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Flashcards

MSK-Connective tissue

Eric Zhang Organ modules English 84 cards

MSK-Connective tissue

Cards in this deck (84)

  1. 1ACL + PCL (goes from where to where)ACL
    - lateral femoral condyle to anterior tibia
    PCL
    - medial femoral condyle to posterior tibia    ACL + PCL (goes from where to where)
  2. 2Anterior Drawer sign (how? meaning?) Posterior Drawer sign (how? meaning?) Abnormal passive abduction/adduction?Anterior
    - knee bent at 90 and foot placed on bed
    - push knee forward...if it glides, ACL injury
    Lachman test is at 30 degrees
    Posterior
    - knee bent at 90 and foot placed on bed
    - push knee back...if it glides, PCL injury
    Ab. passive abduction
    - knee extended OR at 30...THEN
    - lateral valgus force, and medial space widening --> this is MCL injury
    Ab. passive adduction
    - knee extended OR at 30...THEN
    - medial varus force, and lateral space widening --> LCL injury
  3. 3McMurray TestAs you flex and extend knee, you rotate the tibia and foot as well
    - pain, "popping" on external rotation --> medial meniscal tear
    - pain, "popping" on internal rotation --> lateral meniscal tear
  4. 4—"terrible triad"
    - contact sport --> lateral valgus force applied to a planted leg
    - ACL, MCL, and medial meniscus (attached to MCL) damage
    - acute knee pain + joint injury/instability    "terrible triad" - contact sport --> lateral valgus force applied to a planted leg - ACL, MCL, and medial meniscus (attached to MCL) d...
  5. 5—Prepatellar bursitis
    - kneel too much --> inflammation of knee's largest sac of synovial fluid    Prepatellar bursitis - kneel too much --> inflammation of knee's largest sac of synovial fluid
  6. 6—"baker cyst"
    chronic joint disease --> popliteal fluid collection in gastrocnemius-semimebranous bursa
    it communicates with synovial space    "baker cyst" chronic joint disease --> popliteal fluid collection in gastrocnemius-semimebranous bursa it communicates with synovial s...
  7. 7Rotator cuff muscles (what? action? nerve innervation?)SItS
    Supraspinatus
    - suprascapular nerve (C5-C6)
    - abducts arm initially (before deltoid)
    - most common rotator cuff injury (assessed by empty/full can test)
    Infraspinatus
    - suprascapular nerve
    - laterally rotates arm
    - pitching injury
    Teres minor
    - axillary nerve
    - adducts + laterally rotates arm
    Subscapularis
    - upper + lower subscapular nerves
    (both C5-C6)
    - medially rotates and adducts arm    Rotator cuff muscles (what? action? nerve innervation?)
  8. 8Medial vs Lateral epicondylitisMedial - "golfer's elbow"
    - repetitive flexion (forehand shots)
    - pain near medial epicondyle
    Lateral - "tennis elbow"
    - repetitive extension (backhand shots)
    - pain near lateral epicondyle
  9. 9Wrist bonesScaphoid - Lunate - Triquetrum - Pisiform - Trapezium - Trapezoid - Capitate - Hamate
    Scaphoid
    - most commonly fractured carpal bone (fall on outstretched hand)
    - avascular necrosis
    Lunate
    - dislocation --> acute carpal tunnel
    Hamate
    - damage --> acute ulnar nerve injury    Wrist bones
  10. 10Carpal tunnel syndrome (symptoms? causes?)Entrapment of median nerve in carpal tunnel --> nerve compression --> paresthesia + pain + numbness in median nerve distribution (thenar atrophy but still has sensation - palmar cutaneous branch enters hand external to tunnel)
    Causes:
    1. Pregnancy
    2. Rheumatoid arthritis
    3. Hypothyroidism
    4. Diabetes
    5. Amyloidosis
  11. 11Guyon Canal SyndromeCompression of ulnar nerve at wrist of hand
    Seen in cyclists due to pressure from handlebars
  12. 12—
  13. 13Injury to: 1. Axillary nerve 2. Musculocutaneous nerve 3. Radial nerveAxillary (C5-6)
    - Fractures neck of humerus/anterior dislocation of humerus -->
    1. Flattened deltoid
    2. Loss of arm abduction at shoulder
    3. Loss of sensation: deltoid + lateral arm
