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Rheuma/Ortho/Sports
UWORLD + FA Rheumatology, Ortho and Sports Review
| Question | Answer |
|---|---|
| Myasthenia Gravis (MG) is associated with which thymic abnormalities? | 1. Thymoma 2. Thymic hyperplasia |
| The 3rd pharyngeal arch gives rise to the: | Thymus and the INFERIOR PTH (parathyroid) glands |
| What muscles are the most affected by Myasthenia Gravis? | ExtraOCULAR muscles |
| Muscular weakness, especially the extraocular muscles, causing ptosis and diplopia. Patient complains of weakening with activity and exercise. MC Dx? | Myasthenia Gravis (MG) |
| The superior PHT glands are derived from the ________ pouch. | 4th brachial |
| The ______________ and ________________ are derived from the _____ branchial pouch, and the ____________________ are derived form the _______ branchial pouch. | Thymus and Inferior PTH glands --> 3rd; Superior PTH glands ----> 4th |
| What structure is derived from the 1st Pharyngeal Pouch? | Primary Tympanic membrane and Auditory tube |
| The palatine tonsils are derived from the ________________ pouch. | Second Pharyngeal |
| The aortic arches develop into the ____________________ | Arterial system |
| Dorsal wings of the 4th branchial pouch give rise to the ________. | Superior PTH glands |
| Dorsal wings of the 3th branchial pouch give rise to the __________. | Inferior PTH glands |
| What is the main composition of a sarcomere? | Confined between to "Z" lines, it is composed of: --- Thick, MYOSIN bounded by M-line ---Thin, Actin bounded by Z-line |
| Overlap zone in sarcomere between Myosin and Actin filaments | A-band |
| What line runs through the middle of the Myosin, where there is no overlap of Actin? | M-line |
| Zone of thin filaments not superimposed or overlapped by thick filaments? | I band |
| I-band contains only ______________ or ______________ filaments. | Actin or Thin |
| I-band is for actin, as the ____-band is for myosin. | H-band |
| The H-band: | Area of ONLY Thick (myosin), not overlapped with Actin. |
| During contraction which bands in the sarcomere shorten? | The I-bands and the H-zone |
| The _____-band does not change in length during ____________. | A-band; Contraction |
| What muscles are used for sitting up? | 1. External abdominal muscles 2. Rectus abdominis 3. Hip flexors |
| Which muscles make up the hip flexors? | Psoas major, Psoas minor, and iliacus |
| Which muscles are involved in hip ABDUCTION? | Gluteus medius and minimus |
| The EXTENSION of the hip is performed by the following muscles: | 1. Gluteus maximus 2. Semitendinosus 3. Semimembranosus 4. Biceps femoris head |
| Iliopsoas, rectus femoris, and tensor fascia lata | Hip flexors |
| The ADDUCTION of the hip is performed by the: | Adductor brevis, longus, and magnus |
| 1st MCP joint or knee pain and swelling, erythema and exquisite tenderness, are seen in: | Acute Gouty arthritis |
| Needle-shaped, negative birefringent crystals | Gout |
| Gout | Big toe pain and swelling; Needle-shaped crystals and negative birefringent |
| Monosodium crystals, negative birefringent | Gout |
| What is the first line of treatment of Gout? | NSAIDS |
| What is the second line of treatment of Gout? | Colchicine |
| Colchicine | 2nd line of treatment for Gout |
| Colchicine MoA: | Binds and stabilizes tubulin to inhibit microtubule polymerization, impaired neutrophil chemotaxis and degranulation. |
| Which are the ACUTE Gout drugs? | NSAIDs, Glucocorticoids, and Colchicine |
| Chronic treatment drugs for Gout: | Probenecid, Allopurinol, Pegloticase, and Febuxostat |
| Inhibits the reabsorption of uric acid in the PCT | Probenecid mechanism of action |
| Which Gout treatment drugs can also inhibit secretion of penicillin, and the precipitation of uric calculi? | Probenecid |
| Febuxostat MoA: | Inhibit xanthine oxidase (XO) |
| Recombinant uricase catalyzing uric acid to allantoin (a more water-soluble product). | Pegloticase mechanism of action |
| ____________ is a competitive inhibitor of Xanthine oxidase (XO) leading to a decreased conversion of ____________ and __________ into ____________________. | Allopurinol; Hypoxanthine and Xanthine; Urate |
| Besides chronic treatment of Gout, Allopurinol, is used which other cases? | 1. Prevent Tumor Lysis syndrome in cases of Leukemia and Lymphoma chemotherapy. 2. Incrase concentrations of azathioprine and 6-MP |
| ____________ is characterized with swelling, pain, and MORNING STIFFNESS, for over ____________. New treatment is based on ______________, which include:_______________________. | Rheumatoid arthritis; 6 weeks; DMARCs (Disease-modifying anti-rheumatic drugs); MTX, sulfadiazine, Hydroxychloroquine, minocycline, and TNF-a inhibitors. |
| What particularity do DMARCs treatment exhibits which requires NSAIDs initially? | DMARCs take a long time to take effect, thus, NSAIDs treat acute pain. |
| What are the joints involved in Rheumatoid arthritis? | MCP, PIP, and wrist |
| Autoimmune-inflammation induces formation of pannus, which erodes articular cartilage and bone. | Rheumatoid arthritis |
| What is Pannus? | Proliferation granulation tissue |
| Morning stiffness lasting more than 1 hour, that is relieved with use | Rheumatoid arthritis |
| What are some of the extra articular manifestations seen in Rheumatoid arthritis? | 1. Rheumatoid nodules (fibrinoid necrosis with palisading histiocytes) in subcutaneous tissue 2. LUNG --> +pneumoconiosis --> Caplan syndrome 3. Interstitial lung disease 4. Pericarditis, pleuritis, anemia of chronic disease 5. Felty syndrome (neutropenia + splenomegaly) |
| Rheumatoid arthritis bone deformities: | Cervical subluxation, ulnar finger deviation, Swan neck, and Boutonniere |
