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USMLE (MUSK)
| Question | Answer |
|---|---|
| Epidermal Layer nmeumonic and what they stand for | Californians Like Girls in String Bikinis Corrneum, Lucidum, Granulosum, Spinosum, Basalis |
| What layers does psoriasis form between | Granulosum and spinosum |
| Tight junctions of epithelium form in what zone? Function | Zona Occludens; prevents diffusion across paracellular space |
| Epithelial intermediate junction is located where? What is it composed of? Function? | Zona adherens directly below Zona Occludens; CADherins; Surrounds perimeter below zona occludens and connects to actin |
| What are cadherins? Where are they? | Ca-dependent ADhesion molecules; part of intermediate junction in zona adherents of epithelial cells, and Macula adherens |
| Epithelial Desmosomes are located where? Function? | Macula adherens lies below zone adherens; Small, discrete sites of attachment, CADherinsconnect to intermediate filaments |
| Epithelial gap junctions are located where? Function? | Just above basement membrane, allows adjacent cells to communicate for electric and metabolism fxn |
| Hemidesmosome is located where? Function> | At deep boundary of epithelial cells; Connects cells to underlying extracellular matrix |
| Epithelial integrins are located where? function | They are part of a hemidesmosome which lie in within the epithelial cell; maintain integrity of basement membrane by binding to minion in BM |
| What is the unhappy triad? How does it occur | Common football injury caused by lateral impact at the knee. Results in ACL, MCL and lateral (not medial) meniscal tear |
| What physical exam indicates a torn MCL | Abnl passive abduction at knee |
| What nerve block is done as a local pain relief of labor? What is the landmark | Pudendal nerve block along the ischial spine |
| What is McBurney's point | Point over appendix; which is 2/3 of the way from umbilicus to ASIS |
| What causes rotator cuff impingement | Narrowing of supraspinatus outlet - often from excessive overhead motion |
| Winged scapula is the result of what injury? Nerve and Muscle | Long thoracic; Serratus Anterior |
| Erbs palsy is the result of injury to what nerve? What is the MC way of obtaining this injury | Upper trunk which consists of roots C5-6; Lateral traction on neck during delivery, (adults - trauma) |
| What muscles are involved in Erbs palsy? What is the sign of each | Limb hangs by side - Paralysis of abductors (Delt, supraspin); Medially rotated arm - Paralysis of lateral rotators (Infraspin); Forearm pronated - Loss of biceps |
| What causes Klumpke's palsy (infant & Adult) | Embryologic or childbirth defect affecting inferior trunk of brachial C8-T1; MC from arm in hyperextension during breech delivery; Grabbing tree branch to break a fall |
| What muscles atrophy with Thoracic outlet syndrome | Thenar, hypothenar, interossei, lumbricals, intrinsic hand muscles |
| Where do sensory deficits occur in Klumpke's | Medial aspect of forearm and hand |
| What abnormality will occur on physical exam of a pt w/ Thoracic Outlet Syndrome | Radial pulse will disappear moving head towards opposite side; diminishing pulse ox w/ arm abducted above level of heart |
| What muscles are affected in Klumpke's | Thenar, hypothenar, interossei, lumbricals, intrinsic hand muscles |
| What is the most common presentation of Klumpke's | Flexion at elbow, Supination of forearm, mild flexion of wrist, "CLAW HAND" Extension at MCP and Flexion at DIP & PIP |
| Describe Ulnar claw; What nerve, muscles and joints are affected | Distal ulnar nerve lesion; Loss of medial lumbricals; 4th &5th are clawed - MCP extended & PIP flexed |
| Median Claw: What nerve, muscles and joints are affected | Distal median nerve lesion; Loss of lateral lumbricals, 2nd & 3rd clawed - MCP extended & PIP flexed |
| What fracture and/or injury can lead to axillary nerve damage? Motor and send deficits? Sign? | Surgical neck of humerus; Arm abduction @ shoulder; Sensory over deltoid; flattened deltoid |
| What nerve roots make up the axillary nerve | C5 & 6 |
| What nerve roots make up the radial nerve | C5-8 |
| What fracture can lead to radial nerve injury? Motor & sens deficits? Sign? | Mid humeral shaft; MOTOR: Loss of elbow, wrist, & finger extenstion; DEC hand grip. SENSORY: Posterior arm/forearm, & dorsum of hand. "WRIST DROP" |
| What fracture can lead to proximal median nerve damage? Motor/sens deficits? Sign | Supracondylar humerus; opposition of thumb (?pronation); Dorsal/palmar lateral 31/2 fingers and thinner eminence sensation; APE HAND |
| What fracture or condition can lead to Distal median nerve damage? Motor/sens deficits? Sign | Dislocated lunate, Carpal Tunnel syndrome;MOTOR: lateral finger & wrist flex; SENSORY: Dorsal/palmar lateral 31/2 fingers; SIGN: Ulnar deviation on wrist flexion |
| What nerve roots make up the median nerve | C6-T1 |
| What nerve roots make up Ulnar | C8-T1 |
| What fracture can lead to proximal ulnar nerve damage? Motor/sens deficits? Sign | Fx of medial epicondyle of humerus; Medial finger flexion, wrist flexion; Medial 1 1/2 finger & hypothenar eminence; Radial deviation of wrist upon flexion |
| What fracture can lead to Distal Ulnar nerve damage? Motor/sens deficits? Sign | Fracture of Hamate (FOSH); ABduction & Adduction of fingers (interossei), Adduction of thumb, Ext of 4th 5th fingers (lumbricals); Medial 1 1/2 fingers and hypothenar sensory; Ulnar claw POPES BLESSING |
| What injury/condition can lead to musculocutaneous nerve damage? Motor/sens deficits? | Upper trunk compression; Flex of arm at elbow def; Lateral forearm sens |
| What nerve roots make up Musculocutaneous | C5-7 |
| Radial nerve innervates what muscles? What's the nmeumonic | Brachialradialis, Ext wrist & fingers, Supinator, Triceps; BEST |
| What are the Thenar muscles? Mnemonic | Opponens pollicis, ABductor pollicis, Flexor pollicics brevis; OAF |
| What are the hypothenar muscles? Mnemonic | Oppones digiti minimi, Abductor diditi minimi, Flexor didit minimi; MINI OAF |
| Dorsal interosseous muscles carry out what action | ABduct fingers DAB dorsals ABduct |
| Palmar interosseous muscles carry out what action | ADduct fingers PAD palmar ADduct |
| Lumbrical muscles carry out what action | Flex at MP joint |
| What tendons and muscles are affected in tennis elbow | Lateral epicondylitis |
| What tendons and muscles are affected in Golf Elbow | Medial epicondylitis |
| Cause, Motor & Sensory deficit in Obturator Nerve | Pelvic sx or Anterior hip disolocation; DEFICITS: Thigh ADduction; Medial thigh sens |
| Cause, Motor & Sensory deficit in Femoral nerve | Pelvic fx; DEFICITS: Thigh flexion leg ext; Ant thigh and medial leg sens |
| Cause, Motor & Sensory deficit in common peroneal nerve | Trauma to lateral leg; "FOOT DROP" Foot eversion, DF, toe ext PED- Peroneal Everts and Dorsiflex; Anterolateral leg & dorsal aspect of foot sens |
| Cause, Motor & Sensory deficit in Tibial nerve | Knee trauma, bakers (prod lesion), tarsal tunnel syndrome (distal lesion); DEFICITS: Foot inversion & PF, toe Flex TIP Tibial inver & Plantarflex; Sole of foot sens |
| Cause, Motor & Sensory deficit in Superior Gluteal nerve | Post hip dislocation, polio, iatrogenic IM injection upper medial glut; DEFICITS: Thigh ABduction, + Trendelenburg |
| Cause, Motor & Sensory deficit in Inferior Glueal nerve | Pos hip dislocation; Can't jump, climb stairs or rise from seated |
| Superior Gluteal nerve innervates what muscles | Glut medius and minimus |
| Inf gluteal nerve innervates what muscles | Glut max |
| During skeletal muscle contraction Ca is release from _________ and binds _______ allowing binding of ______ to _______ | SR; Troponin C; Actin to Myosin |