    Musculocutaneous (C5-7)
    - Upper trunk compression -->
    1. Loss of forearm flexion and supination
    2. Loss of sensation over lateral forearm
    Radial (C5-T1)
    - mineshaft humerus fracture OR axillary compression -->
    1. Wrist drop (loss of elbow/wrist/finger extension)
    2. Loss of grip strength
    3. Loss of sensation over posterior arm/forearm and dorsal hand
  14. 14Injury to: 1. Median nerve 2. Ulnar nerve 3. Recurrent median nerveMedian nerve (C5-T1)
    - Proximal: supracondylar humerus fracture
    - Distal: carpal tunnel syndrome-->
    1. Loss of wrist/lateral fingers flexion
    2. Loss of sensation over lateral 3.5 fingers
    3. Tinel sign (tingling on percussion)
    Ulnar nerve (C8-T1)
    - Med humerus epicondyle fracture (prox)
    - fractures hook of hamate (distal) -->
    1. flexion --> radial deviation
    2. Loss of wrist/medial fingers flexion
    3. Loss of ab/adduction of fingers
    4. Loss of sensation of medial 1.5 fingers
    Recurrent median (C5-T1)
    - superficial laceration of palm -->
    1. Ape hand
    2. Loss of thenar muscle group --> opposition, abduction, thumb flexion
    3. Sensations spared
  15. 15Erb palsy "waiter's tip" (injury - cause - muscle deficit - functional deficit)Injury (1):
    1. Traction/tear of upper trunk: C5-6 roots
    Causes:
    1. Infants - lateral traction on neck during delivery
    2. Adults - trauma
    Muscle deficient:
    1. Deltoid + supraspinatus
    2. Infraspinatus
    3. Biceps brachii
    Functional deficit
    1. Abduction (arm hands by side)
    2. Lateral rotation (arm medially rotated)
    3. Flexion, supination    Erb palsy "waiter's tip" (injury - cause - muscle deficit - functional deficit)
  16. 16Klumpke palsy (injury - cause - muscle deficit - functional)Injury:
    - Traction/tear of lower trunk (C8-T1 root)
    Causes
    - Infants - upward force on arm during delivery
    - Adults - trauma (grabbing tree branch to break a fall)
    Muscle deficits:
    Intrinsic hand muscles (lumbricals, interossei, thenar, hypothenar)
    Functional:
    Total claw hand (since lumbricals normally flex MCP joints + extend DIP and PIP joints)    Klumpke palsy (injury - cause - muscle deficit - functional)
  17. 17Thoracic outlet syndrome (injury - cause - muscle - function)Injury
    - Compression of lower trunk and subclavian vessels
    Causes
    - Cervical rib + pancoast tumor
    Muscles
    - Intrinsic hand muscles (lumbricals, interossei, thenar, hypothenar)
    Function
    - Intrinsic hand muscle atrophy
  18. 18Winged Scapula (injury - cause - muscle - functional)Injury
    - lesion of long thoracic nerve (C5-7)
    Cause
    - Axillary node dissection after mastectomy
    - stab wound
    Muscle
    - Serratus anterior
    Function
    - inability to anchor scapula to thoracic cage --> cannot abduct arm above horizontal
  19. 19—
  20. 20Hand muscles*OAF*
    Thenar (median)
    1. Opponens pollicis
    2. Abductor pollicis brevis
    3. Flexor pollicis brevis
    Hypothenar (ulnar)
    1. Opponens digiti minimi
    2. Abductor digiti minimi
    3. Flexor digiti minimi
    Dorsal interossei - abduct fingers
    "Dorsal ABduct = DAB"
    Palmar interossei - adduct fingers
    "Palmar Adduct = PAD"
    Lumbricals - flex at MCP, extend at PIP, DIP    Hand muscles
  21. 21Lower Extremity Nerves (roots - cause of injury - presentation) 1. Obturator 2. Femoral 3. Common peroneal 4. TibialObturator (L2-4)
    - Pelvic surgery -->
    1. Dec. thigh sensation (medial)
    2. Dec. adduction
    Femoral (L2-4)
    - Pelvic fracture ->
    1. Dec. thigh flexion
    2. Dec. leg extension
    Common Peroneal (L4-S2)
    - Trauma/compression of lateral leg, fibular neck fracture -->
    1. Foot drop (inverted/plantarflexed at rest)
    2. Loss of eversion + dorsiflexion
    3. Loss of sensation on dorsum of foot
    PED = Peroneal Everts and Dorsiflexes
    if injured --> foot dropPED
    Tibial (L4-S3)
    - Knee trauma
    - Baker cyst (prox) or Tarsal Tunnel (distal)