| Heberden nodes and Bouchard nodes are deformities seen in __________________. | Osteoarthritis |
| What is the treatment drugs used in Osteoarthritis? | Acetaminophen, NSAIDs, and intra-articular glucocorticoids |
| Pain in weight-bearing joints, worst at the end of the day | Osteoarthritis |
| Mechanical-- wear and tear of articular cartilage (degenerative joint disorder) | Osteoarthritis |
| Non-inflammatory synovial fluid | Osteoarthritis |
| OsteoBLAST activity is directly measured by _________, which is ____________-specific. | ALP; bone |
| ALP is produced by ______________ and ________________. | Liver and bone |
| What other enzyme is measured to distinguish if ALP is of bone or liver origin? | GGTP |
| What urinary levels are measured to determine Osteoclast activity? | Urinary DEOXYPYRIDINOLINE |
| Invaginatios of the sarcolema that transmits depolarizion signal sto the sarcoplasmic reticulum to trigger the release of Ca2+ and induce muscle contraction. | Transverse (T-) tubules |
| The T-tubules are involved in __________________ by releasing _____ ions, due to the _____________________ of the sarcomere. | Muscle contraction; Calcium; depolarization |
| Synchronized contraction of sarcomere is due to: | Uniform distribution of T-tubules, which ensures that each myofibril contracts at the same time, leading, to efficient contraction. |
| Seronegative Spondyloarthropathies include: | 1. Ankylosing Spondylitis 2. Reactive arthritis 3. Psoriatic arthritis 4. IBD -associated arthritis |
| HLA B27 (+) are: | Seronegative Spondyloarthropathies |
| HLA B27 (+), chronic inflammatory disorder affecting the sacroiliac joints and axial skeleton, morning stiffness and joint pain in lower back, and decreased ROM of sacroiliac joint. Dx? | Ankylosing arthritis |
| Bamboo spine is associated with: | Ankylosing arthritis |
| What lung disease profile is developed in Ankylosing spondylitis? | Restrictive Lung disease, due to limited wall expansion (costovertebral and costosternal ankylosis) |
| Conjunctivitis, arthritis and Urethritis. | Triad seen in Reactive arthritis |
| What are the organism associated in the development of Reactive Arthritis? | Shigella, Yersinia, Chlamydia, Campylobacter, and Salmonella |
| HLA-2 disorders include: | Rheumatoid arthritis, DM 1, and Celiac disease |
| HLA-2 disorders affect ____________________ and ________________ cells, which present antigens to ___________ T-cells. | Macrophages and Dendritic cells; CD4+ |
| Which branch of the brachial artery runs along posterior part of the humerus? | Deep brachial artery |
| The Deep Brachial artery rides along the ______________ nerve, and it is injured, commonly, with a _____________________ of the ________. | Radial Nerve; MIDSHAFT fracture of the Humerus |
| Radial Nerve injury results in: | Wrist drop |
| Wrist drop is due to injury to the ________________ nerve. | Radial |
| What arterial structure is commonly damaged, in patient with wrist drop? | Deep Brachial artery, as it runs along the radial nerve, and commonly injured in midshaft humeral fractures. |
| Damage to the Median nerve is associated with which hand deformity? | Ape's hand |
| Entrapment of Median nerve in the Carpal tunnel? | Carpal Tunnel Syndrome |
| Proximal lesion of Median Nerve? | Ape Hand and Pope's Blessing |
| Loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of 2nd and 3rd digits | Proximal lesion of the Median nerve |
| Supracondylar fracture of the humerus is common to cause: | Proximal lesion of the Median nerve |
| Carpal Tunnel syndrome and wrist laceration cause: | Distal lesion of the Median nerve |
| Loss of thenar eminence and dorsal and palmar sensation of the 31/2 lateral fingers | Proximal lesion of the Median nerve |
| Ulnar nerve damage ------> | Claw hand |
| Median nerve damage ----> | Ape's hand |
| Radial nerve damage ----> | Wrist drop |
| Inability to oppose thumb is seen in | Median nerve damage causing Ape's hand |
| Claw hand | Ulnar nerve damage; inability to extend fingers at interphalangeal joints, resulting in permanent flexion = "Claw" |
| Inability to extend hand + inability to fully extend forearm is most likely caused by ______________ nerve damage, known as "______________" | Radial; Wrist drop |
| The radial and median nerves come from which nerve roots? | C5-T1 |
| The ulnar nerve arises from roots __________________, and if damaged is commonly to cause __________ hand. | C8-T1; Claw |
| What are the common ways to injure or damage the ulnar nerve: | 1. Proximal lesion: Fracture of MEDIAL epicondyle of humerus 2. Distal lesion: Fracture of the Hook of Hamate from fall with an OUTSTRETCHED hand |
| "Funny bone" fracture is likely to injure the ________________ nerve. | Proximal ulnar |
| Fall with outstretched hand may cause: | Distal Ulnar nerve injury, due to fracture of Hook of Hamate |
| Radial deviation of wrist upon flexion is seen in: | Proximal ulnar nerve damage. |
| What are 3 common ways to injure the Radial nerve: | 1. Compression of axilla (Such as use of crutches) 2. Midshaft fracture of Humerus 3. Repetitive pronation/supination of forearm |
| "Saturday' Night palsy" refers to: | Compression of axilla for a prolonged time, leading to radial nerve damage, presented with wrist drop. |
| A carpenter/plummer has been actively working for 40 years, complains of inability to extend is index finger. Common cause of deficit? | Repetitive pronation and supination of forearm due to extensive use of screwdriver, lead to damage to the radial nerve, leading oth finger drop. |
| Loss of sensation in posterior arm and forearm, as well in dorsar of hand. | Radial nerve damage |
| Common causes of injury of the axillary nerve? | 1. Fracture of the neck of the humerus 2. Anterior dislocation of humerus |
