis, Pectineus, and adductor magnus? | L2-L4 |
| What procedure may result in Obturator nerve injury? | Pelvic surgery |
| What is the presentation of Obturator nerve injury? | Decreased thigh sensation (medial) and adduction |
| Which thigh movement is decreased with Obturator nerve injury? | Adduction |
| A decreased in adduction, may be due to _______________ nerve damage. | Obturator |
| Which lower extremity nerves provide medial thigh sensory innervation? | Obturator, and Genitofemoral nerves |
| What are the nerve roots of the Femoral nerve? | L2-L4 |
| Which two important lower extremities have the same nerve roots, L2-L4? | Obturator and Femoral nerves |
| What is the sensory innervation of the Femoral nerve? | Anterior thigh and medial leg |
| Anterior thing and medial leg receive sensory innervation/information from which lower extremity nerve? | Femoral |
| What is the motor innervation of the Femoral nerve? | Quadriceps, iliacus, pectineus, and sartorius |
| Which lower extremity muscles are innervated by the Femoral nerve? | Quadriceps, iliacus, pectineus, and sartorius |
| Which nerve provides motor innervation to the quadriceps? | Femoral |
| What is the most common cause of Femoral nerve injury? | Pelvic fracture |
| Which nerve may be injured in a Pelvic fracture? | Femoral |
| What is the clinical presentation of Femoral nerve injury? | Decrease in; 1. Thigh flexion 2. Leg extension |
| Which tigh movement is diminished in a Femoral nerve injury? | Flexion |
| A person with difficulty flexing the thin and unable to extend leg, may have what type of nerve injury? | Femoral nerve injury |
| What are the nerve roots of the Sciatic nerve? | L4-S3 |
| Which lower extremity nerve has roots L4-S3? | Sciatic |
| What type of innervation is provided by the Sciatic nerve, motor, sensory, or both? | Only Motor |
| What is the motor innervation of the Sciatic nerve? | Semitendinosus, semimembranosus, biceps femoris, and adductor magnus |
| Which nerve provides motor innervation to the Semitendinosus and Semimembranosus muscles of the leg? | Sciatic |
| Biceps femoris and Adductor magnus are both innervated by the _____________ nerve. | Sciatic |
| What are common causes for Sciatic nerve injury? | Herniated disc, and posterior hip dislocation |
| What is a feature or important anatomical note of the Sciatic nerve? | Splits into Common Peroneal and Tibial nerves |
| The common Peroneal and the _________________ nerve , are both divisions of the Sciatic nerve. | Tibial |
| What are the two divisions (split) of the Sciatic nerve? | Common Peroneal and Tibial nerves |
| Which are the nerve roots of the Common Peroneal nerve? | L4-S2 |
| Which nerve has the nerve roots L4-S2? | Common Peroneal |
| What are the two anatomic divisions of the Common Peroneal nerve? | 1. Superficial Peroneal nerve 2. Deep Peroneal nerve |
| What are the sensory innervation of the Superficial Peroneal nerve? | Dorsum of foot |
| What part of the dorsum of the foot, does the Superficial Peroneal nerve, does not provide sensory innervation? | Webspace between hallux and 2nd digit |
| The dorsum of foot (excepto between the 2nd digit and hallux), has it sensory innervation provided by what nerve? | Superficial Peroneal nerve |
| What is the motor innervation of the Superficial Peroneal nerve? | Peroneus longus and brevis |
| What is the association between the Dorsum of foot and Peroneus longus and brevis? | Superficial Peroneal sensory and motor (respectively) innervation |
| What is the sensory innervation of the Deep Peroneal nerve? | Webspace between hallux and 2nd digit |
| What is the motor innervation of Deep Peroneal nerve? | Tibialis anterior |
| Which nerve provides motor innervation to the Tibialis anterior? | Deep Peroneal nerve |
| What nerve provides sensory information to the webspace between the 2nd digit and the hallux? | Deep Peroneal nerve |
| What are common causes of Common Peroneal nerve injury? | 1. Trauma or Compression of lateral aspect of leg 2. Fibular neck fracture |
| Which lower extremity nerve is at risk of injury in a Fibular neck fracture? | Common Peroneal |
| Which foot movements are performed by the Common Peroneal nerve? | Foot Eversion and Dorsiflexion |
| What is the sensory deficit seen in Peroneal nerve damage? | Dorsum of foot |