    1. Inability to curl toes + loss of sensation on sole of foot
    2. Proximal lesions - foot everted at rest w/ loss of inversion and plantarflexion
    TIP = Tibial Inverts and Plantarflexes
    if injured, can't TIPtoe
    Sciatic nerve (L4-S3) --> posterior thigh -->
    1. Common peroneal
    2. Tibial
  22. 22Lower extremity nerves (roots - muscles innervated - cause of injury - presentation) 1. Superior gluteal 2. Inferior gluteal 3. Pudendal nerve (roots, innervation)Superior gluteal (L4-S1)
    - Gluteus medius, minimus, tensor fascia lata
    - Iatrogenic injury during intramuscular injection to upper medial gluteal region
    1. Trendelenburg sign/gait (pelvis tilts because weight bearing leg/hip can't abduct pelvis - cont. to dropped side, ipsilateral to weight-bearing side)
    *choose superolateral gluteal quadrant
    Inferior gluteal (L5-S2)
    - Gluteus maximus
    - Posterior hip dislocation
    1. Difficulty climb gin stairs/rising from seat
    2. Loss of hip extension
    Pudendal nerve (S2-S4)
    - Perineum innervation
  23. 23Signs of lumbosacral radiculopathy (what? presentation: L3-L4, L4-L5, L5-S1)- Paresthesias + weakness in distribution of specific lumbar/sacral spinal nerves
    - due to intervertebral disc herniation
    - Herniation often posterolaterally (thinner posterior longitudinal ligament)
    L3-L4
    - L4 affected --> weakness of knee extension
    L4-L5
    - L5 affected --> weakness of dorsiflexion, difficulty in heel-walking
    L5-S1
    - S1 affected --> weakness of plantarflexion, difficulty in toe walking
  24. 24Muscle conduction to contraction1. action potential depolarize --> presynaptic voltage-gated Ca channels open --> neurotransmitters release
    2. postsynaptic ligand binding --> muscle cell depolarization in motor end plate
    3. Depolarization travels along muscle cell down T tubule
    4. Voltage-sensitive dihydropyridine receptor depolarize --> mechanically cause Ryanodine receptor on Sarcoplasmic Reticulum to open --> release calcium
    5. Ca binds troponin C --> conformational change that moves tropomyosin out of the myosin-binding groove on actin filaments
    6. Myosin (attached to actin) releases ADP + P --> power stroke (H, I bands shorten)
    7. Myosin binds new ATP --> myosin detach
    8. ATP hydrolyze --> myosin ready for attachment    Muscle conduction to contraction
  25. 25Types of muscle fibers (1 vs 2)Type 1 - slow twitch
    - red fibers: high [mitochondria] + [myoglobin ] --> sustained contraction
    Type 2 - fast twitch
    - white fibers from dec. [mitochondria] + [myoglobin]
    - inc. anaerobic glycolysis
    - proportion inc. after weight training
  26. 26Smooth Muscle Contraction (key enzymes, molecules)Smooth Muscle Contraction (key enzymes, molecules)
  27. 27effect of estrogen on boneEstrogen :
    1. inhibit osteoblast apoptosis
    2. promotes osteoclast apoptosis
    Estrogen deficiency --> osteoporosis
  28. 28Achondroplasia (cause? genetics? association? presentation?)Constitutive activation of fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
    - 85% of mutations occur sporadically
    - autosomal dominant w/ full penetrance (homozygosity is lethal)
    - assoc. w/ increased paternal age
    Most common cause of dwarfism
    1. Failure of longitudinal bone growth (endochondral ossification)
    2. Short limbs
    3. Intact membranous ossification (large head relative to limbs)
    4. Mental function, life span, and fertility are not affected
  29. 29Osteoporosis (causes - drugs/medical conditions, process, diagnosis, labs, prophylaxis, treatment, complications)Cause
    - dec. estrogen = inc. bone resorption
    - drugs:
    1. Corticosteroids
    2. Alcohol
    3. Anticonvulsants
    4. Anticoagulants
    5. Thyroid replacement therapy
    - medical condition
    1. Hyperparathyroidism
    2. Hyperthyroidism
    3. Multiple myeloma
    4. Malabsorption syndromes
    Process:
