MSS Flashcards

Question

Drug-induced lupus erythematosus (DILE)

Answer 1

TB TX ISONIAZID characterized by abrupt-onset lupus symptoms (eg, fever, arthralgia, pleuritis) with positive antihistone antibodies. It has been linked to drugs metabolized by N-acetylation in the liver (eg, procainamide, hydralazine, isoniazid). Genetically predisposed individuals with slow acetylator phenotype are at greater risk for DILE

Answer 2

Early Lyme disease causes flu-like symptoms and erythema chronicum migrans. DERMA The second stage of Lyme disease may involve atrioventricular block and facial palsy. IMPORTANT ALSO NOTE Late Lyme disease can cause chronic asymmetric large joint arthritis and encephalopathy. TX Lyme disease is easily treated with doxycycline or penicillin-type antibiotics (eg, ceftriaxone).

Answer 3

GET BACK TO WORD FILE

Answer 4

1. ruptured the flexor digitorum profundus (FDP) tendon, an injury commonly called "jersey finger." absent DIP flexion The FDP tendon originates from the FDP muscle in the forearm; travels through the carpal tunnel, palm, and flexor tendon sheath; and inserts onto the base of the distal phalanx. It contributes to flexion of proximal joints (wrist, metacarpophalangeal [MCP] joint, proximal interphalangeal [PIP] joint) and specifically causes flexion of the distal interphalangeal (DIP) joint. susceptible to rupture when the actively flexed DIP joint (eg, hooked around opponent's jersey) is forcefully hyperextended A complete tendon rupture, as seen in this patient, results in absent DIP flexion; a partial tendon tear results in weak, incomplete flexion. 2.The flexor digitorum superficialis (FDS) tendon inserts onto the body of the middle phalanx; it does not contribute to DIP joint flexion.

Answer 5

The rotator cuff consists of the tendons of the supraspinatus, infraspinatus, teres minor, and subscapularis (SITS) and contributes to the stability and motion of the glenohumeral joint. During abduction of the humerus, the supraspinatus initiates movement through the first 10-15 degrees; subsequently, the deltoid provides the primary abductive force while the supraspinatus provides stability to the joint. Of all the rotator cuff structures, the supraspinatus tendon is most commonly affected in rotator cuff syndrome. This tendon is vulnerable to chronic repeated trauma from impingement between the head of the humerus and the acromion during abduction.

Answer 6

IMPORTANT TO KNOW THE DIFFERENCE BETWEEN BURSITIS TYPES AROUND THE KNEE A bursa is a fluid-filled synovial sac that serves to alleviate pressure and friction at bony prominences and ligamentous attachments throughout the body. Bursae are vulnerable to injury from acute trauma or chronic repetitive pressure and may also become inflamed due to infection (septic bursitis), crystalline arthropathy (eg, gout), or autoimmune conditions (eg, rheumatoid arthritis). Because bursae are located in prominent and exposed positions, the pain of bursitis may be exquisite, and point tenderness is typical. Other features of bursitis may include swelling and erythema, particularly with more superficial bursae. Active range of motion is often decreased or painful, but passive motion is usually normal as it results in less pressure on the inflamed bursa. 1.Olecranon bursitis presents with localized swelling at the olecranon process. Pain and erythema are typically minimal or absent unless significant inflammation is present. A bursa is not an intraarticular structure; therefore, range of motion of the associated joint is typically preserved and pain-free 2.This patient with acute pain and localized tenderness associated with repetitive anterior knee trauma from kneeling has typical features of prepatellar bursitis, sometimes called "housemaid's knee." The prepatellar bursa is located between the patella and the overlying skin. Other occupations associated with prepatellar and infrapatellar bursitis include carpet layers, mechanics, and plumbers. 3.The suprapatellar bursa is located anteriorly between the distal femur and quadriceps. Bursitis here is most often caused by a direct blow to the distal thigh or prolonged/repetitive quadriceps activity (eg, running). 4.Anserine bursitis presents with pain along the medial knee and well-defined tenderness approximately 4 cm distal to the anteromedial joint margin of the knee. It frequently results from obesity or overuse in athletes.