| What nerve is injured in Foot drop? | Common Peroneal |
| What is Foot drop? | Inverted and plantarflex at rest, loss of eversion and dorsiflexion |
| What kind of gait is seen in Foot Drop? | Steppage gait |
| Foot is inverted and plantarflex while at rest, and patient is unable to evert and/or dorsiflex foot. Dx? | Foot drop |
| Foot drop, means _____________________ nerve damage. | Common Peroneal |
| What are the nerve roots of the Tibial nerve? | L4-S3 |
| Which nerve of the lower extremity has roots L4-S3? | Tibial |
| What is the sensory innervation of the Tibial nerve? | Sole of foot |
| What is the motor innervation of the Tibial nerve? | - Long head of Biceps femoris - Triceps surae - Plantaris - Popliteus - Flexor muscles of the foot |
| The bottom part of the foot, sole, is innervated sensory by the ________ nerve. | Tibial |
| What are causes of Tibial nerve damage? | Knee trauma, Baker cyst (proximal lesion), Tarsal tunnel syndrome (distal lesion) |
| A person with Tarsal tunnel syndrome, may suffer of what nerve damage? | Tibial |
| What is the function of the Tibial nerve? | Foot inversion and Plantarflexion |
| What are features of Tibial nerve damage? | 1. Inability to curl toes and loss os sensation on sole 2. Foot everted at rest with loss of inversion and plantarflexion |
| A patient unable to feel the flood with the sole of feet, may have _______________ nerve damage. | Tibial |
| What kind of nerve injury is suspected if patient is with foot everted at rest, and unable to invert or plantar-flex foot? | Tibial |
| What is the motor innervation of the Superior gluteal nerve? | Gluteus medius, gluteus minimus, and tensor fascia latae |
| What are the nerve roots of Superior gluteal nerve? | L4-S1 |
| Which nerve has nerve roots L4-S1? | Superior gluteal |
| What is the most common cause of Superior Gluteal nerve injury? | IM injection to the superomedial gluteal region, instead of the anterolateral region. |
| What is the most common feature of a Superior Gluteal nerve injury? | Trendelenburg sign/gait |
| What nerve damage leads to Trendelenburg gait? | Superior gluteal nerve injury |
| Description of the Trendelenburg gait/sign: | Pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction |
| The tilt of the pelvis due to the leg not been able to maintain alignment of pelvis while hip is abducted. | Trendelenburg sign/gait |
| In Trendelenburg gait the lesion is: | 1. Contralateral to the side of the hip that drops 2. Ipsilateral to extremity on which patient stands |
| If the lesion to the Superior Gluteal nerve, which causes developmental Trendelenburg gait, is to the right side the: | Hip will drop to the left, while the patient stands on the right leg |
| Trendelenburg gait, suspect what nerve to be injured? | Superior gluteal |
| What are the nerve roots of the Inferior gluteal nerve? | L5-S2 |
| Which lower extremity nerve has roots L5 to S2? | Inferior gluteal |
| What is the motor innervation of the Inferior Gluteal nerve? | Gluteus maximus |
| The Gluteus maximus is innervated by the _____________________ nerve. | Inferior gluteal |
| Which gluteal muscles are innervated by the Superior gluteal nerve? | Gluteus medius and gluteus minimus |
| Lack of motor innervation to the gluteus medius and minimus, will be likely due to damage to the inferior or superior gluteal nerve? | Superior gluteal |
| If the gluteus maximus is deficient in movement, it will probably be due to Inferior or Superior gluteal nerve damage? | Inferior gluteal |
| What is the clinical presentation of Inferior gluteal nerve injury? | 1. Difficulty climbing stairs 2. Difficulty rising from seated position 3. Loss of hip extension |
| What hip movement is affected by an injured Inferior gluteal nerve? | Hip extension |
| What is the MCC of Inferior gluteal nerve injury? | Posterior hip dislocation |
| Posterior hip dislocation is the MCC of what type of nerve injury? | Inferior gluteal |
| What are the nerve roots of the Pudendal nerve? | S2-S4 |
| Which lower extremity nerve has roots S2 - S4? | Pudendal |
| What is the sensory innervation of the Pudendal nerve? | Perineum |
| What is the motor innervation of the Pudendal nerve? | External urethral and anal sphincters |
| What is the MCC of injury to the Pudendal nerve? | Stretch injury during childbirth |