| Where are actin filaments anchored | Z-line of sarcomere |
| An Interesting Zoo Must Have Mammals is a mnemonic for what? | Actin in the I-band attaches at the Z-line, Myosin in the H-band attaches at the M-line |
| What muscle is assessed in the "empt/full" can test? What nerve innervates it? | Supraspinatus; Suprascapular nerve |
| What movements does the supraspinatus provide? What nerve innervates? | ABduction of arm (before deltoid picks up); Suprascapular nerve |
| What is the most common rotator cuff muscle injured | Supraspinatus |
| What movements does the infraspinatus provide? What nerve innervates it? | Laterally rotates the arm; Suprascapular nerve |
| What muscle is commonly associated with "pitchers injury" | Infraspinatus |
| What movement doe Teres minor provide? What nerve innervates it? | ADducts and laterally rotates arm; Axillary |
| What movements does subscapularis provide? What nerve innervates it | Medially rotates and ADducts arm; upper/lower sub scapular nerve |
| What is the mnemonic for carpal bones | So Long To Pinky, Here Comes The Thumb |
| Name the carpal bones | Scaphoid, Lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, Trapezium |
| What is the MC carpal bone injured? And what complication often arises | Scaphoid, AVN |
| What bone is palpated in "Anatomic Snuff Box" | Scaphoid |
| What injury can cause acute carpal tunnel syndrome? | Dislocation of Lunate |
| FOSH most commonly fx what bone and injures what nerve? | Hamate bone & Distal radius and Ulnar nerve |
| What syndrome is classically seen in cyclists, and why? | Guyon Canal Syndrome; compression of ulnar nerve at wrist or hand; d/t pressure from handlebars |
| What is McMurray test? | Pt in supine, knee internally & externally rotated during ROM; Pain/popping on external rotation = medial meniscal tear; on internal rotation = lateral meniscal tear |
| What condition is referred to as "Housemaids Knee" | Prepatellar bursitis |
| What is a positive abnormal passive ABduction test of the knee, and what injury does it indicate | Pt supine, knee extended or at 30, laterally (valgus) applied force w/ medial space widening of tibia; MCL injury |
| What is a positive abnormal passive ADduction test of the knee, and what injury does it indicate | Pt supine, knee extended or at 30, medially (various) applied force w/ lateral space widening of tibia; LCL injury |
| What nerve may be damaged due to longterm use of crutches | Radial |
| What nerve damage is referred to as "Saturday night palsy" | Radial, due to sleeping with arm over a chair |
| Arm/hand pain, ischemia and edema in thoracic outlet syndrome is usually associated to what? | Vascular compression |
| What actions do the lumbricals carry out? | Flexion of MCP and extension of DIP and PIP |
| What nerve injury leads to atrophy of hypothenar eminence | Ulnar nerve |
| What nerve injury leads to atrophy of thinner eminence? What is the classic description of this? | Median nerve; "Ape Hand" |
| What's the MC direction of a disk herniation | Posteriolaterally, d/t thin post longitudinal ligament and thicker ant log ligament |
| Weakness of knee ext and dec patellar reflex may be a sign of herniation of what disk | L3-L4 |
| Weakness of DF, diff heel walking may be a sign of herniation of what disk | L4-L5 |
| Weakness of PF, diff toe walking and dec achilles reflex may be a sign of herniation of what disk | L5-S1 |
| What "paired" nerve and artery lie in the axilla and lateral thorax | Long thoracic nerve & lateral thoracic artery |
| What "paired" nerve and artery lie near surgical neck of humerus? | Axillary nerve, Posterior circumflex artery |
| What "paired" nerve and artery lie near mid shaft of humerus | Radial nerve, deep brachial artery |
| What "paired" nerve and artery lie near distal humerus/cubital fossa | Median nerve, Brachial artery |
| What "paired" nerve and artery lie in the popliteal fossa? | Tibial nerve, Popliteal artery |
| What "paired" nerve and artery lie near posterior to medial malleolus | Tibial nerve, posterior tibial artery |
| What initiates skeletal muscle contraction | Action potential depolarization opens PREsynaptic voltage-gated Ca channel, inducing NT release |
| After PREsynaptic NT release, what happens next in skeletal muscle contraction | POSTsynaptic ligand binding leads to muscle cell depolarization in the motor end plate |
| What happens after motor endplate depolarization in skeletal muscle contraction | Depolarization travels along muscle cell and down T-tubule |
| Depolarization traveling along T-tubule in skeletal muscle depolarizes _____-_____ _____ receptor which causes __(type)___ change, resulting in release of ___ from _____ | Voltage-sensitve dihydropyridine receoptor causing a conformational change, resulting in the release of Ca from SR |
| The voltage-sensitive dihydropyridine receptor is _(HOW)_ coupled to _______ receptor on the ______________ | Mechanically coupled to ryanodine receptor on the SR |
| Ca released from the SR binds to _______ causing a conformational change that moves _______ out of the ______-binding groove on the ______ filaments | Ca released from the SR binds to TROPONIN C causing a conformational change that moves TROPOMYOSIN out of the MYOSIN-binding groove on the ACTIN filaments |
| What is the power stroke in skeletal muscle contraction? What is the result | When tropomyosin releases from the myosin-binding site on actin filament it exposes the cross bridge site for a myosin head to bind. Myosin then pulls actin shortening the sarcomere. Resulting in skeletal muscle contraction. |
| Contraction results in the shortening of ___ & ___ bands and btw ___ lines; but the ____ band remains the same length | Contraction results in the shortening of H & I bands and btw Z lines; but the A band remains the same length (HIZ shrinkage) |
| At the end of skeletal contraction binding of a new ____ molecule causes detachment of _____ head from ____ filament. Hydrolysis of _____ to ____ causes ______ to adopt _____-energy position, called ______ for the next contraction cycle | At the end of skeletal contraction binding of a new ATP molecule causes detachment of MYOSIN head from ACTIN filament. Hydrolysis of ATP to ADP + PO causes MYOSIN HEAD to adopt HIGH-energy position "COCKED" for the next contraction cycle |
| T-tubules are extensions of the _____ _____ juxtaposed w/ _____ ______. They are part of _______ | T-tubiules are extensions of the PLASMA MEMBRANE juxtaposed w/ TERMINAL CISTERNAE . They are part of the SR |
| In skeletal muscle, what equals a triad | 1 T-tubule + 2 terminal cisternae |
| In cardiac muscle what equals a diad | 1 T-tubule + 1 Terminal cisternae |
| Type 1 muscle fibers are what color? Fast or Slow | Red, Slow |
| Type 2 muscle fibers are what color? Fast or Slow | White, Fast |
| What gives type 1 muscle fibers is characteristics | INC mitochondria & myoglobin concentration, results in INC oxidative phosphorylation, SUSTAINED CONTRACTION |
| What gives type 2 muscle fibers is characteristics | DEC mitochondria & myoglobin concentration, results in INC anaerobic glycolysis |
| What type of muscle fibers hypertrophy in weight training | Type 2 |
| With an INC of Ca in smooth muscle cytoplasm, Ca binds to _______, which activates ________ | Calmodulin, Myosin light-chain kinase MLCK |
| Action potential depolarizes smooth muscle, which leads to opening of ____-_____ ____ channels, INC ____ in cytoplasm. | Action potential depolarizes smooth muscle, which leads to opening of VOLTAGE-GATED Ca channels, INC Ca in cytoplasm. |