Answer 7

1.Posterior hip dislocation (ie, femoral head displaced posteriorly from the acetabulum) can occur in motor vehicle collisions in which the knee strikes the dashboard or from falls in elderly patients. On examination, the leg appears shortened and internally rotated, with the hip held in flexion and adduction. The sciatic nerve is vulnerable to injury in posterior hip dislocation IMPORTANT 2.The femoral artery runs anterior to the hip and can be injured in anterior (not posterior) dislocation, which is rare and typically occurs in association with additional traumatic injuries (eg, hip fracture); examination shows abduction and external rotation of the thigh. The femoral nerve also runs anterior to the hip joint; it is occasionally injured in hip arthroplasty but is not at risk in posterior dislocation. 3.femoral neck fracture, which can also present with leg shortening; however, the leg is typically rotated externally with femoral neck fracture due to contraction of the iliopsoas without the normal acetabular counterforce. MEDIAL FEMORAL CIRCUMFLEX ARTRY

Answer 8

Greater trochanteric pain syndrome is an overuse tendinopathy of the gluteus medius and gluteus minimus at their insertion on the greater trochanter of the femur. Examination shows tenderness over the greater trochanter; pain is reproduced by resisted hip abduction and internal rotation (when the hip is flexed). Their primary functions include: Hip abduction Hip external rotation (internal rotation when the hip is flexed [eg, leg crossing]) Horizontal stabilization of the pelvis during ambulation NOTE :The sartorius . Its primary functions are to flex, abduct, and externally rotate the hip, and to flex the knee. It is often called the "tailor's muscle" because it allows for the cross-legged sitting position traditionally used by tailors.

Answer 9

REMEMBER ARM The proximal humerus and glenohumeral joint receive their blood supply via the anterior and posterior circumflex humeral arteries, which are branches of the axillary artery that form an anastomosis at the neck of the humerus. Humeral neck fractures can disrupt this blood flow, leading to avascular necrosis of the humeral head. Osteonecrosis presents insidiously with shoulder pain, decreased range of motion, and flattening of the humeral head on x-ray. #anterior humerus dislocation Flattening of the deltoid muscle with acromial prominence after a shoulder injury suggests an anterior humerus dislocation. This injury most commonly results from a blow to an externally rotated and abducted arm. There is often associated axillary nerve injury, resulting in deltoid paralysis and loss of sensation over the lateral shoulder. #The median nerve and brachial artery run along the anteromedial aspect #The radial nerve runs anterior to the lateral epicondyle at the elbow. (anterolaterally) #The ulnar nerve runs posterior to the medial epicondyle SO 1.Supracondylar humeral fractures commonly occur after hyperextension of the elbow as a result of a fall onto an outstretched arm. MEDIAN NERVE INJRY 2.The ulnar nerve runs posterior to the medial epicondyle and can be injured with hyperflexion injuries (eg, falling onto a flexed elbow), resulting in posterior displacement of the proximal humerus or fracture of the medial epicondyle 3.The radial nerve runs anterior to the lateral epicondyle at the elbow. It can be injured in supracondylar humeral fractures when the proximal fracture fragment is displaced anterolaterally

Answer 10

1.The lunate bone is the more medial (ulnar) of the 2 proximal carpal bones that articulate with the radius. A fall onto an outstretched hand can cause dislocation of the lunate bone with resulting compression of the median nerve (eg, wrist pain, numbness in the first 3½ digits). 2.The scaphoid is the most lateral (radial) of the proximal carpal bones and articulates with the radius. It is the carpal bone most frequently affected by a FOOSH; dislocation or fracture of the scaphoid can present with wrist pain and tenderness in the anatomic snuffbox. Scaphoid fractures have a high risk of avascular necrosis. 3.hook of the hamate and the pisiform bone in a fibroosseous tunnel known as Guyon canal. Here, it divides into a superficial branch that provides sensation to the medial 1½ digits and a deep motor branch that supplies most of the intrinsic muscles of the hand. The ulnar nerve is commonly injured by trauma or nerve compression at the elbow (funny bone) or at Guyon canal (eg, striking the ground during a fall).