| Complicated childbirth can cause injury to which lower extremity nerve? | Pudendal |
| What are the clinical characteristics of Pudendal nerve damage? | 1. Decreased sensation in perineum and genital area 2. May cause fecal or urinary incontinence |
| The Pudendal nerve may be blocked in childbirth, to block pain. What landmark is used to apply the anesthetic injection? | Ischial spine |
| What is the association between the Ischial spine and the Pudendal nerve? | During childbirth, the Pudendal nerve can be blocked by injection anestesia using the Ischial spine as anatomical landmark. |
| Which are the abductors of the hip? | Gluteus medius and Gluteus minimus |
| What hip action or movement is performed by the Gluteus minimus and medius? | Abduction |
| List of adductor hip muscles: | Adductor magnus, Adductor longus, and Adductor brevis |
| Adductor _____________, ____________, and _________________, perform hip adduction. | Magnus, Longus, and Brevis |
| Which are the Extensor hip muscles? | Gluteus maximus, semitendinosus, and semimembranosus |
| What action of the hip is performed by the Gluteus maximus? | Hip extension |
| The Gluteus maximus, semitendinosus, and semimembranosus, are the hip ________________. | Extensors |
| What hip action may be affected by injury to the G. maximus? | Hip extension |
| List of Flexor hip muscles: | 1. Iliopsoas, 2. Rectus femoris 3. Tensor fascia lata 4. Pectineus 5. Sartorius |
| Which hip muscles produce internal rotation? | Gluteus medius, Gluteus minimus, and Tensor fascia latae |
| What two hip action or movements are performed by the G. medius and minimus? | Abduction and internal rotation |
| What are the muscles of the hip that perform External rotation? | Iliopsoas, Gluteus maximus, Piriformis,and Obturator |
| What hip action is performed by the G. maximus, Iliopsoas, Piriformis and Obturator muscles? | External rotation |
| Piriformis and Obturator muscles are involved in which hip movement or action? | External rotation |
| List of common Musculoskeletal conditions: | 1. Iliotibial band syndrome 2. Medial Tibial stress syndrome 3. Limb compartment syndrome 4. Plantar fasciitis 5. De Quervain tenosynovitis 6. Ganglion cyst |
| What musculoskeletal condition is associated primarily with "runners"? | Iliotibial band syndrome |
| Overuse injury o lateral knee that occurs primarily in runners. Dx? | Iliotibial band syndrome |
| What causes the pain in Iliotibial band syndrome? | Secondary to fricito of iliotibial band against lateral femoral epicondyle |
| What is a more common name for Medial tibial stress syndrome? | Shin splints |
| What are "Shin splints"? | Common cause of shin pain an diffuse tenderness in runes and military recruits |
| What is the cause of Medial tibial stress syndrome? | Bone resorption that outpaces bone formation in tibial cortex |
| Shin pain and diffuse tenderness, is the basis of shih musculoskeletal condition? | Medial tibial stress syndrome |
| What is Limb compartment syndrome? | Increase pressure within a fascial compartment of a limb lead to venous outflow obstruction an arteriolar collapse which causes anoxia and necrosis |
| What is the pressure gradient in order to consider limb compartment syndrome? | Compartment pressure to diastolic blood pressure gradient of <30 mmHg. |
| What are some of the causes of Limb Compartment syndrome? | Long bone fractures, reperfusion injury, animal venoms. |
| What are clinical symptoms of Limb Compartment syndrome? | - Severe pain and tense, swollen compartments with limb flexion - Motor deficits are late sign or irreversible muscle and nerve damage |
| The motor deficits shown in Limb Compartment syndrome indicate: | Late deficits are indicative of irreversible muscle and nerve damage |
| What limb action/movement elicits pain in Limb Compartment syndrome? | Flexión |
| What is Plantar Fasciitis? | Inflammation of plantar aponeurosis characterized by heel pain an tenderness |
| Heel pain and tenderness, especially severe in the morning and after extended periods of inactivity. Dx? | Plantar fasciitis |
| Inflammation of plantar aponeurosis causing heel pain and tenderness. | Plantar fasciitis |
| Noninflammatory thevenin of abductor pollicis longus and extensor pollicis brevis tendons | De Quervain tenosynovitis |