    trabecular (spongy) and cortical bone lose mass + interconnections --> bone pain + fractures in weight bearing areas (vertebrae, hip, distal radius)
    Diagnosis:
    bone mineral density scan w/ a T-score < -2.5
    Labs
    Serum Ca, PO4, PTH, Alk Phos - all normal
    Prophylaxis:
    1. Regular weight-bearing exercise
    2. Adequate Ca and Vit D intake
    Treatment:
    1. Bisphosphonate (kills osteoclasts)
    2. Exercise, Vit D, and calcium (limit loss)
    3. Denosumab (RANKL antibody)
    4. Glucocorticosteroids - contraindicated
  30. 30Osteopetrosis (marble bone disease) (Cause, process, complications)Cause:
    Carbonic anhydrase II mutation --> osteoclasts can't make acidic environment
    Process
    W/o acidic environment --> osteoclasts can't resorb bone --> abnormally thick heavy bone that fractures easily
    Complications
    1. Fractures
    2. Bone fills marrow space --> pancytopenia
    3. (hence) extra medullar hematopoiesis
    4. Vision + hearing impairment (impingement on cranial nerves)
    5. Hydrocephalus (narrowing of foramen magnum)
    6. Metabolic acidosis (due to lack of carbonic anhydrase)
    Cure
    Potentially bone marrow transplant --> since osteoclasts are from monocytes
  31. 31Osteomalacia (rickets) (cause - process - findings (children vs adults) - x-ray)Rickets in children, osteomalacia in adults
    Cause
    poor diet, malabsorption, liver failure, renal failure -->
    Vit - D deficiency --> dec. serum Ca --> inc. PTH secretion --> dec. serum PO4
    Hyperactivity of osteoblasts --> inc. Alk Ph
    Process
    Osteoids are formed by osteoblasts --> cartilaginous growth plates are formed --> with low Vit D, they're not mineralized
    Findings - Children
    1. Bow legs
    2. Bead-like costochondral junctions (rachitic rosary)
    3. Craniotabes (soft skulls) + frontal bossing (osteoid deposition)
    4. Pigeon-breast deformity (inward bending of ribs w/ anterior protrusion of sternum)
    Findings - Adults
    1. weak bone w/ increased risk for fracture
    X-ray findings:
    1. Epiphyseal widening + metaphysical cupping
  32. 32Paget disease of bone (osteitis deformans) (process? lab findings? x-ray? complications?)Process:
    - localized disorder of bone remodeling:
    inc. Osteoclast --> inc osteoblast --> poor bone formation --> thick/sclerotic bone that fractures easily
    lytic --> mixed --> sclerotic --> quiescent
    Lab findings
    1. normal: Ca, PO4, PTH
    2. inc. Alk Phos
    X-ray
    1. Mosaic pattern of woven and lamellar bones
    Complications
    1. Arteriovenous shunts (in bone) --> inc blood flow through these leads to high-output cardiac failure
    2. Inc. osteosarcoma
    3. Increasing cranial size --> buy new hat
    4. Hearing loss (narrow auditory foramen)
    5. Lion-like facies - craniofacial bones
    Treatment
    1. Calcitonin - inhibits osteoclast function
    2. Bisphosphonates - apoptosis of osteoclasts
  33. 33Osteonecrosis (process? causes? presentation? location?)Process
    - infarction of bone and marrow --> very painful
    - common site - femoral head
    Causes (BIG CASTS)
    1. Corticosteroids
    2. Alcoholism
    3. Sickle Cell Disease
    4. Trauma
    5. Bends (caisson/decompression disease)
    6. LEgg-Calve-Perthes (idiopathic)
    7. Gaucher's disease
    8. Slipped capital femoral epiphysis    Osteonecrosis (process? causes? presentation? location?)
  34. 34Lab values in bone disordersLab values in bone disorders
  35. 35OsteochondromaMost common benign bone tumor
    Males
    < 25 years old
    - Arises from a lateral projection of the growth plate (metaphysis)
    - Overlying cartilage can transform rarely transforms into chondrosarcoma
    NOT CHONDROMA    Osteochondroma
  36. 36Giant Cell Tumor (epidemiology? location? x-ray?)20-40 years old
    Occurs at the epiphyseal end of long bones, often around knee
    "osteoclastoma"
    Locally aggressive benign tumor
    "soap bubble" appearance on X-ray
    Multinucleated giant cells + stromal cells    Giant Cell Tumor (epidemiology? location? x-ray?)
