Myositis ossificans - what is it? - cause and location - x-ray finding

- growth of bone in muscle (heterotrophic ossification) - trauma, located in traumataized muscle - bony ossification in muscle

Polymyalgia rheumatica: lab findings - ESR - CRP - CK

- ESR: elevated - CRP: elevated - CK: normal (vs. polymyositis/dermatomyositis)

Amount and usage for each dose of aspirin - low - intermediate - high

- low: <300mg, anti-platelet aggregation - intermediate: < 300, <2400: antipyretic, analgestic - high:<2400, <400: anti-inflammatory

MSK- FA Flashcards by harry park

Acute gout: Is allopurinol an option?

NO.
allopurinol is used as a prevention (for chronic gout)

For ACUTE gout attack, first line is NSAIDs and
other anti-inflammatory drugs (glucorcorticoid, colchicinine) are also options for acute gout)

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medial epicondyle vs. lateral epicondyle: injury due to what kind of repetitive arm motion?

medial: golfer, forehand shots- flexion
lateral: tennis, backhand shots- extension
* golf swings medially, tennis swings backhand

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Which hand bone can be palpated in snuff box? what is special about this bone?

scaphoid

scaphoid is the most common injury site for avascular necrosis due to retrograde blood supply
(this is UWORLD question)

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Myositis ossificans

what is it?
cause and location
x-ray finding

growth of bone in muscle (heterotrophic ossification)
trauma, located in traumataized muscle
bony ossification in muscle

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Polymyalgia rheumatica: lab findings

ESR: elevated
CRP: elevated
CK: normal (vs. polymyositis/dermatomyositis)

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Compare etiologies: femoral nerve damage vs. obturator nerve damage

femoral n: pelvic fracture
obturator n: pelvic surgery
makes sense: femoral n. runs lateral, kinda all over across pelvic bone, while obturator nerve runs medial, and inside of pelvic area (inside=deep= surgery related)

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Lumbricals

innervated what nerve? nerve root?
motion of MCP
motion of DIP/PIP

ulnar (C8-T1)
MCP flexion
DIP/PIP extension

*think about clawed hand (lower root, ulnar damage)
: hands can’t flex MCP, and can’t extent DIP/PIP

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Compare fracture etiologies: median nerve damage vs. radial nerve damage

median n: supracondylar fracture

radial n: midshaft humerus fracture

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MOA of N-acetylcysteine as a antidote for acetoaminophen overdose

regeneration of glutathione

GS-SG -> 2GH

*acetoaminophen causes centrilobular necrosis of liver by generating free radicals

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Dislocation of what bone may cause carpal tunnel syndrome

lunate

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Amount and usage for each dose of aspirin

low
intermediate
high

low: <300mg, anti-platelet aggregation
intermediate: < 300, <2400: antipyretic, analgestic
high:<2400, <400: anti-inflammatory

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Acanthosis nigrans: hyperplasia of what dermal layer

acanthosis: hyperplasia of stratum spinosum

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What wrist bone damage is associated with ulnar nerve injury?

hammate

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Most common cause of death in osteitis deformans?

osteitis deformans= pagets

hight output HF

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Smoker has weak muscle strength, dry mouth and impotence. What’s up?

Lambert-Eaton syndrome (associated with small cell lung cancer)

autonomic symptoms of Lambert-Eaton: dry mouth and impotence

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Patient taking probenecid for chronic gout. How penicillin dose needs to be modified? why?

Dose needs to be lowered.

probenecid also limits penicillin secretion, increasing interstitial nephritis

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Carpal tunnel syndrome: how is sensation of thenar eminence affected? why?

thenar eminence sensation is intact

recurrent branch of median nerve (which innervates thenar eminence) does not go through carpal tunnel

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Sarcoidosis: facial manifestation?

facial palsy

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UV- which type mediates sunburn? which type mediates tanning? which type mediates skin aging?