| MLCK activated in smooth muscle leads to _______ + ______ formation called ____ _____ | Myosin P + Actin = Cross-bridge w/contraction |
| What enzyme transforms contraction to relaxation of smooth muscle. And how? | Myosin light-chain phosphatase MLCP, removes the phosphate group attached to myosin |
| Bones of axial, appendicular skeleton, and base of skull undergo what type of ossification? | Endochondral |
| In endochondral ossification, __________model of bone is 1st made by _____. Then ______ &______ replace with _______ bone; which is later remodeled into ______ bone | cartilaginous model of bone is 1st made by chondrocytes. Oseoclast/blasts later replace w/ woven bone and then remodeled to lamellar bone |
| Osteoblasts are differentiated from? | Mesenchymal stem cells in periosteum |
| Osteoclasts are differentiated from? | Monocytes and macrophages |
| Multinucleate cells that dissolve bone by secreting acid & collagenases | Osteoclasts |
| Cells that build bone by secreting collagen & catalyzing mineralization | Osteoblast |
| What osseous disorder can result from hyperparathyroidism | Osteitis fibrosa cystica |
| What induces apoptosis in osteoclasts | Estrogen |
| Achondroplasia affects what bones? And what ossification process? What ossification process is unaffected | Longitudinal bones, Endochondral oss; membranous oss not affected |
| How is Achondroplasia inherited | Auto DOM |
| What is the result of homozyygosity of achondroplasia | Lethal |
| MC cause of dwarfism | Achondroplasia |
| DEXA test with T score of ______ diagnosises osteoporosis | T less than or equal to -2.5 |
| What systemic abnormal labs would you expect to see in osteopetrosis | Pancytopenia, extramedullary hematopoiesis |
| "Bone in Bone" appearance on XRay is indicative of? | Osteopetrosis |
| Osteomalacia is the result of what deficiency? How does this result in osteomalacia | Vit D; defective mineralization/calcification of osteoid, leading to soft bones that "Bow Out" |
| Osteomalacia in and adult is equivalent to what in a child | Rickets |
| Osteomalacia: ___ Vit D--> ___ serum Ca--> ____ PTH secretion--> ___ serum PO | Dec VitD, Dec Ca, inc PTH, Dec PO |
| Osteomalacia result in the hyperactivity of _____ which lead to INC _____, | osteoblasts, Inc in ALP, |
| Osteoblasts require what type of environment | Alkaline |
| What are the 4 stages of Pagets ds | 1) Lytic - osteoclasts; 2) Mixed - Osteoclast and blasts; 3) Sclerotic - osteoblasts; 4) Quiescent - Minimal osteoclast/blast activity |
| What cardiac condition are pts with Pagets at risk for | High-output heart failure d/t INC blood flow from INC arteriovenous shunts |
| What Ca are Pagets pts at risk for | Osteogenic sarcoma |
| Increased hat size and hearing loss is common in pts w/ ______? Why? | Pagets, auditory foramen narrowing |
| What is the MC site of AVN, and why | Femoral head, infuse medial circumflex femoral artery |
| Mnemonic for causes of AVN, And causes | ASEPTIC; Alcoholism, Sickle cell, Storage, Exogenous/Endogenous corticosteroid, Pancreatitis, Trauma, Idiopathic (Legg-Calve), Caisson ("the bends" |
| Hypervitaminosis D: ___Ca-->___PO-->____PTH; ALP ____ | Inc Ca, Inc PO, dec PTH, no change in ALP |
| What other ds can cause hypervitaminosis? | Sarcoidosis, (granulomatous ds) |
| "Brown Tumors" Pathomneumonic for? | Osteitis fibrosa cystica, d/t fibrous replacement of bone |
| Primary hyperparathyroidism: ___Ca-->___PO-->____ALP-->___PTH | Inc Ca-->dec PO-->Inc ALP-->Inc PTH |
| Secondary hyperparathyroidism: ___Ca-->___PO-->____ALP-->___PTH | Dec Ca-->Inc PO-->Inc ALP-->Inc PTH |
| What is secondary hyperparathyroidism usually due to | ESRD (dec PO excretion and production of activated it D) |
| Population, Location, Characteristics of Giant cell tumor | 20-40yrs; Epiphyseal of long bones commonly at knee; Locally aggressive benign tumor "SOAP BUBBLE" on xr |
| "Soap Bubble" on Xray Pathomneumonic for | Giant cell tumor |
| Population, Location, Characteristics of Osteochondroma | M<25yr; mature bone w/ cartilaginous (chondroid) cap; MC benign tumor, rarely transforms to chondrosarcoma |
| 2nd MC malignant tumor | Osteosarcoma (asteogenic sarcoma) |
| Population, Location, Characteristics of osteosarcoma | Bimodal: Primary - 10-20yr, secondary >65yr Metaphysis of long bones often at knee. "SUNBURST or CODMAN TRIANGLE" XR pattern |
| What 5 factors predispose to osteosarcomas? | Pagets, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome |
| Le-Fraumeni syndrome is a mutation in what germline | p53 |
| Tx of osteosarcoma | Agressive. Sx bloc resection & chemo |
| What is the MC malignant tumor | Multiple Myeloma |
| Population, Location, Characteristics of Ewing sarcoma | M<15yr; diaphysis of long bones Pelvis, scapula, ribs; "ONION SKIN" on XR; anapestic small blue cell on stain |
| "ONION SKIN" on XR is pathopneumonic for | Ewing sarcoma |
| anapestic small blue cell on stain is pathopneumonic for | Ewing sarcoma |
| What protein translocation is associated with Ewing | t(11;22) translocation causing protein EWS-FLI 1 |
| RA etiology | Autoimmune inflammatory destruction of synovial joints. Mediated by cytokines and type III & IV hypersensitivity rxn |
| Herberden nodes at DIP are associated with? | OA |
| Bouchard nodes at PIP are associated with? | OA |
| Are MCP involved in OA | no |
| Swan neck and boutonniere deformities are associated with | RA |
| Pannus in MCP and PIP are associated with? | RA |
| Rheumatoid factor is found in ____% of people with RA? what specifically is rheumatoid factor | 80%; anti-IgG antibody |
| What is the most specific marker for RA | Anti-cyclic citrullinated peptide antibody |
| HLA-DR4 is strongly associated with? | RA |
| Arthritis that improves after rest is what type | OA |
| Morning stiffness that improves with use is what type of arthritis? How long does the stiffness usually last? | RA; >30mins |
| Symmetric joint involvement is associated with what type of arthritis | RA |
| What systemic symptoms are associated with RA (5) | Fever, fatigue, weight loss, pleuritic, pericarditis |
| Disease modifying TX of RA (2) | Methotrexate, sulfasalazine |
| Biologics TX of RA (1) | TNF-alpha inhibitors |
| Where does cartilage loss begin in the knee of OA? What might this lead to? | Medially, "bowlegged" |
| Pathology of Sjogren syndrome | Autoimmune destruction of exocrine glands MC Lacrimal & Salivary |
| Signs (3) and symptoms (1) of Sjogren syndrome | Symptom: Inflam joint pai; Signs: Xerophthalmia (dec tears -->coreneal damage); Xerostomia (dec saliva); B/L parotid enlargement |
| What Ab will you see in Sjorgren syndrome | Antinuclear Ab: SS-A (anti-Ro) and/or SS-B (anti-La) |
| If parotid gland enlargement is present in a Sjorgren pt what must you r/o | Mucosa-associated lymphoid tissue lymphoma MALT |
| What in the mouth is commonly affected by Sjogrens | Tooth decay |
| Acute inflammatory monoarthritis? | Gout |
| What medication commonly exacerbates gout | Thiazide diuretics |
| What 2 syndromes are commonly associated with gout | Lesch-Nyhan; Tumor lysis syndrome |
| What other disease is commonly associated with gout | Von Gierke ds |
| Describe gout crystal appearance | Needle shaped and, - birefringent under polarized light |
| Gout crystals are _______ under parallel light, and _____ under perpendicular light | YeLLow under ParaLLel light, blue under perpendicular light |
| What is Podagra and what is it pathopneumonic for? | Painful MTP of great toe; gout |
| Where are Tophi commonly located? What condition are the associated with | External ear, olecranon bursa, achilles tendon; Gout |
| Tx for acute gout (3) | indomethacin, glucocorticoids, colchicine |
| Preventative tx for gout (2) | Allopurinol, febuxostat |