| Deficiency of Homogentisic acid dioxygenase | Alkaptonuria |
| Alkaptonuria is due to deficiency in ____________________. This enzyme is involved in __________________ metabolism. | Homogentisic acid dioxygenase; Tyrosine |
| What is the result of the excess homogentisic acid accumulated in Alkaptonuria? | Diffuse blue-black deposits in connective tissue. |
| What is common characteristics seen in the clinical presentation of Alkaptonuria? | Adults present with sclera and ear cartilage HYPERPIGMENTATION + osteoarthropathy of the spine and large joints. |
| Which receptors initiate the Extrinsic pathway of apoptosis? | Ras |
| Fas-receptor or Fas-Ligand mutations lead to development of? | Prevention of cell apoptosis, leading to increased risk of autoimmune disease development such as SLE. |
| Stomatitis is a common side effect of? | MTX |
| Common fist line of treatment drug for RA? | MTX |
| Oral/buccal ulcers, bone marrow suppression, and abnormal liver function enzymes. | MTX adverse effects |
| MTX is commonly associated to cause _______________ anemia, _______________, and ____________________. | Megaloblastic; Pulmonary fibrosis, and mucositis (oral ulcers) |
| Folic acid analogue that competitively inhibits dihydrofolate reductase | MTX |
| Bone marrow suppression seen with Methotrexate can be avoided by using ___________________. | Leucovorin |
| Teratogenic effects of MTX | Neural Tube defects |
| What are the most common cancers treated with MTX? | Leukemias (ALL), lymphomas, choriocarcinomas, and sarcomas |
| MTX is _____-phase specific in the cell cycle. | S-phase |
| Which TNF-a inhibitor is commonly added to MTX in cases of severe RA? | Etanercept |
| Etanercept is a ____________ protein, which "links" TNF-a and _____ component of _________. It works a _______________. | Fusion; Fc portion of the IgG1; Decoy-receptor |
| -----mab | monoclonal antibody |
| -----cept | receptor molecule |
| -----nib | kinase inhibitor |
| RA affects the ___________________ spine, which lead to _____________ and _____________________. | CERVICAL spine; Subluxation; Cord compression |
| What is the most specific labs seen in RA? | RA factor and anti-CCP antibodies |
| What inflammatory markers are elevated in correlation with RA severity? | ESR and C-reactive protein |
| Ulnar deviation of the DIGITS is a key characteristic of __________. | Rheumatoid arthritis |
| What kind of bone is first affected by Osteoporosis? | Trabecular bone |
| Overtime, osteoporosis affects the ____________ bone as well, which the one that composes the ___________ skeleton. | Cortical; Appendicular |
| The degeneration of trabecular bone in osteoporosis, involves the ____________________, leading to ________________________________. | Dorsolumbar vertebral bodies; Vertebral Compression fracture |
| What kind is fracture is commonly seen in patients with osteoporosis? | Vertebral Compression fracture |
| McCune-Albright syndrome is seen with: | 1. Fibrous disease of the bone 2. Endocrine abnormalities 3. Cafe-au-lait spots |
| McCune-Albright syndrome is due to a mutation of the _________________________________ signaling pathway. | G-protein/cAMP/adenylyl cyclase |
| WHat are the endocrinological abnormalities seen in MAS (McCune-Albright syndrome)? | Thyrotoxicosis, Acromegaly, and Cushing syndrome |
| Mutation of the GNAS gene | McCune - Albright syndrome |
| What is fibrous dysplasia of the bone? | The normal bone and marrow is replaced by fibrous tissue, resulting in bone that is weak and prone to expansion. |
| What is the most commonly fractured bone? | Clavicle |
| A clavicle fracture causes opposing displacements. | Medial fragment has a superior displacement caused by the "pull" of the sternocleidomastoid muscle. The lateral fragment of clavicle has a inferior displacement due to the downward "pull" of the Pectoralis major and weight of arm |
| What muscle causes the superior clavicle displacement in a a clavicle fracture? | Sternocleidomastoid |
| Besides the weight of the arm, the ______________, cases the inferior displacement of the lateral part of a fractured clavicle. | Pectoralis major |
| What are the two factors/substances that aid osteoCLAST differentiation? | Macrophage colony-stimulating factor (M-CSF) and RANK-L |
| What condition or disease is characterized by elevated numbers of osteoclasts? | Paget's Disease of the Bone |
| Increased number of Osteoclasts, excessive bone turnover, and disorganized bone remodeling. is seen in? | Paget's Disease of the Bone |
| Paget's Disease of the Bone --> | Too much bone destruction due to too many osteoclast and disorganized bone remodeling |
| Mutations to RANK-L would lead to ____________________. | Poor Osteoclast differentiation |
| Exaggerated inhibition of CHONDROCYTE inhibitor in growth plates of long bones. | Achondroplasia |
| Patient presents with: Proximal limb shortening, midface hypoplasia, and macrocephaly. Dx? | Achondroplasia |
| Which bones and cells are affected in Achondroplasia? | Chondrocytes of the long bones |
| Failure of longitudinal bone growth | Achondroplasia |
| Another term used for longitudinal bone growth | Endochondral ossification |
| Endochondral ossification is affected results in -----> | Short limbs |
| Membranous ossification defective results in -------> | Macrocephaly relative to limbs |
| What is the MCC of dwarfism? | Achondroplasia |
| Achondroplasia is associated with _______________________ and mutation of the ________________ gene. | Increased paternal age; FGFR3 gene mutation |
| What are the medications associated with Drug-induced SLE? | Procainamide, Hydralazine, Isoniazid, MInocycline, and TNF-alpha inhibitors. |