UVA- Aging
UVB- sun Burn

A-aging B-burn

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cardiac manifestation of anklyosing spondylitis

aortic regurgitation

aortitis (inflammation) -> dilation of aortic root -> AR

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Which autoanitbody in SLE tells about prognosis? which organ is usually involved in the presence of this antibodiy?

anti-dsDNA

renal is usually involved with positive anti-dsDNA

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woman with breast cancer had mastetomy. what skin cancer should I worry about?

angiosarcoma

this is UWORLD question

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List 4 drugs that can cause lupus. What autoantibody is specific for drug induced lupus?

proclainamide, INH, phenytoin, and HYDRALYZINE

anti-histone

*pt wit heart condition showing lupus symptoms, think drug induced lupus

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Which cell’s activity is impaired in osteopetrosis? which enzyme?

ostetoclast

defective carbonic anhydrase

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What type of fracture is common in osteoporosis?

vertebral compression/ fracture

What two insults cause axillary nerve damage?

- anterior transolocation of humeral head | - humeral neck fracture

What two insults cause radial nerve damage?

- midshaft fracture of humerus | - axillary compression (crutch)

What two insults cause median nerve damage? | one in arm, one in wrist

- suprcondylar fracture | - lunate fracture

What two insults cause ulnar nerve damage? | one in arm. one in wrist

- lateral epicondyle fracture | - hammate fracture

Two dermatologic processes in psoriasis?

- hyperkaratosis | - parakaratosis (retained nuclei in startum corenum)

Achondroplasia - what gene, what is function of this gene - what mutation - inheritance pattern - most sporadic? or inherited? - phenotype of homozygosity?

- FGFR3, inhibition of chondrocyte - constitutive activation -> inhibition of chondrocyte - autosomal dominant - most cases are sporadic - homozygote lethal

Which nerve innervates each rotator cuff muscle?

- supra/infrasipnatous: suprascapular nerve - teres minor: axillary - subscapularis: subscapular nerve

function of dorsal interossei? palmar interossei? what is pneumonic for it? (there is pneumonic for this)

PAD DAB Palmar interossei- finger adduction Dorsal interossei - fingeer abduction abduction- kinda like stretch - backside (dorsal) adduction- kinda like flexion - frontside (palmar)

What is melasma?

hyperpigmentation in preganants

Describe pathologic findings (2) in osteitis fibrosa cystica

- cystic lesions in bone | - brown fibrous tissue

Three side effects of NSAIDs

- anti-inflammtory - anti-pyretic - analgestic

neurologic manifestation in osteopetrosis? why?

cranial impingement due to narrowing of foramina

Thenar vs. Hypothenar eminence: innervated by what nerve in each?

- thenar eminence: recurrent branch of median | - hypothenar eminence: ulnar

Which disc level herniation is responsible for - femoral n. compression - peroneal n. compression - tibial n. compression

- L4 (L3-L4) - L5 (L4-L5) - S1 (L5-S1)

nerve root for - femoral n. - obturator n. - peroneal n. - tibial n.

- femoral and obturator: L2-L4 (3) - peroneal: L4-S2 (4) - tibial: L4-S3 (5)

How does estrogen works for bone?

estrogen -> OPG -> decoy receptor for RANKL | -> inhibition of osteoclast activity

Which nerve and artery have increased risk for damage in humeral neck fracture?

posteior circumflex

What is common theme of drugs for acute gout management? List their names (3)

anti-inflammatory - NSAID - colchinine - glucorcorticoid

Sarcoidosis: skin manifestation?

erythema nodosum

Which muscle of rotator cuff is commonly injured in pitcher? what about nerve?

infraspinatous musculocutaneous nerve is also frequently damaged in pitcher

Name 3 diseases that predispose development of osteosarcoma

- retinoblastoma - Li-Furafani - pagets

Rosacea: describe dermatologic finding

erythematous papules, skin flushing after external stimuli (alcohol)

Sciatic nerve splits into what two nerves

peroneal and tibial

What is bony land mark for injection for knocking down pudendal nerve?

ischial spine * this is UWORLD question

nerve root for pudendal nerve

S2-S4

prognosis of Ewing sarcoma? treatment option?

- bad prognosis, aggresive | - well respond to chemotherapy

What does TXA2 do to vasculature?

- vasoconstriction | * this is different to other COX cytokines (prostacycline, prostaglandin)

What mutation on what gene is associated with melanoma?

BRAF V600E

Erysipelas and Cellulitis are skin manifestations (also impetigo) of GAS infection. What is main difference between two?