| What is the characteristic pain in De Quervain tenosynovitis? | Pain or tenerse at radial styloid |
| Pain at radial styloid often indicates which condition? | De Quervain tenosynovitis |
| (+) Finkelstein test. Dx? | De Quervain tenosynovitis |
| What is the Finkelstein test? | (+) when pain at radial styloid is elicited with active or passive stretch of thumb tendons |
| What is a Ganglion cyst? | Fluid-filled swelling overlying joint or tendon sheath, most commonly at dorsal side of wrist |
| Where is the most common location for a Ganglion cyst? | Dorsal side of wrist |
| What is the most common way for the arisal or development of a Ganglion cyst? | Herniation of dense connective tissue |
| The herniation of dense connective tissue at the dorsal side of wrist often lead to development of: | Ganglion cyst |
| Fluid-filled swelling overlying joint or tendon sheath. Dx? | Ganglion cyst |
| What are the Lumbosacral radiculopathy signs? | Paraesthesia and weakness related to specific lumbosacral spinal nerves. |
| What causes Lumbosacral radiculopathy? | Intervertebral disc herniates posterolaterally through annulus fibrosus into central canal due to thin posterior longitudinal ligament and thieche anterior longitudinal ligament along midline of vertebral bodies. |
| What is the common distribution or affection of the nerve affected in Lumbosacral radiculopathy? | It affects below the level of herniation |
| Which are the most common lumbosacral radiculopathy disc levels? | 1. L3-L4 2. L4-L5 3. L5-S1 |
| In L3-L4 lumbosacral radiculopathy, which nerve is affected? | L4 |
| What are the clinical signs of L3-L4 Lumbosacral Radiculopathy? | Weakness of knee extension and, decreased patellar reflex |
| What is the main reflex affected or diminished in L3-L4 Radiculopathy? | Patellar reflex |
| What are the clinical signs of L4-L5 Radiculopathy? | 1. Weakness of dorsiflexion 2. Difficulty in heel walking |
| What are the most significant signs of L5-S1 Radiculopathy? | 1. Weakness of plantar flexion 2. Difficulty in toe walking 3. Decreased Achilles reflex |
| What reflex is affected in L5-S1 Radiculopathy? | Achilles reflex |
| What nerve and artery are paired in the Axilla/ lateral thorax? | Nerve - Long Thoracic Artery - Lateral Thoracic |
| Which are the neurovascular pairing are at the surgical neck of humerus? | Axillary nerve and Posterior circumflex artery |
| Neurovascular pairing at the Midshaft of humerus? | Radial nerve and Deep brachial artery |
| Median nerve and Brachial artery are paired at what location? | Distal humerus/cubital fossa |
| What nerve and artery are paired at the Popliteal fossa? | Tibial nerve and Popliteal artery |
| Neurovascular pairing at the Posterior to medial malleolus? | Tibial nerve and Posterior tibial artery |
| What are T-tubules? | Extensions of plasma membrane in contact with the sarcoplasmic reticulum |
| Extension of plasma membrane in contact with the sarcoplasmic reticulum. | T-tubules |
| What is the role of T-tubules in the motorneuron action potential to muscle contraction? | Allows coordination of contraction of striated muscles |
| Which structure allows the coordination of the of striated muscles? | T-tubules |
| What is the 1st step in striated muscle contraction process? | AP opens presynaptic voltage-gated Ca2+ channels, inducing ACh release |
| AP opens presynaptic voltage-gated Ca2+ channels, inducing ACh release | 1st Step of striated muscle contraction |
| What follows the presynaptic release of ACh in striated muscle contraction? | Postsynaptic ACh binding lead to muscle cell depolarization at the motor end plate |
| Postsynaptic acetylcholine binds to receptors causing cell depolarization at the motor end plate. | 2nd step of striated muscle contraction |
| What structure allows for the depolarization (striated muscle contraction) to travel over the entire cell and deep into the muscle? | T-tubules |
| What is the 3rd step of striated muscle contraction? | Cell depolarization travels along the entire cell and deep into the muscle via the T-tubules |
| What does the striated muscle membrane depolarization cause to the sensitive dihydropyridine receptor? | Conformation changes which allows to be coupled with ryanodine receptor --> Ca2+ release from the SR into the cytoplasm |