| Pseudogout crystal are ______ under parallel light | BLUE |
| What type of crystals are formed in pseudogout | Calcium pyrophosphate |
| Pseudogout crystals are ______ on polarized light | weakly birefringent |
| 3 ds commonly associated with Pseudogout | Hemochromatosis, hyperparathyroidism, osteoarthritis |
| MC bugs of septic arthritis (3) | S. Aureus, Stretococcus, N. Gonorrhoeae |
| Migratory arthritis w/ an asymmetric pattern. Pathpneumonic for? What's the Mneumonic | Gonococcal arthritis; STD: Synovitis (knee), Tenosynovitis (hand), Dermatitis (pustules) |
| HLA-B27 codes for what? | MHC class I |
| What conditions are associated with HLA-B27? Whats the mneumonic? | PAIR: Psoriatic arthritis, Ankylosing spondylitis, IBD(Crohns & UC), Reactive arthritis (reiter syndrome) |
| "Sausage Fingers" pathopneumonic for? AKA | Psoriatic arthritis; Dactylitis |
| "Pencil-in-cup" pathopneumonic for? | Psoriatic arthritis |
| Joint pain and stiffness w/ psoriasis? | Psoriatic arthritis |
| Conjunctivitis/Uveitis, Urethritis, Arthritis... Pathopneumonic for? What's the mnemonic | Reiters syndrome (reactive arthritis); "Can't see, can't pee, can't ben my knee" |
| "Bamboo spine" is pathopneumonic for? What does it look like? | Ankylosing spondylitits; Fusion at edges of vertebrae |
| Crohns and UC are often accompanied by what types of arthritis | Ankylosing or peripheral arthritis |
| What infections is Reactive Arthritis often following | Shigella, Salmonella, Yersinia, Campylobacter; Chlamydia |
| Facial rash, joint pain, fever in female.... | SLE |
| What test is commonly falsely + for SLE pts | VDRL/RPR |
| Non-bacterial wart-like vegetations on both sides of a heart valve is pathopneumonic for? What disease is it associated to? | Libman-Sacks Endocaditis; SLE - MC cardiac manifestation of SLE |
| What is the MC kidney manifestation of SLE | Lupus Nephritis (nephritic or nephrotic) |
| Lupus nephritis is what type of rxn | Type III hypersentitivity |
| What is the difference btw nephritic and nephrotic | Nephritic - Diffuse proliferative glomerulonephritis; Nephrotic - membranous glomerulonephritis |
| 3 Common causes of death in SLE | Cardiovascular ds, Infxn, renal ds |
| Antinuclear Abs (ANA) are ______ not _____ for _____ | Sensitive, not specific for SLE |
| Anti-dsDNA Abs are ______ for _____ ; and indicate __________ | Specific for SLE; indicate poor prognosis |
| Anti-Smith Abs are ______ not _____ for _____: what are they directed against | Specific, not Prognostic, for SLE; directed against snRNPs |
| Antihistone Abs are indicative of? | Drug-induced lupus |
| What immune compliment factors are decreased in SLE? Why? | C3, C4, CH50; Immune complex formation |
| Tx for SLE (4) | NSAIDS, steroids, immunosuppressants, hydroxychloroquine |
| Primary or secondary autoimmune disorder MC associated w/ SLE | Antiphospholipid Syndrome |
| Antiphospholipid Syndrome is dx based on hx of (2) | Thrombosis: Arterial or venous; Spontaneous abortion |
| Antiphospholipid Syndrome lab findings (3) | Lupus anticoagulant, anticardiolipin, anti-Beta2 glycoprotein Abs |
| What other syndrome may result in fast + VDRL? What causes it? | Antiphospholipid Syndrome; Anticardiolipin and lupus anticoagulant |
| What 2 tests may have false + in Antiphospholipid Syndrome pts? What causes this? | VDRL, PTT; Anticardiolipin and lupus anticoagulant |
| Widespread noncaseating granulomas.... | Sarcoidosis |
| Labs associated with sarcoidosis (3) | Inc ACE, Inc CD4+/CD8+ ratio, Inc Ca |
| MC population for sarcoidosis | Black females |
| CXR findings of sarcoidosis | Bilateral hilar and mediastinal adenopathy & coarse reticular opacities |
| Only sign - Enlarged lymph nodes, What must you r/o | Sarcoidosis |
| Epithelioid Granulomas containing microscopic Schaumann and asteroid bodies are associated with what ds | Sarcoidosis |
| What is the cause of hypercalcemia in sarcoidosis | Inc in 1,25-dihydroxy Vit D mediated ACTIVATED MARCROPHAGES |
| What other pulmonary condition is associated with sarcoidosis | restrictive lung ds (interstitial fibrosis) |
| What palsy is associated with sarcoidosis | Bells |
| What skin conditions is associated with sarcoidosis (2) | Erythema nudism, Lupus pernio |
| Pain and stiffness in shoulders & hips w/ fever, malaise and weight loss; but NO muscular weakness | Polymyalgia Rheumatica |
| Condition strongly associated with Polymyalgia rheumatica | Temporal giant cell artertitis |
| Lab findings in Polymyalgia Rheumatica | Inc ESR, Inc CRP, nl CK |
| Tx of polymalgia rheumatica | rapid response to low-dose corticosteroids |
| Tx of fibromyalgia | TCAs, SNRIs |
| Serum Ab in common for polymyositis & dermatomyositis (5) | Inc CK, +ANA, +anti-Jo-1, +anti-SRP, +anti-Mi Abs |
| + Anti-Jo-1 ..... | polymyositis & dermatomyositis |
| + anti-SRP | polymyositis & dermatomyositis |
| + anti-Mi antibodies | polymyositis & dermatomyositis |
| Classic presentation of polymyositis | Progressive SYMMETRICAL PROXIMAL muscle weakness, MC involves shoulders |
| What is inflamed in polymyositis? What is present w/i the inflammation | Endomysial inflammation with CD8+ T cells |
| Classic presentation of dermatomyositis | Progressive SYMMETRICAL PROXIMAL muscle weakness, MC involves shoulder, ALSO involves skin conditions like MALAR RASH or "Shawl and Face" rash, "mechanics hands" |
| Name to 5 skin conditions associated with dermatomyositosis | Malar rash, " Gottron papules, heliotrope rash, "shawl and face" rash, "mechanic's hands" |
| What is endomysial | sheath surrounding individual muscle fibers |
| What is perimysial | Sheath surrounding group of muscle fibers or muscle cell |
| What is inflamed in dermatomyositis? What is present w/i the inflammation? | Perimysial inflammation with CD 4+ T cells |
| What is the MC NMJ ds | Myasthenia Gravis |
| Autoantibodies to what in MG | ACh receptors |
| Ptosis, diplopia, weakness that worsens with muscle use | MG |
| Thymoma, and thymic hyperplasia are associated with what ds | MG |
| What drug induces reversal of MG symptoms | AChE inhibitor |
| Autoantibodies to ______ in Lambert-Eaton Myasthenic syndrome? What is the result | Presynaptic Ca channels; leads to dec of ACh release |
| Proximal muscle weakness that improves with use, dry mouth, impotence Classic for? | Lambert-Eaton Myasthenic syndrome |
| What ds is highly associated with Lambert-Eaton Myasthenic syndrome? | Small cell lung ca |
| Metaplasia of skeletal muscle into bone following muscular trauma | Myositis ossificans |
| Autoimmunity, Noninflammatory vasculopathy, collagen deposition w/ fibrosis | Scleroderma |
| Puffy, that skin w/o wrinkles, and fingertip pitting | Scleroderma |
| MC cause of death in scleroderma | Pulmonary complications |
| What three systems are commonly effected in scleroderma | Cardio, GI, Pulm |
| Scleroderma favors which gender | Female 75% |
| Which type of scleroderma is associated with Scl-70 antibody? Ab is AKA | Diffuse scleroderma; anti-DNA topoisomerase I Ab |
| Diffuse scleroderma has ______ skin involvement, ______ progression, _____ visceral involvement | Diffuse scleroderma has WIDESPREAD skin involvement, RAPID progression, EARLY visceral involvement |
| What locations is Limited Scleroderma found | Fingers & face |
| Conditions associated with Limited Scleroderma? Whats the mnemonic? | CREST: Calcinosis & antiCentromere, Raynauds, Esophageal dysmotility, Sclerodactyly and Telangiectasia |
| Ab associated with Limited Scleroderma | Anti-centromere Ab |
| 3 layers of skin | epidermis, dermis, subcu fat |
| Flat lesion with well-circumscribed change in skin color<1cm | Macule (freckle, labial macule) |
| Macule >1cm | Patch (large birthmark AKA congenital nevus) |