| What are the antibodies present in Drug-induced SLE? | 1. anti-Histone antibodies (common) 2. anti-dsDNA antibodies (rare) |
| Clinical features of drug-induced SLE: | Fever, fatigue, ARTHRALGIAS, arthritis, rash and SEROSITIS. |
| Drug-induced SLE has a predilection to ________________________. | Slow acetylators |
| Common TNF-alpha inhibitors: | Etanercept, Infliximab, and adalimumab |
| What kind of preventive test must be done with TNF-a inhibitors? Why? | Tuberculin Skin test, as these are important for sequestration of mycobacteria within a granuloma. |
| What kind of drugs are contraindicated in people with Hx of TB infection? These also by cause the development of what condition? | TNF-alpha inhibitors may reactivate latent TB and may develop drug-induced SLE. |
| Defective synthesis of Type 1 collagen by Osteoclasts | Osteogenesis Imperfecta (OI) |
| Child present with pathological fractures, blue sclera, hearing loss and malformed teeth. MC Dx? | Osteogenesis Imperfecta (OI) |
| What substance is predominant in Type 1 collagen, which gives it its laxity and flexibility? | Osteoid |
| During skeletal muscle contraction , Calcium (Ca2+) binds to ____________________ . | Troponin |
| Multinucleated synticium | Skeletal muscle |
| Functional syncytium | Cardiac muscle |
| Striated muscle is found in: | Skeletal and Cardiac muscle |
| Cells are short, fat, branched, with one nucleus located at the center of the cell; intercalated discs present | Cardiac muscle |
| Cells are independent (structurally and functionally) which are long, cylindrical, and multinucleated; nuclei located in periphery of the sarcolemma | Skeletal muscle |
| Muscle Excitation-Contraction in Skeletal muscle is defined as ____________, | Mechanical coupling |
| Muscle Excitation-Contraction in Cardiac muscle is defined as: | Calcium-Induced, Calcium -release |
| Intercalated discs with adhesions and gap junctions, describes the: | Cardiac muscle cell structural features |
| What is the difference in cardiac, skeletal and smooth muscle Calcium regulation? | Cardiac and skeletal muscle Ca2+ regulation is done by Tropomyosin on thin filaments Smooth muscle Ca2+ regulation is done by Calmodulin on Myosin heads |
| Calmodulin on myosin heads is the _______________________ seen in ___________ muscle. | Calcium ion regulation; SMOOTH |
| snRNPs are synthesized by _________________, and are present in _______. | RNA polymerase II; SLE |
| What is the role of SPLICEOSOMES? | Removing introns form pre-mRNA to form mature mRNA. |
| The ___________________ are essential components of _____________. | snRNP; Spliceosomes |
| Spliceosomes are involved in the _____ step of mRNA modification. | 3rd (RNA splicing) |
| What are the 3 mRNA modifications (in order of occurrence)? | 1. RNA capping 2. RNA polyadenylation 3. RNA splicing |
| Addition of methylated guanine to the 5'end of pre-mRNA | RNA capping |
| Addition of several adenine nucleotides in the 3' end of pre-mRNA | RNA polyadenylation |
| Poly-A tail refers to: | RNA polyadenylation |
| The removal of INTRONS (non-coding) by spliceosomes | RNA splicing |
| RNA capping occurs at the ______ end, while, RNA polyadenylation occurs the _____ end of the pre-mRNA. | 5' -end; 3'-end |
| What is the main toxin of Cl. perfringens? | Lecithinase, which degrades Lecithin |
| What is the infection caused by Cl. perfringens called? | Gas gangrene |
| Which toxin and which disease cause the inhibition of the release of ACh at NMJ, resulting in flaccid paralysis? | Botulinum toxin seen in Botulism |
| Flaccid paralysis is seen in | Botulism |
| Allopurinol will increase the conversion of ______________ into ____________ metabolites, as it prevents its degradation by _______. | Azathioprine; Active; Xanthine oxidase (XO) |
| Another name for "Gluteus medius gait" | Trendelenburg gait |
| Hip drops down as the ipsilateral foot is lifted off the ground, and contralateral trunk deviation while standing still | Trendelenburg gait |
| What causes the development of Trendelenburg gait? | 1. Contralateral Superior Gluteal nerve injury or, 2. Gluteus medius injury |
| Injection to which quadrant of the gluteus, should be avoided in order to prevent damage to the Superior Gluteal nerve? | Superior medial quadrant |
| Sensory receptors located at the junction of the muscle and the tendon. | GTO (Golgi Tendon Organs) |
| The GTOs are innervated by: | group of Ib sensory axons |
| What is the main purpose or function of GTOs? | Regulate and maintain muscle TENSION |
| How do GTO protect damage to the musculoskeletal system? | At point of excessive force, the GTOs will inhibit contraction, causing a SUDDEN muscle relaxation. |
| Reflex contraction is due to: | Stretch of muscle spindles |
| Stretch of GTOs cause: | Reflex relaxation |
| Erythema chronicum migrans is often seen in: | Lyme disease |
| What are some symptoms developed in the second stage of Lyme disease? | 1. 3 degree AVB 2. Facial (CN7) palsy |
| What is the MC treatment for Lyme disease? | Doxycycline and Ceftriaxone |
| The third stage of Lyme disease is characterized by: | Chronic asymmetric large joint arthritis and encephalopathy |
| First symptoms or signs of gout can take up to ______ hours. The first line of treatment are ________________ and ______________, both with are ________________. | 24 hours; Naproxen and Indomethacin; NSAIDs |
| Colchicine mode of action | Inhibition of Tubulin polymerization and microtubule formation, which lead to reduced neutrophil chemotaxis |
| Monosodium crystals | Gout |
| Why do some anticonvulsant drugs are prone to increase risk of osteoporotic fractures? | Increase Vitamin D catabolism (Phenobarbital, Phenytoin, and Carbamazepine) |
| Why do Aromatase inhibitors dn GnRH agonist increased cases of osteoporotic fractures? | Decrease estrogen |