Answer 11

#Patella fractures -- inability to extend the knee against gravity #femoral neck fracture --The medial circumflex femoral artery #The anterior cruciate ligament (ACL) -- attaches proximally to the lateral femoral condyle #Fractures of the greater trochanter -- gluteus medius tendon -- weakness of hip abduction. #winging of the scapula--Dissection of the axillary lymph nodes can injure the long thoracic nerve--weakness of the serratus anterior muscle --and impaired abduction of the shoulder past the horizontal position. # #

Answer 12

Q: What condition is suggested by upper extremity neurologic symptoms in a patient with an extra rib? A: Thoracic outlet syndrome (TOS). Q: What structures can be compressed in thoracic outlet syndrome? A: Brachial plexus, subclavian artery, and subclavian vein. Q: What are the typical neurologic symptoms of brachial plexus compression in TOS? A: Numbness, tingling, and weakness, often in an ulnar distribution (due to lower trunk compression). Q: What symptoms occur when the subclavian vein/artery are compressed in TOS? A: Upper extremity swelling and exertional arm pain. Q: Where does TOS most commonly occur anatomically? A: Scalene triangle. VERY IMPORTANT Q: What forms the scalene triangle? IMPORTANTTT A: Anterior scalene muscle Middle scalene muscle First rib Q: What structures pass between the anterior and middle scalene muscles? A: Brachial plexus trunks and subclavian artery. Flashcard 11 Q: What anatomical variations predispose to TOS? A: Cervical rib and scalene muscle anomalies. Flashcard 12 Q: What activities or history are commonly associated with TOS? A: Trauma or repetitive overhead arm movements (e.g., swimming, stacking boxes).

Answer 13

The clavicle is commonly fractured in children after a fall on an outstretched arm. In a distal clavicle fracture, the deltoid muscle IMPORTANT and the weight of the arm cause inferolateral displacement of the distal fragment, whereas the sternocleidomastoid and trapezius muscles cause superomedial displacement of the proximal fragment.

Answer 14

#OLD :Spinal stenosis occurs most commonly in the lumbar region and presents with posture-dependent lower extremity pain---due to intervertebral disc herniation, ligamentum flavum hypertrophy, and osteophyte formation affecting the facet joints. #ADOLECENT : spondylolisthesis (ie, anterior displacement of the vertebral body), which often occurs due to bilateral spondylolysis (ie, pars interarticularis fracture). EXPLINATION : The posterior vertebral arch connects the anterior and posterior portions of the vertebral column and consists of the pedicle, the intervening pars interarticularis, and the lamina. The posterior vertebral arch and the posterior portion of the vertebral body form the triangularly shaped spinal canal repetitive extension of the spine (as in gymnasts) stresses the facet joints and posterior vertebral arch, which can lead to spondylolysis with subsequent spondylolisthesis.

Answer 15

Acute compartment syndrome (ACS) is caused by increased pressure within fascial compartments of the limbs, leading to impaired perfusion. ACS can cause severe pain, myonecrosis, and nerve injury. #The anterior compartment of the leg, which contains the deep peroneal (fibular) nerve, is the most common site of ACS. IMPORTANT #The peroneal veins accompany the peroneal artery and drain blood from the lateral compartment into the deep posterior compartment and eventually into the posterior tibial veins. The lateral compartment of the leg contains the superficial peroneal nerve and the proximal part of the deep peroneal nerve. ACS in this compartment can produce loss of sensation in the lower leg and dorsum of the foot as well as foot drop. #The deep posterior compartment contains the posterior tibial artery, peroneal artery, and tibial nerve. ACS involving this compartment may cause decreased sensation in the plantar surface, decreased toe flexion, and pain with passive toe extension.

Answer 16

MEDIAL NERVE interphalangeal joint extension thumb abduction thumb flexion thumb opposition MEDIAL AND ULNER finger interphalangeal joint flexion each for 2 fingers ULNER NERVE thumb adduction fingers adduction and abductions RADIAL NERVE thumb extension fingers extension

Answer 17

Findings of femoral neuropathy include quadriceps weakness, decreased patellar reflex, and sensory loss over the anterior thigh and medial lower leg. Causes include compression from an abscess or hematoma (eg, retroperitoneal hematoma in an anticoagulated patient), trauma, or injury during surgery or childbirth. IMPORTANT

Answer 18

BIOCHEM , MICRO,IMMUONO,HISTO

Answer 19

Osteomyelitis is an infection of bone and bone marrow that occurs by 1 of 3 mechanisms: 1.Hematogenous seeding due to an episode of bacteremia 2.Spread from a contiguous focus of infection, as occurs in an infected diabetic foot wound 3.Direct inoculation of bone, such as with a compound fracture Hematogenous osteomyelitis is predominantly a disease of children that most frequently affects the long bones. Staphylococcus aureus is implicated in most cases secondary to a bacteremic event. Streptococcus pyogenes (group A streptococcus) is the second most common cause of hematogenous osteomyelitis.