| Elevated solid skin lesion<1cm | Papule (mole, acne) |
| Papule>1cm | Plaque (psoriasis) |
| Small fluid-containing blister<1cm | Vesicle (chickenpos-varicella, shingles-zoster) |
| Large fluid-containing blister >1cm | Bulla (Bullous pemphigoid) |
| Vesicle containing puss | Pustule (pustular psoriasis) |
| Transient smooth papule or plaque | Wheal (urticaria) |
| Flaking off of stratum corneum | Scale (Eczema, Psoriasis, SCC) |
| Dry exudate | Crust (impetigo) |
| Inc thickness of stratum corneum | hyperkeratosis (Psoriasis, calluses) |
| Hyperkeratosis w/ retention of nuclei in stratum corneum | Parakeratosis (Psoriasis) |
| Epidermal accumulation of edematous fluid in intercellular spaces | Spongiosis (Eczema dermatitis) |
| Separation of epidermal cells | Acantholysis (Pemphigus Vulgaris) |
| Epidermal hyperplasia, inc spinosum | Acanthosis (acanthosis nigricans) |
| Albinism has _____ melanocyte # with ____ melanin production | Normal melanocyte, DEC melanin production |
| 2 causes of albinism | 1) DEC tyrosinase activity or detective tyrosine transport; 2) Failure of neural crest cell migration during development |
| What ds has an INC risk in albinism | Skin cancer |
| "Mask of pregnancy" | Melasma AKA Chloasma |
| Melasma is a __________ associated with _______ or _____ | Hyper pigmentation associated with pregnancy or OCP use |
| Irregular areas of complete depigmentation | Vitiligo |
| What causes vitiligo | Autoimmune destruction of melanocytes |
| Obstructive and inflammatory ds of the pilosebaceous unit | Acne |
| Pruritic eruption, commonly on skin flexures | Atopic dermatitis AKA eczema |
| Typical presentation of atopic dermatitis | Face in infancy --> appears in antecubital fuss thereafter |
| Atopic dermatitis is commonly associated with what other atopic ds (2) | Asthma, allergic rhinitis |
| Allergic contact dermatitis is what type of rxn | Type IV hypersensitivity |
| Common allergens that cause allergic contact dermatitis (3) | Nickel, poison ivy, neomycin |
| Melanocytic nevus is AKA | Common benign mole |
| What type of melanocytic nevus are associated with transformation to melanoma | Congenital or atypical moles |
| Intradermal melanocytic nevi are described as | Papular |
| Junctional melanocytic nevus are describes as | Flat merciless |
| What type of cancer are scleroderma pts at risk for? | Barrets esophagus d/t esophageal dysmotility |
| "Silvery Scaling" | Psoriasis |
| Psoriasis: ____ Stratum spinosum, _____ stratum granulosum | Inc spinosum, Dec granulosum |
| What's auspitz sign | Pinpoint bleeding spots from exposure of dermal papillae when scales are scared off in psoriasis |
| Acanthosis w/ parakeratotic scaling (nuclei still in stratum corneum) | Psoriasis |
| Facial erythematous papule and pustules, BUT no comedones | Rosacea |
| What generally exacerbates rosacea? What type of rxn is it? | ETOH, heat; inflammatory |
| Chronic exacerbation of rosacea can lead to? | Rhinophyma - bulbous deformation of nose |
| Flat, Greasy, pigmented w/ horn cysts.... | Seborrheic keratosis |
| What are horn cysts | keratin-filled cysts associated w/ seborrheic keratosis |
| Seborrheic Keratosis have a ________ appearance | "Stuck on" |
| What is "Leser-Trelat" sign? | Sudden appearance of multiple seborrheic keratoses, indicating and underlying malignancy (Gi, lymphoid) |
| Warts caused by HPV are called | Verrucae |
| Soft, tan, cauliflower-like papules on hands.... | Verrucae warts d/t HPV |
| Condyloma acuminatum on genitals... | Verrucae warts d/t HPV |
| What is Koilocytosis | Structural changes in Squamous epithelium d/t HPV |
| "Wheal" | Urticaria |
| Pruritic _____ that forms due to ____ ____ _____ | Wheal, after mast cell degranulation |
| What 2 bugs commonly cause impetigo | S. Aureus (blisters), S. Pyogenes (Crusts) |
| Bulllous impetigo is commonly caused by? | S. aureus |
| Acute, painful spreading infix of deep dermis and subcu | Cellulitis |
| Common bugs of cellulitis (2) | S. Pyogenes, S. Aureus |
| Infection involving upper dermis and superficial lymphatics that presents w/ well-defined demarcation btw infected and normal skin | Erysipelas |
| Common bug of Erysipelas | S. Pyogenes |
| Collection of pus from a walled-off infxn w/i deeper layers of skin | Abscess |
| MC bug causing abscesses | S. Aureus, frequently MRSA |
| Superficial sign of bull and purple color skin... | Necrotizing fasciitis |
| Bugs commonly associated with Nec Fasc | S. Pyogenes, or anaerobic bacterias |
| Crepitus found in Nec Fas is caused by | methane and CO2 production |
| What is the agent that causes SSS | Exotoxin |
| Fever, generalizer erythematous rash w/ sloughing of upper layers of epidermis that heals completely | Staph, scalded skingsyndrome SSS |
| How is SSS different from Toxi epidermal necrolysis | Toxic epidermal necrolysis destroys epidermal-dermal junction; SSS destroys keratinocyte attachments in stratum gran ONLY |
| SSS is commonly seen in what populations | Newborns & children, adults w/ renal insuff |
| Whitlow Finger.... | Herpes |
| Umbilicated papules commonly seen in children | Molluscum contagiosum |
| Molluscum contgiosum bug | poxvirus |
| When Molluscum contagiosum is seen in adults what is it likely d/t | STD form |
| Varicella zoster virus, which causes chickenpox, which shingles | Varicella - chickenpox; Zoster - Shingles |
| Multiple crops of lesions in various stages from vesicles to crust.... | Chickenpox |
| Irregular, white, painless plaques on tongue that CANNOT be scraped off | Hairy leukoplakia |
| What populations are vulnerable to hairy leukoplakia | HIV, AIDS, Organ transplant |
| Hairy leukoplakia agent | EBV |
| Differentiate hairy leukoplakia and thrush presentation, why is this distinction so important | Thrush scrapable, and Leukoplakia is NOT; Leukoplakia is precancerous |
| Potentially fatal autoimmune skin ds with flaccid intraepidermal bullae | Pemphigus Vulgaris |
| Pemphigus Vulgaris associated Ab? Where do they attack | IgG Ab against desmoglein, component of desmosomes |
| Flaccid intraepidermal bullae is caused by? | Keratinocytes in stratum spinosum are connected by desmosomes which are attacked by Autoimmune IgG against desmoglein |
| What is Nikolsky sign? What disorders is it associated with? | Separation of epidermis upon manual stoking of skin; Pemphigus Vulgaris Nikolsky +; Bullous pemphigoid Nikolsky - |
| What diagnoses Pemphigus Vulgaris? | Immunofluorescence reveals Ab around epidermal cells in "Reticular Net-Like Patter", Nikolsky + |
| "Reticular-Net-Like-Pattern" | Pemphigus Vulgaris |
| Tense blisters containing eosinophils affect skin but spare oral mucosa | Bullous pemphigoid |
| Bullous pemphigoid Ab? Where is it found? What does it attack? | IgG Ab against hemidesmososmes in the epidermal basement membrane, antibodies are BULLOw the epidermis |
| Dx of Bullous Pemphigoid? | Immunofluorescence reveals linear pattern at epidermal-dermal junction, Nikolsky - |
| Pruritic papules, vesicle and bull often found on elbow | Dermatitis herpetiformis |
| What Ab is associated with Dermatitis herpetiformis? Where is it found? | IgA at the tips of dermal papillae |
| What ds is strongly associated with Dermatitis Herpetiformis | Celiac |
| Two important distinctions to differentiate btw Pemphigus Vulgaris and Bullous pemphigoid | Pemphigus Vulgaris involves oral mucosa and is Nikolsky + |
| Presentation of merciless, papule, vesicles, TARGET LESIONS; describe the target lesions | Erythema Multiforme; multiple rings and dusky center |
| Agents causing Erythema Multiforme (5) | Mycoplasma, pneumoniae, HSV; OR Sulfa, Beta-Lactams, Phenytoin |
| Fever Bullae and necrosis, sloughing of skin, HIGH FATALITY RATE | Stevens-Johnson Syndrome SJS |