| Decreased Ca2+ absorption that lead to increased osteoporotic fracture, is seen in ______ use. | PPI |
| Positive for ANA and anti-Jo-1 antibodies | Dermatomyositis and Polymyositis |
| What are the cutaneous manifestation in dermatomyositis, not present in Polymyositis? | Gottron papules and Heliotrope rash |
| What is a Heliotrope rash? What condition is it commonly associated with? | Distinctive rash around the eyelids; Dermatomyositis |
| Polymyositis and Dermatomyositis, both present: | 1. difficulty climbing staining, standing up form chair, and carrying heavy objects 2. Both have abnormally elevated CK and ALDOLASE. |
| What would a biopsy of damaged tissue in Polymyositis would show? | ENDOMYSIAL mononuclear infiltrate, with Patchy necrosis, highly associated with interstitial lung disease and myocarditis. |
| Lateral epicondylitis is also known as "___________________________" | Tennis elbow |
| Overuse of the Extensor carpi brevis, is the underlying pathogenesis of ______________________________. | Tennis elbow |
| Golfer's elbow, involves the _________ of their attachment to thee ______________________. | Wrist Flexors; MEDIAL EPICONDYLE |
| Chronic damage to Medial epicondyle causes __________ elbow, and chronic injury of the _______________ epicondyle causes the _______ elbow. | Medial --- Golfer's elbow Lateral --- Tennis elbow |
| What are the main joints affected in Osteoarthritis? | Knee, DIP joint, and 1st CMC joint |
| A marathon runner would have higher density of Type _____ _______ ________________. | Type 1 Red Fibers |
| Type 1 Red fibers are mostly ______________________. | Aerobic |
| "slow twitch" fibers are: | Type 1 Red Fibers |
| Type 1 Red fibers are: | 1. High in MYOGLOBIN (Oxygen storage) 2. high in MITOCHONDRIA (Aerobic respiration) |
| Description of actions of Type 1 Red fibers" | 1. Slow twitch 2. Performs actions of low level SUSTAINED FORCE (Posture) 3. Commonly seen in Paraspinal muscles |
| Which fibers generate rapid and forceful pulses of movement? | Type 2 Fibers (white) |
| What are type 2A fibers? | "Fast-twitch"; intermediate fibers between type 1 and type 2 |
| ___________________ derive ______ energy from _______________ glycogenolysis and subsequent glycolysis. | Type 2B fibers; ATP; ANAEROBIC |
| A 100m -sprinter, has a higher density of ______________ fibers. | Type 2 FIbers (white) |
| A _____________________, is characterized by excessive metalloproteinase (MMP) activity and by excessive myofibroblast accumulation. Occurs mostly at wound margins in times of healing. | Contracture. |
| What cells commonly are able to secrete MMP? | Fibroblasts, macrophages, neutrophils and synovial cells |
| What is the main function of MMP? | Degradation of collagen and other proteins |
| Disruption of previous closed wound in cases of extreme additional pressure. | Wound dehiscence |
| What is a result of inadequate vascularization to a injured area at time of wound healing? | Ulceration |
| What are Keloids? | Hypertrophic scars in which excessive collagenous scar tissue is deposited by fibroblasts permanently extend beyond margins of the original wound. |
| What is a severe adverse effect of Bisphosphonates? | Erosive (hemorrhagic) esophagitis |
| Attach to hydroxyapatite binding sites on bone surfaces | Bisphosphonate MoA |
| What is a osteoporotic drug that binds to RANK-L? | Denosumab |
| Denosumab: | Attaches to RANK-L leading to the inhibition of osteoclast survival and differentiation. |
| What is digit clubbing? | Thickening of distal phalanges associated with conditions that ultimately cause HYPOXIA |
| Finger with "drumstick" appearance, flattening of finger nails | Digit clubbing |
| Common lung condition producing digit clubbing? | Large cell carcinoma, TB, cystic fibrosis, bronchiectasis, pulmonary hypertension, and emphysema. |
| Clubbing of the fingers is seen in ____________________________, which are hearth pathologies. | Cyanotic congenital disease and bacterial endocarditis |
| Autoimmune disorder characterized by inflammatory myopathy and cutaneous involvement. | Dermatomyositis |
| What are the Groton papules? | Red, flat-topped papules over joints and bony prominences, especially in the hands and a Heliotrope rash |
| Muscle enzymes elevated in dermatomyositis: | CK and aldolase |
| Dermatomyositis and Polymyositis are both (+) for: | Anti-Jo-1 antibodies |
| What is the MC dislocated JOINT in the whole body? | Glenohumeral joint |
| The glenohumeral joint dislocates most commonly _______________, | Anterior |
| Typical scenario of a person with an anterior glumerohumeal joint dislocation. | Quarterback tackled while throwing the ball |
| Young athlete presents focal shoulder pain. Patient got injured while having arm externally rotates and abducts. Dx is dislocation of which joint? | Glenohumeral joint |
| High school student presents with a flattened deltoid, protrusion of the acromion, adn anterior axillary fullness. Patient indicates that injury occured in football tryouts. MC Dx? | Anterior Glenohumeral joint dislocation |
| In case of injury to the axillary nerve, what areas loss sensation? | Lateral shoulder |
| ________________ dislocation often causes loss of sensation over the _________________ due to ________________ nerve injury. | Glenohumeral joint; Lateral shoulder; Axillary |
| What kind of injury would cause an upward displacement of the clavicle without bone fracture and no nerve damage? | Anteroclavicular subluxation due to downward blow on the tip of the shoulder. |
| What knee ligament RESISTS the force that pushes the knee MEDIALLY? | Medial Collateral Ligament (MCL) |
| What is valgus stress? | Twist inward or blow to lateral knee causing an MCL injury. |