| What is the result of coupled Ryanodine receptor after DHPR conformational changes? | Ca2+ release from Sarcoplasmic reticulum into the cytoplasm |
| What component usually blocks Myosin-biding sites on the actin filaments, prior to Ca2+ arrival from SR? | Tropomyosin |
| What is the role or function of Tropomyosin? | Block Myosin-binding sites on actin filament |
| Ca2+ released by the SR, binds to _______________ in order to expose Myosin-binding site on actin filament. | Troponin C |
| Ca2+ binding to Troponin C (TnC) causes ----> | Shifting tropomyosin to expose the myosin-binding sites |
| What does the Ca-Tn- induced myosin-binding site exposures causes? | Myosin head strongly binds to actin forming a crossbridge |
| What is formed by the binding of Myosin head and Actin during striated muscle contraction? | Crossbridge |
| What is release upon formation of Myosin-Actin crossbridge? | Phosphate (Pi) |
| What initiates the Power stroke? | The release of Pi as the actin-myosin crossbridge is formed |
| What is initiated by the Myosin-Actin crossbridge release of Pi? | Power stroke |
| How is force produced in the Power stroke? | Myosin pulls on the thin filament, leading to muscle shortening |
| How which bands are involved in muscle shortening? | Shortening of H and I bands and between Z lines |
| HIZ shrinkage? | Mnemonic used to recall the H and I bands and between Z lines get shrunk during muscle contraction |
| Which band always remains the same length in muscle contraction? | A band |
| What is released at the end of the Power stroke? | ADP |
| ADP is released at: | The end of the Power stroke |
| How is the Myosin head detached from actin filament? | By the binding of new ATP |
| What happens to Ca2+ when Myosin head is detached from the actin filament? | Re-sequestered |
| ATP hydrolysis into ADP and Pi results in: | Myosin head returning to high-energy position (cocked) |
| In muscle contraction, the Myosin head can keep binding to new site on actin to form a crossbridge as long as: | Ca2+ remains available |
| What are the two types of muscle fibers? | Type 1 muscle and Type 2 muscle |
| Which muscle fibers are "slow twitch"? | Type 1 muscle fiber |
| Which muscle fibers are "red" fibers? | Type 1 muscle fiber |
| What are the Type 1 muscle fibers? | Slow twitch; red fibers resulting from increased mitochondria and myoglobin concentration --> sustained contraction |
| What type of exercise results in elevated levels of Type 1 muscle fibers? | Endurance training |
| A marathon runner or cyclist, will likely have higher amounts of Type 1 or Type 2 muscle fibers? | Type 1 muscle fiber |
| Which type of muscle fiber has increased amounts of mitochondria and myoglobin concentration? | Type 1 muscle fiber |
| Which type of muscle fibers are associated with increased oxidative phosphorylation? | Type 1 muscle fiber |
| Which type of muscle fiber produces a sustained contraction? | Type 1 muscle fiber |
| Type 2 muscle fibers are fast or slow twitch? | Fast twitch |
| What color are denominated the Type 2 muscle fibers? | White |
| Which muscle fibers are of fast twitch and white? | Type 2 muscle fiber |
| Which muscle fiber is with low mitochondria and myoglobin concentration? | Type 2 muscle fiber |
| Which muscle fiber type is associated with increased anaerobic glycolysis? | Type 2 muscle fiber |
| What exercises increase the proportion of Type 2 muscle fibers? | Weight/resistance training, and sprinting |
| A bodybuilder will have higher proportion of Type 1 or Type 2 muscle fibers? | Type 2 muscle fiber |
| A 100-m sprinter has elevated proportion of Type ____ muscle fiber. | Type 2 muscle fiber |
| Nitric oxide is stimulates smooth muscle contraction or relaxation? | Relaxation |
| What stimulates smooth muscle contraction? | Elevated levels of Ca2+ |
| Which kinase, MLCK or MLCP, is involved in smooth muscle contraction? | MLCK |
| Which kinase, MLCK or MLCP, is involved in smooth muscle relaxation? | MLCP |
| How is Ca2+ possible to enter the smooth muscle cell? | Using L-type voltage-gated Ca2+ channels |
| After, Ca2+ enters via L-type voltage-gated Calcium channels, the smooth muscle cell, it forms: | Calcium - Calmodulin complex |