| SJS with > 30% of body surface involved = _____; Whats the worry range? | Toxic Epidermal Necrolysis SJS-TEN; 10-30% |
| Symmetric, hyper pigmented thickening of skin, commonly in axilla or neck | Acanthosis Nigricans |
| What co-morbities are associated with Acanthosis Nigricans | Hyperinsulinemia: DM, obesity, and Cushing syndrome |
| What cancer are pts with Acanthosis Nigerians at higher risk for | Viseral malignancy, commonly gastric adenocarcinoma |
| Small, rough, erythematous or brownish papules and/or plaques | Actinic keratosis |
| What causes actinic keratosis? And what risk does it indicate? | Sun exposure; Risk of squamous cell carcinoma (which is proportional to degree of epithelia dysplasia) |
| Painful inflammatory lesions of sub fat, commonly on extensor/anterior surface of shins | Erythema nodosum |
| Although Erythema Nodosum is usually idiopathic what are a few conditions associated with it? (4) | Sacroidosis, TB, Chrons, Strep infxns |
| Pruritic, Purple, Polygonal Planar Papules and Plaques | Lichen Planus (6P's) |
| "Wickham Striae" | Lichen Planus - reticular white lines |
| "Sawtooth infiltrates" of lymphocytes at dermal-epidermal junction | Lichen Planus |
| Lichen Planus is associated with what ds | Hep C |
| "Herald Patch"..... What follows it? | Pityriasis Rosea; Scaly erythematous plaques several days later |
| "Christmas Tree" distribution | Ptiyriasis Rosea |
| Tx for pityriasis Rosea? | Nothing usually self-resolving in 6-8wks |
| "Collarette Scale" | Pityriasis Rosea |
| Sunburns cause damage to? | DNA mutations inducing apoptosis of keratinocytes |
| UVA is dominant in _____ and _____ | Tanning, and photoaging |
| Primary cause of sunburn? UVA or UVB | UVB |
| What cancers are higher risk following multiple sunburns (3) | Basal cell carcinoma, squamous cell carcinoma, melanoma |
| What is the MC skin cancer | Basal Cell Carcinoma |
| Pink, pearly nodules, commonly with telangiectasisas, rolled borders and central crusting or ulceration | Basal Cell Carcinoma |
| Nonhealing ulcers with infiltrating growth | Basal Cell Carcinoma |
| Scaling plaques | Superficial Basal Cell Carcinoma |
| "Palisading Nuclei" | Basal Cell Carcinoma |
| Second MC skin cancer | Squamous Cell Carcinoma |
| Where is Squamous Cell Carcinoma commonly located | Face, Lower lip, Ears, hands |
| "Keratin Pearls" | Squamous Cell Carcinoma |
| Squamous Cell Carcinoma pathogenesis | Locally invasive, may spread to lymph nodes, rarely metastasize |
| Basal Cell Carcinoma pathogenesis | Locally invasive, rarely metastasizes |
| Ulcerative red lesions with frequent scales in Squamous cell carcinoma is associated with what condition | Chronically draining sinuses |
| Squamous Cell Carcinoma variant that grows rapidly (4-6 wks) and may spontaneously regress over months... | Keratoacanthoma |
| Common skin tumor with significant risk of metastasis | Melanoma |
| What is the tumor marker associated with Melanoma? | S-100 |
| What correlates with risk of metastasis for melanoma? | Depth of tumor |
| ABCDEs of Melanoma | Asymmetry, Border irregularity, Bolor variation, Diameter>6mm, and Evolution over time |
| 4 types of melanoma | Superficial spreading,, Nodular, Lentigo Maligna, Acral Lentiginous |
| "BRAF kinase" | Melanoma |
| "BRAF V600F"; what is the recommended tx | Metastatic or unresectable melanoma; may benefit from Vemurafenib which is BRAF kings inhibitor |
| What is the MOA of acetaminophen? | REVERSIBLY inhibits cyclooxygenase, mostly in CNS; inactivated peripherall |
| What syndrome is associated with use of aspirin in children with viral infxn | Reye's Syndrome |
| MOA of acetaminophen toxicity | Hepatic Necrosis: Metabolite NAPQI depletes glutathione and forms toxic tissue byproducts in liver |
| What is the antidote to acetaminophen toxicity? | N-acetylcysteine - regenerates glutothione |
| LTB4 is a _______ chemotactic agent | Neutrophil |
| Neutrophils arrive _____ others | B4 (LTB4 - leukotriene chemotactic agent) |
| PGI2 MOA | Inhibits platelet aggregation and promotes vasodilation; PGI - Platelet-Gathering Inhibitor |
| Aspirin MOA | IRREVERSIBLY inhibits cyclooxygenase (COX 1 & COX 2) via acetylation; which DEC synthesis of TXA2 & Protaglandins |
| Aspirin has what effect on coagulation studies | Inc bleeding time; NO EFFECT on PT, PTT, |
| ASA dose to dec platelet aggregation | <300mg/day |
| Antipyretic & Analgesic dose of ASA | 300-2400mg/day |
| Anti-inflammatory dose of ASA | 2400-4000mg/day |
| ASA toxicity can cause what GI conditions (2) | Gastric Ulcer, GI bleed |
| ASA toxicity can cause what kidney conditions | Acute Renal Failure, Interstitial nephritis |
| ASA toxicity can affect what CN? Whats the symptom | CN VIII, tinnitus |
| Early ASA toxicity may present as ______, later transforms to ______ | Respiratory Alkalosis, later transitions to mixed metabolic acidosis-respiratory alkalosis |
| Celecoxib MOA | REVERSIBLY inhibits specifically cyclooxygenase COX-2, Spares COX-1, Spares TXA2 |
| Where is COX-2 found and what does it mediate | Inflammatory cells and vascular endothelium; it mediates Inflammation and pain |
| An agent that spares COX-1 has what benefit? What does it also spare and why? | Helps maintain Gi lining; Spares Platelet fxn as TXA2 production is dependent on COX-1 |
| What allergy is a contraindication to use of Celecoxib? | Sulf-allergy |
| Toxicity of Celecoxib leads to risk of? | Thrombosis |
| NSAID MOA | REVERSIBLY inhibits COX-1 & COX-2; Blocks prostaglandin synthesis |
| What medication is used to close PDA | Indomethacin (NSAID) |
| Prostaglandins protect ________. Therefore a medication that blocks them such as ______, leads to increased risk of _______ | Protect GASTRIC MUCOSA, Medication such as NSAIDS, leads to increased risk of GASTRIC ULCER |
| Prostaglandins vasodilate ________. Therefore a medication that blocks them such as ______, leads to increased risk of _______ & ______ | Vasodilate renal afferent arteriole; Med such as NSAIDS, increased risk of RENAL ISCHEMIA and INTERSTITIAL NEPHRITIS |
| Bisphosphonates MOA | Pyrophsphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity |
| Bisphosphonate toxicity can cause (2) | Corrosive esophagitis - pts should take with water and sit upright for 30mins; Osteonecrosis of Jaw |
| Teriparatide MOA | Recombinant PTH analog given subcu daily; INC osteoblastic activity |
| Teriparatide toxicity | Transient hypercalcemia, may inc risk of osteosarcoma - any previous cancer is a contraindication |
| Allopurinol MOA | Inhibits Xanthine oxidase after being converted to alloxantlhine, --> DEC conversion of xanthine to uric acid |
| Other than Gout what ds is allopurinol used in? Whats the MOA | Lymphoma & leukemia; Prevent tumor lysis-associated rate nephropathy, INC concentration of azathioprine & 6-MP (both normally metabolized by xanthine oxidase |
| Febuxostat MOA, Tx what? | Inhibits xanthine oxidase; Chronic gout prevention, *safer for renal pts |
| Pegloticase MOA, Tx what? | Recombinant fricassee that catalyze metabolism of uric acid to allantoin (more water soluble product); Prevenative gout |
| Probenecid MOA, Tx what? | Inhbits reabsorption of uric acid in proximal convoluted tubule (also inhibits secretion of PCN); Gout preventative |
| Risk of Probenecid | Precipitation of uric acid calculi |
| NSAIDS for acute gout (2) | Naproxen, indomethacin |
| Admin of glucocorticoids for acute gout (2) | Oral, intra-articular |
| Colchicine MOA | Binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation |
| What class of drug should be avoided in Acute Gout and why? | Salicylates; all but the highest does depress uric acid clearance. |