| Test performed with the knee extended, and placing one hand along the lateral thigh and pressing inward, while the other hand is pace on the MEDIAL aspect of the ankle pushing outward. | Valgus Stress Test |
| Abnormal laxity of the knee or medial joint widening and/or a (+) valgus stress test indicate --> | MCL Injury |
| Abnormal passive abduction of knee | MCL Injury |
| Abnormal passive ADDUCTION of knee | LCL injury |
| What common sign or test is used to indicate ACL injury? | Positive anterior drawer sign |
| (+) Anterior Drawer sign | ACL injury |
| Excessive anterior "sliding" of the knee, most likely indicates | ACL injury and Positive anterior drawer sign |
| Besides the Anterior Drawer test, which other test is used to diagnose an ACL injury? | Lachman Test |
| PCL injury has a positive ______________________ sign. | Posterior Drawer |
| McMurray Test is used to determine _________________ tear or injury. | Meniscal |
| What test would be used in a patient suspected of a meniscal tear? | McMurray test |
| Patient is asked to extend and flex the knee while the physician rotates the tibia/foot. | McMurray test |
| "Popping" or pain upon internal rotation during McMurray test, would indicate? | Lateral meniscal tear/injury |
| Pain elicited upon external rotation of the knee while been performed the McMurray test indicates most likely? | Medial meniscal tear/injury |
| LAMP | Mnemonic used to remember ACL and knee condyle association |
| LAMP (mnemonic) stands for: | Lateral femur condyle to Anterior Tibia: ACL Medial femoral condyle to Posterior TIbia : PCL |
| The "m" -like image of knee and ligaments, its the _____________ view. | Anterior |
| Excess androgens can cause: | Follicular epidermal hyperproliferation and excessive sebum production, thus promoting acne. |
| What kind of profession should always raise a flag for potential anabolic steroid use? | Aspiring athletes |
| MC injured ligament in a "sprain"? | Anterior TaloFibular ligament |
| Inversion of foot will cause damage to the _______________ ligament. | Anterior TaloFibular ligament |
| What is the ligament most commonly injured in eversion? | TibioFibular ligament |
| Eversion causes _____________________ ligament damage, and Inversion cases _______________________ ligament damage. | TibioFibular; Anterior TaloFibular |
| Inversion of foot ____________________________ damage. | Anterior TaloFibular ligament |
| Osteolytic, Mixed, and Osteoclastic Phase. Describes which pathology? | Paget Disease of the Bone |
| Bone pain + Elevated ALP + Bx with mosaic pattern of the bone. Dx? | Paget Disease of the Bone |
| What is the cause of the mosaic pattern of bone seen with Paget Disease of the Bone? | Disorganised bone remodeling |
| What is the most basic or underlying cause or pathogenesis for Paget Disease of the bone? | Too much or excessive Osteoclast activity |
| In Paget Disease of the Bone, the which phase is characterized as osteoCLAST dominant? | Osteolytic Phase |
| The osteosclerotic phase in Paget Disease of the bone, is _____________________ dominant, and it produces __________, _____________ woven bone. | Osteoblast: weak, thickened woven bone. |
| Another name for Paget Disease of the bone? | Osteitis deformans |
| Disorder characterized by increased osteoclastic activity, followed by increased osteoblastic activity | Paget Disease of the Bone |
| Normal levels of serum Calcium, Phosphorus and PTH are seen in? | Paget Disease of the Bone |
| Why is hearing loss common in Paget Disease of the bone? | Auditory foramen narrowing |
| What is the treatment for Osteitis deformans (Paget Disease of the bone)? | Bisphosphonates |
| What kind of fractures are often seen with Paget Disease of the bone? | Chalk-stick fractures |
| What is the MC organism causing Necrotizing fasciitis? | Strep Pyogenes |
| Pain out of proportion, is classic pain description seen in | Necrotizing fasciitis |
| What disease is due to repetitive quadriceps contractions? | Osgood-Schlatter disease |
| Focal pain and swelling in the Tibial tuberosity, is the pathological clinical presentation of? | Osgood-Schlatter disease |
| What is the most common injured or affected tendon in Osgood-Schlatter disease? | Patellar tendon |
| Osteomyelitis in children most commonly affects the ______________ of _________ bones, due to a ______________________ and capillaries fenestrated. | METAPHYSIS; of long bones; slower blood flow |
| Why is the metaphysis of long bones most affected by osteomyelitis in children? | Slower blood flow to such areas. |
| Humeral fractures most commonly are ___________________ displaced. | Anterior |
| A medial or lateral humeral displacement due to fracture causes? | Medial -- injury to brachial artery and median nerve Lateral -- injury to the radial nerve --> wrist drop |
| Cervical spine involvement and subluxation and cord compression are seen in: | Rheumatoid arthritis |
| Antibody (IgM) specific for Fc component of IgG | Rheumatoid factor (RF) |
| Dystrophin molecules is affected by which AR disease? | Duchenne Muscular Dystrophy |
| What is the role of the protein dystrophin? | Provides stabilizing interaction between the sarcolemma and intracellular contraction apparatus |
| Disruption of dysptropyin in Duchene's causes ______________ | Myonecrosis |
| Fall on outstretched hand causes ___________________ fracture. | Scaphoid |
| Upon wrist and hand examination, there is (+) snuffbox tenderness and recent hx of fall onto outstretched hand? | Scaphoid fracture |
| An _______________ fracture is vulnerable for eventual _________________________. | Scaphoid; Avascular necrosis |