  37. 37Osteosarcoma (osteogenic sarcoma) (pathogenesis? epidemiology? predisposing factors? x-ray? characteristics?)Osteosarcoma (osteogenic sarcoma)
    Pathogenesis
    - malignant proliferation of osteoblasts
    Epi
    - 2nd most common primary malignant bone tumor (after multiple myeloma)
    - bimodal age distribution: 10-20, > 65
    Predisposition:
    1. Paget disease of bone
    2. bone infarcts
    3. radiation
    4. Familial retinoblastoma
    5. Li-Fraumenia syndrome
    X-ray
    1. Codman triangle (periosteum is lifted)
    2. sunburst (a destructive mass)
    Characteristics
    1. Usually at metaphysics of long bones, often around knee
    2. Aggressive --> treat w/ surgical en bloc resection + chemo
  38. 38Ewing Sarcoma (Epidemiology, histology, genetics, x-ray, characteristics)Epidemiology
    1. Boys < 15 years old
    Histology
    1. Anaplastic small blue cell tumor (that resembles lymphocytes)
    2. Arises from neuroectoderm
    Genetics
    1 t(11:22) --> EWS-FLI 1
    X-ray
    "onion skin periosteal reaction in bone"
    Characteristics
    1. Appears in diaphysis of long bones, pelvis, scapula, ribs
    2. Extremely aggressive w/ early metastasis
    3. Responsive to chemotherapy
  39. 39Osteoarthritis (pathogenesis, predisposing factors, presentation, joint findings, treatment)Pathogenesis
    - mechanical wear/tear destroys articular cartilage
    - chondrocytes mediate degradation and inadequate repair
    Predisposing factors
    1. Age
    2. Female
    3. Obesity
    4. Trauma
    Presentation
    1. Pain in weight bearing joints after use
    - improves with rest
    2. Asymmetric joint involvement
    3. Medial knee cartilage loss first --> bow legged
    Joint findings
    1. Osteophytes (bone spurs)
    2. Joint space narrowing
    3. Subchondral sclerosis + cysts
    4. DIP (Heberden nodes), PIP (Bouchard nodes), 1st CMC - not MCP
    Treatment
    1. Acetaminophen/NSAIDs
    2. Intra-articular glucocorticoids    Osteoarthritis (pathogenesis, predisposing factors, presentation, joint findings, treatment)
  40. 40Rheumatoid arthritis (pathogenesis - predisposing factors - Labs - presentation - joint findings - treatment)Pathogenesis:
    Autoimmune inflammatory cytokines + cells --> PANNUS (proliferative granulation tissue) --> erode articular cartilage + bones
    Predisposing factors:
    1. Female
    2. HLA-DR4
    3. Smoking
    4. Factors
    Labs
    1. 80% patients --> + Rheumatoid factor (IgM autoantibody against Fc of IgG)
    2. specific --> anti-cyclic citrullinated peptide antibody
    Presentation
    1. Pain + swelling
    2. Morning stiffness > 1 hr improves w/ use
    3. Symmetric joint involvement
    4. Systemic symptoms (fatigue, fever, weight loss)
    5. Extra-articular manifestations common*
    Joint findings
    1. erosions
    2. juxtaarticular osteopenia
    3. joint space narrowing
    4. Subchondral cysts
    5. Deformities (subluxation, ulnar deviation, swan neck, boutonniere)
    6. Synovial fluid: WBC > 2000/ml
    7. MCP, PIP, not DIP or 1st CMC
    Treatment
    1. NSAIDS
    2. Glucocorticoids
    3. DMARDS (methotrexate, sulfasalazine, leflunomide, hydroxychloroquine)
    4. Biologics - TNF-a inhibitors    Rheumatoid arthritis (pathogenesis - predisposing factors - Labs - presentation - joint findings - treatment)
  41. 41Rheumatoid arthritis (extra-articular manifestations)1. Rheumatoid nodules (fibrinoid necrosis w/ palisading histiocytes) in
    a) subcutaneous tissue
    b) lung
    2. Interstitial lung disease
    3. Pleuritis
    4. Pericarditis
    5. Anemia of chronic disease