- Erysipeals: superficial epidermis | - Cellulitis: deep including dermis

SLE manifestation in oral / pharyngeal area?

oralpharyngeal ulcer

What infection is associated with hairy leukoplakia? how is it different from thrush?

- EBV | - not scrapable

Gaucher disease: bone manifestation?

avascular necrosis

Two most common bacteria for septic arthritis?

- S. auerus | - N. gonorrhoeae

Three antibodies for anti-phospholipid syndrome?

- cardiolipin - lupus anticoagulant - beta 2 glycoprotein

midshaft of humerus fracture- what nerve and artery are getting damaged

- raidal n. | - deep brachial artery

Describe histology of basal cell carcinoma. what about gross appearance?

purlent (shiny) palisading nuceli * pathoma p.205

median nerve runs with which artery? through what fossa?

brachial artery

low dose aspirin vs. high dose aspirin: different effect on gout?

- high dose: inhibit uric acid reabsorption - low dose: inhibit uric acid secretion * needs HIGH dose to be beneficial

weakness in dorsiflexsion, difficulty with heel walking: what disc herniation?

- peroneal, L4-L5

weakness of knee extension, decreased patellar reflex: what disc herniation?

- femoral, L3-L4

weakness of plantarflexion, difficulty in toe walking: what disc herniation? what reflex will be diminished?

- tibial, L5-S1 reduced archillis tendon reflex

Base of skull: endochondral ossification? or membranous ossification?

endochonral ossification * facial bone is membranous ossification, which is not same as base of skull

gap junction: what protein?

connexons * gap junction CONNEcts between two cells, allowing communication

adhesion junction: what protein?

Cadherine *cADHERine

tight junction: what proteins (2)?

- occludin | - claudin

dermatologic term for pemphigus vulgaris? (positive Nilkosky sign?)

acantholysis

Name three diseases/conditions that can lead to pseudogout

- hemochromatosis - joint trauma - hyperparathyroidism * MCP deposition of calcium pyrophosphate in hemochromatosis => Don't get confused with RA!!

basement membrane: what protein?

integrin * integrity of basement membrane

benign, painful, red-blue tumor under fingernails. what tumor is this?

glomus tumor

Describe finding in immunmofluoresecne in pemphigus vulgaris? vs. bullous pemphigoid?

pemphigus vulgaris: fish net (all over epidermis) bullous pemphigoid: linear (along basement membrane)

which cell is in the blisters of bullous pemphigoid?

eosiniphils

Which drug is used to diagnose myasthenia gravis?

edrophonium (tensilon) * edrophonium is rapid acting AchE inhibitor. positive edrophonium test means transient improvement of muscle strength after edrophonium

What two bugs are associated with erythema multiforme?

- mycoplasma bacteria | - HSV (UWORLD)

umbilicated papule. what infection?

poxvirus *umbilicated: central depression

Which amino acid is precursor for NO synthesis?

L-Ariginine

Grabbing a tree branch to break a fall: what nerve root injury?

This is classic case for Klumpke palsy, so lower trunk of brachial plexus

Ulnar nerve penetrates through what structure in elbow?

cubital fossa

What is PGI2? its functions (2)? From where is it released?

- prostacyclin - inhibits platelet aggregation and vasoconstriction * exactly opposite to TXA2 - endothelial cells release PGI2

MOA of aspirin? vs. acetoaminophen?

aspirin: IRREVERSIBLE COX1 and 2 inhibitor via ACETYLATION acetoaminophen: REVERSIBLE COX inhibitor, mostly in CNS => why it is not anti-inflammatory, rather analgestic and antipyretic

During delivery, anesthetic is injected to nerve that runs between sacrospinus ligament and ischial spine. what nerve is this?

pudendal (S2-S4) pudendal nerve is somatic nerve. * also remember this nerve is associated with ejacuation in male (point, shoot, spoon) * keyword: delivery, ischial spine = pudendal

Which nerve innervates biceps?

musculocutaneous

nerve root of long thoracic?

C5-C7 * I thought it is C5-T1, but no. JUST FIRST THREE

paget disease: how levels get changed? - Ca2+ - phosphate - ALP - PTH

everything is normal EXCEPT ALP (high)

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