| What are the 3 most common injuries of falling onto an Outstretched hand? | 1. Scaphoid fracture 2. Lunate dislocation 3. Distal Radius fracture |
| Hamate, Capitate, Triquetral, Pisiform, Lunate, Trapezoid, Trapezium, and Scaphoid | Carpal bones |
| Which carpal bone condition is often associated with distal ulnar nerve injury? | Fracture of Hook of Hamate |
| What kind of injury is often seen in person with activity that demands sudden decelerations and pivots on extended knee? | ACL injury |
| Compression of LOWER TRUNK of the Brachial plexus causes? | Thoracic Outlet Syndrome |
| What vessels are affected in Thoracic Outlet syndrome? | Subclavian vessels |
| In Thoracic Outlet syndrome, the subclavian vessel are affected by: | Vein --> Upper extremity swelling Artery --> exertional arm pain |
| What are common causes of Thoracic Outlet syndrome? | Cervical rib and Pancoast Tumor |
| Which muscles are affected in Thoracic Outlet syndrome? What other condition affects the same muscles? | The intrinsic hand muscles, are both affected by Thoracic Outlet syndrome and Klumpke palsy. |
| Lesions to the Brachial Plexus: -- Upper Trunk (C5-C6 roots) --> --Lower trunk --> --Lower trunk + Subclavian vessels --> --Long thoracic nerve ---> | A) Erb palsy (Waiter's tip) B) Klumpke palsy C) Thoracic Outlet syndrome D) Winged Scapula |
| Which brachial plexus injury cause a Total Claw Hand? | Klumpke's palsy |
| What nerve roots are affected in Klumpke's palsy? | C8 and T1 |
| What are the MCC of Klumpke's palsy in infants? Adults? | Infants upon upward force on arm during delivery. Adult often due to attempting to grab a tree branch to break a fall. |
| What deficit may be provoked by lateral traction on neck during delivery? | Erb's palsy |
| A winged scapula is often due to______________________________ or _____________ wounds. | Axillary node dissection after mastectomy; Stab |
| C5-C7 nerve roots are affected in_____________________. | Winged Scapula |
| Rhomboid-shaped calcium pyrophosphate crystals | Pseudogout |
| Positive birefringent | Pseudogout |
| Which joint is associated with over 50% of pseudogout cases? | Knee |
| A healthy individual is infected by Parvo B19, more commonly he will develop? | Symmetric Arthropathy |
| Eosinophilic granulomatosis with polyangiitis | Churg-Strauss syndrome |
| Name for P-ANCA | Neutrophil myeloperoxidase |
| What is the MCC of Rotator cuff syndrome? | Supraspinatus Tendinopathy |
| What is the function of the Supraspinatus muscle? | Abduction of arm and stabilization of glenohumeral joint |
| What are the clinical manifestations of patella fracture? | Patella tenderness, inability to extend the knee against gravity, and a palpable gap in the extensor mechanism. |
| What are two common side effects of Colchicine? | Nausea and diarrhea |
| Colchicine interrupts the actions of ___________ which leads to ________________. | LTB4; Leukocyte attraction |
| What are the manifestations of conditions with PROXIMAL muscle weakness? | Weird gait, difficulty climbing stairs, difficulty getting up from a chair. |
| What cranial nerves are involved or affected in LEMS? | Cranial nerve II and Cranial nerve XI |
| COX-2 inhibitors are preferred in _________ patients, and contraindicated in patients with___________________ as it may increase the risk for __________________________ events. | PUD (Peptic Ulcer Disease); Hyperlipidemia; Thrombotic |
| Membrane potential is mainly determined by which electrolyte concentrations? | Sodium, Potassium, and Chloride |
| Under normal conditions of a membrane potential, the levels of electrolytes are inside a cell: | Low concentration of Na+ and Cl- inside the cell High concentration of K+ in cytoplasm |
| What are the levels of electrolytes in the extracellular matrix? | High levels of Na and Cl, and low levels of K+ |
| Why are COX-2 inhibitors better for PUD patients? | Decrease inflammation and decrease arachidonic acid metabolites and no COX-1 effects. |
| 1. Anterior hip dislocation 2. Pelvic surgery | Common causes for Obturator nerve injury |
| What motor and sensory deficits are seen in Obturator nerve? | Thigh adduction and Medial sensory loss of thigh |
| What are the most common causes for Femoral nerve injury? | 1. Pelvic fracture 2. Mass involving the iliopsoas/iliacus muscles |
| Deficit in Flexion of the thigh and extension of leg is seen with damage to the _______________ nerve. | Femoral |
| What nerve is commonly affected by Fracture of the neck of the fibula? | Common Peroneal Nerve |
| What motor functions are affected in Common Peroneal nerve damage? | Foot Extension, Dorsiflexion, and Toe Extension |
| Trauma to the knee may cause _____________ nerve damage, which is clinically manifested with sensory loss of the ________________ face of the foot, and motor deficits for ____________, __________, and __________. | Tibial; Plantar; Foot inversion, plantar flexion, and Toe flexion |
| Toe Extension is done by the ________________ nerve, and toe flexion is performed by the ______________ nerve. | Common Peroneal; Tibial |
| "Foot drop" is due to injury or damage to the ____________________. | Deep branch of the Common Peroneal Nerve |
| Supplies the lower extremity thigh adductor muscles? | Obturator Nerve |
| Synonym for Peroneal | Fibular |
| Which nerve supplies the anterior thigh? | Femoral |
| The Sciatic nerve supplies the __________________ thigh. | Back (posterior) |
| The Tibial nerve supplies the ________________ ________ and ________. | Posterior leg and foot |
| What nerve or nerve branch supplies the lateral side of the leg? | Superficial branch of the Common Peroneal Nerve |
| The anterior leg is innervated by the ______________________ nerve. | Deep branch of the Common Peroneal Nerve |