    6. AA amyloidosis
    7. Neutropenia + splenomegaly (Felty)
    8. Sjogren syndrome
    9. Scleritis
    10. Carpal tunnel syndrome
  42. 42Gout (causes, pathogenesis, symptoms, treatment)Uric acid from purine metabolism --> kidney excretion
    Causes:
    1. Renal insufficiency - underexcretion of uric acid (thiazide diuretic) --> 90%
    2. Overproduction of uric acid
    a) Lesch-Nyhan syndrome
    b) PRPP (phosphoribosyl pyrophosphate) excess
    c) tumor lysis syndrome
    d) von Gierke disease (glucose-6-phosphate deficiency --> liver can't make glucose) --> 10%
    Pathogenesis
    hyperuricemia --> Na-Urate precipitate --> acute inflammatory monoarthritis
    (neg. birefringent - yellow under parallel light, blue under perpendicular light)
    Symptoms
    1. Asymmetric joint distribution
    2. Joint is swollen, red, painful
    3. Podagra (painful MTP joint of big toe)
    4. Tophi (achilles tendon, olecranon bursa)
    5. Occurs after large meal/binge alcohol
    Treatment
    acute - NSAIDs, glucocorticoids
    Chronic - XO inhibitors (allopurinol, febuxostat), colchicine
  43. 43Calcium Pyrophosphate deposition disease (pseudogout) (epidemiology, pathogenesis, findings, lab, treatment)Epidemiology
    1. Age > 50
    2. Male = female
    3. Assoc. w/ hemochromatosis, hyperparathyroidism
    Pathogenesis
    1. Deposition of calcium pyrophosphate crystals within the joint space
    Findings
    1. Pain + swelling w/ acute inflammation (pseudogout) +/-
    2. Chronic degeneration (pseudoosteoarthritis)
    3. Knee most commonly affected
    Lab
    1. X-ray --> chondrocalcinosis (cartilage calcification)
    2. Rhomboid, + birefringent crystals
    Treatment
    acute - NSAIDs, glucocorticoids
    prophylaxis - colchicine
  44. 44Sjogren Syndrome (epidemiology, pathogenesis, findings, labs, complications)Epidemiology
    1. Females 40-60
    Pathogenesis
    1. Lymphocytic infiltrates --> destruction of exocrine glands --> autoimmune
    could be 1* disorder
    could be 2* disorder assoc. w/
    a) Rheumatoid arthritis
    b) SLE
    c) systemic sclerosis
    Findings
    1. Inflammatory joint pain
    2. Keratoconjunctivitis sica (dec. tear production --> corneal damage)
    3. Xerostomia (dec. saliva production)
    4. Bilateral parotid enlargement
    Labs
    anti-nuclear antibodies:
    1. SS-A (Ro)
    2. SS-B (La)
    Complications
    1. Dental caries
    2. MALT
    3. Lymphoma (masquerade as parotid enlargement)
  45. 45Septic arthritis (organisms - findings - lab - if gonococcal)Organisms:
    1. Staph aureus
    2. Streptococcus
    3. Neisseria gonorrhoeae
    Findings:
    1. Swollen - red - painful (single) joint
    Lab
    1. Purulent synovial fluid (WBC > 50,000/ml)
    If gonococcal:
    1. Purulent arthritis (of the knee) OR
    2. Triad:
    a) polyarthralgias
    b) tenosynovitis (tendon sheath inflammation of the hand)
    c) dermatitis (pustules
  46. 46Seronegative spondyloarthritis (what is it? which syndromes? common findings?)Group of chronic inflammatory diseases w/ shared features w/o rheumatoid factor
    1. Psoriatic arthritis
    2. Ankylosing spondylitis
    3. IBD (crohn's, ulcerative colitis)
    4. Reactive arthritis
    Genetics - HLA-B27
    1. Chromsome 6
    2. Inuit, ethnic russians, alaskans, germans
    3. Strongest association w/ ankylosing spondylitis
    Findings
    1. Inflammatory back pain (improves w/ use, age < 40)
    2. Sacroiliitis (inflammation of one/both sacroiliac joints)
    3. Spinal ankylosis (spinal stiffness from vertebrae fusion)