| Risk of all TNF-alpha's inhibitors | Predispose to infxn, including reactivation of latent TB, TNF is important in granuloma formation and stabilization |
| Etanercept tx (3)? MOA | RA, Psoriasis, Anky Spondy; MOA: Fusion protein produced by recombinant DNA (receptor for TNF-alpha +IgG1Fc), EtanerCEPT is a TNF decoy reCEPTor |
| Infliximab. adalimumab tx (4)? MOA? | IBD, RA, psoriasis, Anky Spondy; MOA: Anti-TNF-alpha monoclonal Ab |
| MC cause of asymmetric inflammatory arthritis of Lower extremities in young men | Reactive arthritis |
| "Gower sign" | Uses hands to get up from squatted position; Associated with X-linked DMD |
| Dystrophin is what type of protein? How does it work? | Structural protein of muscles. Allow interaction btw extracellular connective tissue & intracellular contraction apparatus |
| Deletions that are not multiples of 3 cause what type of mutation? Is this more or less severe? | Frameshift mutation; MORE severe |
| Osteomyelitis of vertebrae in a Potts ds pt MC agent | Mycobacterium Tuberculosis |
| Osteomyelitisof long bones in a sickle cell pt MCagent | Salmonella |
| 2nd MC cause of hematogenous osteomyelitis in children | Strep Pyogenes (Group A strep) |
| Drugs that end in "mab" are what type of medication | Monoclonal Ab |
| Drugs that end in "nib" are what type of medication | kinase inhibitor |
| Drugs that end in "cept" are what type of medication | Receptor moecule |
| snRNPs are what type of molecule? What is their function? | snRNPs = Spliceosomes + proteins; Fxn RNA splicing (removal of non-coding regions) |
| What ds are snRNPs associated with? How? | snRNPs are highly associated with anti-smith Ab in SLE |
| What nerve innervates forearm flexors? | musculocutaneous |
| What nerve carries sensation for lateral forearm | Musculocutaneous |
| 4 major indications for long-term gout therapy | 1) Macroscopic tophaceous deposits; 2) More than 3 acute gout attacks per year; 3) Uric Acid Stones; 4) Gross elevation of serum uric acid |
| Which drug, over allopurinol, is safer for renal pts with gout | Febuxostate |
| Pts who excrete uric acid or have kidney stones should avoid which gout medication. Why? | Uricosuric agents. (Probenecid & sulfinpyrazone); to prevent uric acid nephrolithiasis |
| MG is what type of autoimmune ds? What type of Ab are involved? | Autoimmune type II hypersensitive ds; IgM and/orIgG Ab bind to cell surface Ag and/or extracellular matrix components |
| Under normal physiologic conditions there is a ____ concentration of Na and Cl in the cell, and a ____ concentration of K in the cytoplasm | Low; High |
| Under normal physiologic condition there is a ____ concentration of Na and Cl in the extracellular space; and ____ concentration of K in the cytoplasm | High, Low |
| Calcitonin has what effect on osteoclasts | inhibits osteoclasts, DEC bone resorption |
| PTH effects osteoclasts how? | Stimulates osteoclasts indirectly, INC bone resorption |
| How does PTH effect osteoblasts | Binds osteoblasts causing INC of RANK-ligand and monocyte colony -stimulating factor (M-CSF); these factors stimulate osteoclastic precursors to mature |
| PTH main fxn | INC bone resorption |
| PTH _____ serum Ca; and ____ serum phosphate levels, ____ urine phosphate levels | Inc serum Ca, Dec serum PO, Inc urine PO |
| Caudal regression syndrome is? What condition in pregnancy has been linked to it? | Agenesis of sacrum and occasionally lumbar spine. Resultant flaccid paralysis of legs, DF contactures of feet, and urinary incontinence; Frequently related to poorly controlled DM in pregnancy |
| Which race has naturally higher bone density in women, Black or white | Black |
| Fibroblasts + AA = tripple helix; AKA | Collagen |
| Fibroblast MOST AVIDLY consume ________ to form triple helix of ______ | Glycine; Collagen |
| MC cause (1st & 2nd) of osteomyelitis in a sickle cell pt | 1) Salmonella; 2) E. Coli |
| In primary (age related, post menopausal) OA. Serum Ca and PTH are ____, ______ | Normal!! both |
| Which is present ONLY when inflammatory cells are activated? Cox-1 and/or COX-2? | COX-2; |
| Unlike most NSAIDS; _____ is able to bind _______COX-1 & COX-2, thus to continue enzyme activity of COX 1&2 what must happen | ASA; Irreversibly; Synthesis of new enzymes is required |
| Type I muscle fibers perform actions requiring ____-level sustained force. They fxn primarily by _______ metabolism. Therefore they have ____ myoglobin, and _____ mitochondria | Low-level; Aerobic metabolism, HIGH myoglobin, HIGH mitochondria |
| Muscular oxygen storage | Myoglobin |
| Muscular aerobic respiration is carried out by? | Mitochondrial |
| Type II fibers dervie ATP from _____ &______. Therefore, the have _____ levels of glycogen | Anaerobic glycogenolysis & glycolysis |
| "SDH + B/L retinal hemorrhages" in a baby are pathopneumonic... | Shaken baby syndrome |
| What antibiotic is effective against osteomyelitis with known gram negative + B-lactamse production | Pipercallin-Tazobactam |
| Colchicine binds intaceullular protein _____; inhibits its _______ into _____. Which disrupts ______-dependant fxn such as ______ &_______ | TUBULIN Inhibits POLYMERIZATION into MICROTUBULES. Disrupts MEMBRANE-dependant fxn CHEMOTAXIS & PHAGOCYTOSIS |
| Tubulin is a _______ protein. Which is part of ______ | Structural protein, part of the cytoskeleton |
| Spasm in which head and heels bend backward and body bows forward | Opisthotonus |
| Forced sustained elevation of eyes in upward position | Coulogyric crises |
| Muscle spasms or stiffness, spasmodic torticollis and tongue protrusion or twisting is referred to as what condition? What iatrogenic cause can lead to acute presentation of this condition? | Acute dystonic rxn; Iatrogenic cause can be anitpsychotic medication |
| MOA of acute dystonic rxn? Antidote? | Strong D2 blocker; Antidote: M1 receptor antagoinist diphenhydramine & benzotropine re-establishes dopaminergic-cholinergic balance |
| Acute dystonia run can develop ____hrs to ___days from admin of _____ medication | 4hrs to 4days from admin of antipsychotics |
| + Trendelenburg... | Superior Gluteal nerve damage |
| "Shawl and Face" rash.... | Dermatomyositis |
| "Mechanics Hands".... | Dermatomyositis |
| Osteogenesis Imperfecta is a dz that causes a ______ or _____ in ______ collagen | causes a DEFICIENCY or ABNORMALITY in TYPE I collagen |
| Seronegative spondyloarthropathies (4) express _____ which have specific HLA Class serotype ______ | Ankyl Spondy, Psoriasis, IBD, Reiters; HLA-B27; HLA serotype I |
| MG is autoimmune hypersensitive type ____. | Type II |
| Good Pasture syndrome has hypersensitivity type ____ | Type II |
| What ion will flow OUT of a physiologically nL condition cell when channel open | K+ |
| What ion will flow IN of a physiologically nL condition cell when channel open | Cl-, Ca, Na, |
| PTH _____ serum ca; _____ serum PO, _____ PO urine secretion | PTH inc serum Ca & dec serum PO, Inc urine PO secretion |
| PTH ____ resorption of ____ &_____ | INC resorption of Ca & PO |
| PTH____kidney resorption of Ca in ______ _____ tubule | PTH Inc kidney resorption of Ca in DISTAL CONVOLUTED TUBULE |
| PTH____ kidney resorption of PO in _____ _____ tubule | PTH dec resorption PO in PROXIMAL CONVULUTED tubule |
| PTH _____ 1,25-OH2D3 (Calcitriol) production by stimulating kidney ______ in _____ _____ tubule | PTH Inc calcitriol production by stimulating kidney 1alpha-hydroxylase in PROXIMAL CONVOLUTED tubule |
| How does tetanus vax provide immunity | Circulating Ab that neutralize bacterial products (toxins) |
| Multiple phenotypic manifestations resulting from a single genetic mutation? What type of genetic illnesses exhibit this? | Pleiotropy; Syndromic genetic illnesses |