| Which nerve is often lacerated or cut in a suicide attempt by cutting the wrists? | Median nerve |
| Hypothenar eminence sensory loss is due to ___________ _________ injury. | Ulnar nerve |
| Damage to the ___________ causes thenar eminence sensory loss. | Median nerve |
| What nerve is damaged in a patient that forms the Hand of BENEDICTION? | Median nerve on finger flexion |
| In median nerve damage, the index and middle fingers are ____________, thus, cannot ______, leading to the _______________ deformity. | Affected; Flex: Hand of Benediction |
| What deformity is presented and what nerve is damaged on a failed attempt to finger extension? | Claw Hand due to Ulnar nerve damage |
| The Saphenous nerve is a branch of the ___________________ nerve. | Femoral |
| What ligament covers the Tarsal tunnel? | Flexor Reticulatum |
| Eye redness, unilateral pain, and blurry vision, are common symptoms of _________________. | Uveitis |
| Why does a patient with ankylosing spondylitis develops hypoventilation? | Due to involvement of the thoracic spine and costovertebral and costosternal junctions which limit chest expansion and cause hypoventilation. |
| Fluid-filled synovial sac that serves to alleviate pressure on bony prominences. | Bursa |
| Vasculitis that produced non-blanching , palpable purpura, and commonly affects the lower extremities after new antibiotic treatment? | Leukocytoclastic vasculitis |
| What are common drugs involved in Leukocytoclastic vasculitis? | Penicillins, cephalosporins, sulfonamides, Phenytoin,and Allopurinol. |
| Hypersensitivity vasculitis is also commonly known as? | Leukocytoclastic vasculitis |
| What are some common causes of Gout due to increase urate production? | 1. Myeloproliferative/ lymphoproliferative disorders 2. Tumor lysis syndrome 3. HGPT deficiency |
| Chronic kidney disease and Thiazide/Loop diuretics use cause Gout due to? | Decreased urate clearance |
| Recurrent skin and mucosal infection without purulence, delayed separation of umbilical cord and persistent leukocytosis. Dx? | Leukocyte Adhesion deficiency (LAD) |
| Absence of CD18 antiges necessary for the formation of INTEGRINS. | Leukocyte Adhesion deficiency (LAD) |
| What organism causes recurrent infections in LAD's patients? | Staph aureus and gram (-) rods |
| DIP enlargement is called _______________________, and PIP enlargement are known as ______________, both characteristic bone deformities of _____________________. | Heberden nodes; Bouchard nodes; Osteoarthritis |
| Thick filament | Myosin |
| Thin filament | Actin |
| In Giant cell arteritis, what is the most relevant or important regulatory cytokine? | IL-6 |
| What is the treatment for Giant cell arteritis? | anti-monoclonal antibody against IL-6; Tocilizumab |
| What are two common bisphosphonates? | Alendronate and Risedronate |
| Most significant side effect of bisphosphonates? | Erosive (hemorrhagic) esophagitis |
| What is the MC ligament to be injured in a lateral blow to the knee? | MCL |
| Anti-Jo-1 antibody is directed against _________________________. | Histidyl-tRNA-synthetase |
| Mutations to the Fas receptor and Fas-Ligand produce effects in the : | Extrinsic pathway of Apoptosis |
| The binding of Fas receptor - Fas-L, leads to the activation of ______________________________ leading to _________________. | Caspases 8 and 10; Apoptosis |
| Which caspases are involved in the Extrinsic Pathway of Apoptosis? | Caspases 8 and 10 |
| How are Osteophytes connected to each other? | Gap junctions |
| What is the role of Gap junctions in bone? | Connect osteophytes with each other |
| Bone-specific ALP measures: | Osteoblast activity |
| In what kind of population does a Parvo B19 infection causes the "Fifth Disease"? | Normal healthy child |
| What is the effect of Parvo B19 infection in a patient with Hemolytic anemia? | Transient Aplastic Crisis |
| Child with isolated idiopathic osteonecrosis of the hip. Dx? | Legg-Calve-Perthes Disease |
| The ____________________ muscle assists in the ________________ of the arm and stabilization of the ______________________ joint. | Supraspinatus; ABDuction; Glenohumeral |
| What is the innervating nerve of the Latissimus dorsi muscle? | Thoracodorsal nerve |
| Where is the origin of the Latissimus dorsi muscle? | Originates for the Iliac crest and inserted in the groove of the humerus. |
| What is the role of the Trapezius muscle? | Moving, rotating, and stabilizing the scapula, and extending the head at the neck |
| What is the innervation of the Trapezius muscle? | Accessory nerve (motor) and cervical spinal nerve |
| Muscles of the Rotator cuff | Supraspinatus Infraspinatus Teres minor Subscapularis |
| Which is the most commonly injured rotator cuff muscle? | Supraspinatus |
| The supraspinatus muscle: | Innervated by the Suprascapular nerve - Abducts arm initially prior action of the Deltoid - Tear or injury assessed with the "empty can test" |
| Which rotator cuff muscle is injured by a "pitching injury"? | Infraspinatus |
| What rotator cuff muscles are innervated by the Suprascapular nerve? | Supraspinatus and Infraspinatus |
| The Infraspinatus? | Externally rotates the arm; innervated by Suprascapular nerve; Pitching injury |
| Adducts and externally rotates the arm. | Teres minor |
| The teres minor function? | Adduction and external rotation of the arm |
| What is the innervation in Teres minor? | Axillary nerve |
| What is the motor function of the subscapularis? | Adduction and internally rotate the arm |
| What is the innervation of the Subscapularis muscle? | Upper and lower subscapular nerves; primarily by roots C5 and C6 |
| Internal rotation of arm and adduction is done by the _____________ muscle | Subscapularis |
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