Answer 20

📌 In one sentence Osteocytes act as the bone’s “sensors” that detect mechanical stress and communicate through gap junctions to control local bone remodeling—this is why weight-bearing exercise helps prevent osteoporosis. 🦴 What are osteocytes? Start as osteoblasts (cells that build bone). When osteoblasts get trapped inside the bone they built → they turn into osteocytes. Osteocytes live in small spaces called lacunae. These lacunae are connected by tiny tunnels called canaliculi. Osteocytes send long “arms” through these tunnels to talk to each other. Imagine an underground network of rooms connected by tunnels. The “workers” inside (osteocytes) talk to each other through these tunnels using gap junctions. 🏋️‍♀️ How does exercise strengthen bones? (Force adaptation) When you put pressure on a bone—like during walking or lifting— the bone slightly bends/deforms. Osteocytes feel this mechanical stress through attachments on their surface (like sensors). When they sense stress, they respond by sending out signals that control bone remodeling: 🚨 Signals osteocytes send: RANKL → increases osteoclast activity (bone breakdown) Sclerostin → regulates osteoblast activity (bone building) PTH response → helps control calcium and mineralization FGF23 → hormone that regulates phosphate levels in the blood These signals tell the body when to build more bone or break it down. 🔌 Why are gap junctions important? Gap junctions connect osteocytes to each other. They allow signals like calcium and cAMP to spread quickly through the whole bone network. This helps coordinate how much bone is built or removed in that region. Basically: Osteocytes = bone's communication network. They detect mechanical stress and then direct osteoclasts/osteoblasts to remodel the bone. #Pericytes are multipotent cells embedded within the microvascular wall. In the bone, they help facilitate fracture healing by regulating local blood flow, promoting angiogenesis, and functioning as an ancillary source for differentiating osteoblasts.

Answer 21

Phosphoribosyl pyrophosphate (PRPP) synthetase is the enzyme responsible for the production of the activated ribose necessary for de novo synthesis of purine and pyrimidine nucleotides. As a result, more purine molecules will undergo degradation, resulting in hyperuricemia and an increased risk of gout. (NSAIDs) are first-line therapy for treating acute gouty arthritis. They inhibit cyclooxygenase and exert a broad anti-inflammatory effect that includes inhibition of NEUTROPHILS.

Answer 22

Adalimumab is a recombinant human IgG that binds tumor necrosis factor-alpha (TNF-alpha). Antidrug antibodies can develop against adalimumab (or other immunoglobulin-based anti-TNF agents) that can block its interaction with TNF-alpha, preventing the drug from functioning and leading to more rapid drug clearance.

Answer 23

The receptor activator of nuclear factor kappa B (RANK)/RANK ligand (RANK-L) interaction is essential for the formation and differentiation of osteoclasts. Osteoprotegerin OPG blocks binding of RANK-L to RANK and reduces formation of mature osteoclasts. Low estrogen states cause osteoporosis by decreasing osteoprotegerin production, increasing RANK-L production, and increasing RANK expression in osteoclast precursors. Bone turnover is therefore regulated by the ratio of OPG to RANK-L; bone turnover increases when OPG is low and RANK-L is high. the loss of estrogen effect (eg, menopause, oophorectomy) increases the expression of RANK-L and decreases production of OPG . The decreased OPG to RANK-L ratio leads to increased osteoclast activity and bone resorption

Answer 24

Increased production of IL-17, TNF-α & prostaglandins Increased risk with HLA-B27 which have synergistic proinflammatory effects and induce bony erosions and abnormal bone regrowth in the skeleton.

Answer 25

OA SYMPTOMS WITH DARKINING EARS Alkaptonuria is an autosomal-recessive disorder caused by a deficiency of homogentisic acid dioxygenase, an enzyme involved in tyrosine metabolism. Excess homogentisic acid causes diffuse blue-black deposits in connective tissues. Adults have sclerae and ear cartilage hyperpigmentation along with osteoarthropathy of the spine and large joints.

MSS Flashcards

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