| B anthracis releases ____toxin, Edeam factor increases ______ by acting on ________,causing edema & _____ _____ | B anthracis releases ANTHRAX EXOTOXIN, inc cAMP by acting on ADENYLATE CYCLASE, causing edema & PHAGOCYTE DYSFUNCTION |
| What is the lethal factor of B anthracis is | Zinc-dependent protease that inhibits MAPK signaling, causing apoptosis & multisystem physiologic disruption |
| In primary osteoperosis, serum Ca, PO and PTH are? | Normal |
| Glcogen degradation is coupled with skeletal muscle contraction d/t _______mediated ________activation | Ca-mediated myophosphorylase |
| "Drumstick fingers" describe what? and are attributed to? | Flattening of nail folds, shininess of nail & distal portion of fingers. Lung dz associated w/ hypoxia **esp large-cell carcinoma; Cyanotic congenital heart dz esp tetralogy; IBD, hyperthyroidism |
| What complications are common in ankyl spondy pts? What condition could also arise and should be monitored on all pt visits | Enthesopathies, inflammation at site of tendon insertion. Costovertebral and costosternal junctions may cause limitation in chest expansion. Should be monitored |
| Mneumoic for collage types? And the types | SCAB; Skin=type I; Connective tissue=type II; Arteries=type III; Basement membrane=type IV |
| What steps of collagen synthesis occur in ER | Proline hydroxylation (Vit C), Lysine hydroxylation (copper), +galactose/glucose to lysine; FORMS triple helix---secreted as PROCOLLAGEN thru golgi to extracellular matrix |
| What Collagen synthesis steps occur in the extracellular matrix | Procollagen peptidase cleaves N & C teminals of procollagen -->Tropocollagen; Tropo+tropo+lysine-hydroxylysine cross links = Collagen fibril |
| What is hand-and-foot syndrome? What dz is it related to? | Small infarctions w/i marrow, trabeculae, inner cortical layer hands/wrists/feet/ankles causing swelling, tenderness, and warmth. Common in early childhood of sickle cell pts bc they still have hematopeoitic bone marrow |
| Hand-and-foot AKA | Dactylitis |
| What lab abnormality would you expect to see in an acute hand-and-foot flare (3) | Dec haptoglobin, Inc in serum indirect bili & lactate dehydrogenase |
| The suffix "donate" indicates what type of medication? It is a structural analogue to? | Bisphosphonates; which are structural analogues to pyrophosphate |
| In healthy ppl what is the greatest contributing factor to bone density? | Genetics |
| Fas initiates ____ pathway of apoptosis. Fas mutations are present in what type of dz | Extrinsic pathway; autoimmune dz like SLE |
| What is the classic biochemical defect in Marphans? Where is it found | Fibrillin-1 gene; Zonular fibers of lens,periosteum and aortic media |
| PRPP gene.... | Gout |
| 95% cases of gas gangrene are caused by what bacteria | Clostridium Perfringens |
| When a muscle exerts too much force ______ inhibit contraction of the muscle causing _____ | Golgi-tendon organ; sudden muscle relaxation |
| In adults ____ can cause arthritis of the PIP, MCP, knee & ankle joints. What does this infection cause in children? | Parvovirus; Causes 5th dz AKA erythema infectiosum characterized by nonspecific prodrome and bright red rash of cheeks 5-7days later |
| Presence of lactic acidosis and ragged red skeletal muscle fibers suggests? | Mitochondrial myopathy |
| During wound healing, Excessive _____ activity and ______ accumulation in the wound margins can result in _____ | Matrix Metalloproteinase MPP; myofibroblast accumulation; contracture |
| Sunlight catalyses the _____rxn in activating ______ synthesis of _____. ______ transforms to Vit D3 AKA_______ | 1st rxn, Vit D. 7-dehydrocholesterol transforms to Chlecalciferol |
| 25-hydroxylation occurs ___&___. ______ catalyzes the final step to Vit D | Liver & Kidney; 1-alpha hydroxylase catalyzes |
| Involuntary muscle contractions which force certain parts of the body into abnl, sometimes painful, movements or postures. What is the cause of this | Dystonia; often idiopathic, but is the result of impaired basal ganglia |
| MC focal dystonia | Spasmodic torticollis |
| 2nd MC focal dystonia | Blepharospasm |
| Involuntary, forcible closure of eyelids. How does it start? | Blepharospasm; starts with uncontrollable blinking. |
| Writers cramp is a form of? | Focal dystonia |
| Hematogenous Osteomyelitis is MC in what population? And location? | Children; metaphysis of long bones |
| KOH skin scraping reveals "spaghetti & meatballs". What is the infectious agent | Pityriasis vesicolor; Malassezia Furfur |
| Excitatory pathway of BG: _____ inputs stimulate ____, which is stimulated to release _____, which _____ the thalamus via ________ which (INC/DEC?) motion | CORTICAL inputs stimulate the STRIATUM, which stimulates the release of GABA, which DISINHIBITS the thalamus via the GPi/SNr, INC motion |
| Ingibitory pathway of BG: ____ inputs stimulate the _____, which _____ STN via ____ & ___stimulates _____ to inhibit the thalamus, causing a (INC/DEC?) motion | CORTICAL input stimulates the STRIATUM, which DISINHIBITS STN via GPe, STN stimulates GPi/SNr to inhibit the thalamus, DEC motion |
| Which receptor is stimulatory in the BG? | D1-Receptor = DIRect pathway |
| Which receptor is inhibitory in the BG? | D2, the INdirect pathway is INhibitory |
| Dopamine bind to D1, stimulating the _____ pathway, leading to_____ | Excitatory, Increased movement |
| Dopamine bind to D2, ______ the _____ pathway, leading to _____ | Inhibiting the Inhibitory pathway, leading to Increased movement |
| Slow, writhing "snake-like" movements; especially seen in fingers... | Athetosis |
| Athetosis is common in what dz? Where is the lesion | Huntington; BG |
| Sudden, jerky, purposeless movements... | Chorea |
| Chorea is common in what dz? where is the lesion | Huntington, BG |
| Tx of essential tremor (2) | Beta-blockers; primidone |
| Sudden, wild flailing of 1 arm +/- ipsilateral leg... | Hemiballismus |
| Hemiballismus is common in what condition? Where is the lesion | Lacunar strokes; Contralateral subthalamic nucleus |
| Slow, zigzag motion when pointing/extending toward a target.... | Intention tremor |
| Intention tremors are common in dysfunction of what part of the brain | Cerebellar dysfunction |
| Sudden, brief, uncontrolled muscle contraction... | Myoclonus |
| Jerks, hiccups, are common in ______ abnormalities such as ____ & ____ failure | Common in METABOLIC ABNORMALITIES, such as LIVER & RENAL failure |
| High-frequency tremor w/ sustained posture (outstretched arm), worsened w/ movement or when anxious | Essential tremor |
| Uncontrolled movement of distal appendages, alleviated by intentional movement.... Where is it most noticeable | Resting tremor; most noticeable in hands |
| "Pill Rolling" ..... | Parkinson |
| Parkinson mneumonic?.... | TRAPS: Tremor (pill-like), Rigidity (cogwheel), Akinesia (bradykinesia), Postural instability, Shuffling gait |
| alpha-synculein-intracellular eosinophilic inclusions, refer to what? | Lewy bodies |
| Depigmentation of substantial nigra pars compacta..... | Parkinsons |
| Autosomal dominant trinucleotide repeat disorder on chromosome 4.... ____ repeats which are categorized as _____ | Huntington dz; CAG repeats categorized as anticipation |
| 4 common characteristics of Huntington | Choreiform movements, aggression, depression, dementia |
| Huntington: ____ DA, ____GABA, ____ ACh | Inc DA, Dec GABA, Dec ACh |
| Huntington: Neuronal dealth via _____ binding & ____ toxicity | via NMDA-R binding & GLUTAMATE toxicity |
| Atrophy of caudate nuclei with ex vacuo dilation of frontal horns seen on MRI.... | Huntingtons, CAG: Caudate loses ACh & GABA |
Created by:
Rickib82