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Musculoskeletal

FA complete review

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