| Which enzyme reacts with the Ca2+--Calmodulin complex during smooth muscle contraction? | MLCK |
| L-arginine + NO synthase in the endothelial cells yield --> | Nitric oxide |
| How does NO enter the smooth muscle cell? | NO diffusion |
| What are the two types of bone formation? | 1. Endochondral ossification 2. Membranous ossification |
| Which bones are formed via endochondral ossification? | Bones of axial skeleton, appendicular skeleton, and base of skull |
| Which bones are formed via membranous ossification? | Bones of calvarium, facial bones, and clavicle |
| The bones of the face, are formed via ______________ ossification. | Membranous ossification |
| The axial skeleton is formed via _________________ ossification. | Endochondral ossification |
| Woven bone formed directly without cartilage. | Membranous ossification |
| What is the form by which endochondral ossification occurs? | Cartilaginous model of bone is first made by chondrocytes. Osteoclast and osteoblasts later replace with woven bone and then remodel to lamellar bone |
| Which type of bone formation starts with cartilage model? | Endochondral ossification |
| Cells that create cartilage. | Chondrocytes |
| What instances in adults lead to formation of woven bones? | After fractures and in Paget disease of bone |
| Defective Endochondral ossification leads to which important condition? | Achondroplasia |
| What is the defective form of bone formation in Achondroplasia? | Endochondral ossification |
| What is the end result of healthy bone formation? | Lamellar bone |
| Is Lamellar bone, the initial or final type of bone maturation? | Final |
| Bones in extremities is made via what type of bone formation? | Endochondral ossification |
| Builds bone by secreting collagen and catalyzing mineralization in alkaline environment via ALP. | Osteoblast |
| Where do osteoblasts differentiate from mesenchymal stem cells? | Periosteum |
| What can be used to measure the activity of Osteoblast? | 1. Bone ALP 2. Osteocalcin 3. Propeptides of type I collagen |
| Which bone cells build bone? | Osteoblast |
| Which bone cell dissolve or destroy bone? | Osteoclast |
| Dissolves bone by secreting H+ and collagenases | Osteoclast |
| What bone cell differentiation from a fusion of monocyte/macrophage lineage? | Osteoclast |
| What important receptors are found on osteoclasts? | RANK receptors |
| What stimulates the RANK receptors on osteoclasts | RANKL |
| RANK-L is secreted by: | Osteoblast |
| What blocks RANK receptors on osteoclasts? | OPG (osteoprotegerin) |
| What is an important RANKL decoy receptor? | OPG (osteoprotegerin) |
| What is the result of RANK receptor on osteoblasts blockage? | Decreased osteoclast activity |
| What is secreted by Osteoclasts in order to dissolve (crush) bone? | H+ and collagenases |
| What is secreted by Osteoblasts? | Collagen |
| Collagen is secreted by which bone cell? | Osteoblast |
| Osteoblast work in acidic or alkaline environments? | Alkaline |
| What is a key enzyme for osteoblast activity? | ALP |
| What is the effect of low PTH levels on osteoblasts and osteoclasts? | Anabolic effects (building bone) |
| Chronic high levels of PTH has what type of effects of bone cells? | Catabolic effects, duchas osteitis fibrosa cystica |
| What is a common condition that leads to Osteitis fibrosa cystica? | Primary hyperparathyroidism |
| Which PTH condition is associated with chronic levels of PTH leading to catabolic effects on osteoblasts and osteoclasts? | Primary hyperparathyroidism |
| What is the role of estrogen on bone formation? | Inhibits apoptosis in bone-forming osteoblast and induces apoptosis in bone-resorbing osteoclasts. |
| What is the effect of Estrogen on Osteoblasts? | Inhibition of apoptosis |
| What is the effect of Estrogen on Osteoclasts? | Promote apoptosis |
| _________________ causes closure of epiphyseal plate during puberty. | Estrogen |
| Estrogen deficiency leads to: | Increase cycles of remodeling and bone resorption with increases the risk of osteoporosis. |
| Estrogen excess or deficiency lead to postmenopausal osteoporosis? | Estrogen deficiency |
| How does the deficiency of estrogen cause increase risk of developing osteoporosis? | Increase cycles of remodeling and bone resorption |
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