    4. Multiocular enthesitis (periosteolar bone forming and invading tendons)
    5. Syndesmophytes (bony growth inside a ligament)
    6. Uveitis, colitis, etc
  47. 47Ankylosing spondylitis (epidemiology, presentations, X-ray, treatment)*seronegative spondyloarthropathy*
    Epidemiology
    1. Young men (10-30)
    2. HLA-B27 positive
    3. Will have family history of it
    4. Frequent GI tract infections (IBD)
    Presentations
    1. Inflammatory back pain (insidious, > 3 mo)
    2. Spinal ankylosis (joint fusion --> morning stiffness that improves w/ use)
    3. Limited chest expansion w/ breaths
    4. Uveitis/iritis
    5. Aortic regurgitation
    6. Psoriasis
    Radiographics
    1. Sacroiliitis on X-ray
    Treatment
    GOLD --> exercise
    1. NSAIDs for symptoms
    2. DMARDs (methotrexate, sulfasalazine, hydroxychloroquine, leflunomide)
    3. Biologics (TNF-a inhibitor)
  48. 48Psoriatic arthritis (epidemiology, findings, treatments)*seronegative spondyloarthritis*
    Epidemiology
    1. Men = women
    2. late 20s to 30s
    3. 1/3 of psoriasis patients get this
    Presentation
    1. Salmon patching (silver scale)
    2. Erosive arthropathies of hands, spine --> debilitating
    3. Sausage fingers (DIP, PIP synovitis)
    4. Dactylitis (inflammation of toes)
    5. Sacroiliitis
    6. Arthritis mutilans (pencil in cup erosions)
    Treatment
    1. NSAIDs for symptomatic relief
    2. Corticosteroids - swelling reduction
    3. DMARDs (methotrexate, sulfasalazine, hydroxychloroquine, leflunomide)
    4. TNF-a inhibitors
  49. 49Reactive arthritis (causative organisms, presentation, treatment)*seronegative spondyloarthropathy*
    Causes:
    1. Chlamydia
    2. Salmonella
    3. Shigella
    4. Campylobacter
    5. Yersinia
    6. Strep
    usually 2-3 weeks after prolonged diarrhea
    can't see, can't pee, can't climb tree
    1. Conjunctivitis/anterior uveitis --> can't see
    2. Urethritis --> can't pee
    3. Arthritis --> can't climb tree
    4. Sausage fingers - DIP and PIP synovitis
    5. Sacroiliitis
    Treatment
    1. NSAIDs - symptomatic
    2. Corticosteroids - topical for uveitis/conjunctivitis
    3. DMARDs (for ppl likely to move onto chronic arthritis)
    4. TNF-a blocker --> if axial skeleton involved
  50. 50Systemic Lupus erythematous (epidemiology, presentations, labs, treatment)Epidemiology
    Black reproductive age female
    RASH OR PAIN
    Rash - malaria or discoid
    Arthritis - nonerosive
    Serositis - (i.e. pleuritis, pericarditis, etc)
    Hematologic disorder (i.e. cytopenias)
    Oral/nasaopharyngeal ulcers
    Renal disease (lupus nephritis, glomerular deposition of anti-DNA immune complexes --> nephritic or nephrotic)
    Photosensitivity
    Antinuclear antibodies
    Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
    Neurologic disorders (seizures, psychosis)
    Antibodies:
    1. ANA - sensitive, not specific
    2. Anti-dsDNA - specific, poor prognosis (renal disease)
    3. Anti-Sm - specific, not prognostic
    4. Anti-histone antibodies - drug-induced lupus
    5. Dec. C3, C4, from immune complex formations
    Treatments
    1. NSAIDs
    2. Steroids = immunosuppressants
    3. Hydroxychloroquine
  51. 51Antiphospholipid syndrome (epidemiology - antibodies - symptoms - diagnosis - treatment)Epidemiology
    - 1* or 2* autoimmune disorder
    - most commonly assoc. w/ Lupus
    Antibodies
    - Anti-Cardiolipin Antibody (ACA)
    - Anti-Beta-2 glycoprotein Antibody
    - Lupus anticoagulant
    Symptoms
    1 Arterial AND venous thrombosis
    2 Recurrent pregnancy loss
    3 Thrombocytopenia
    4 CNS syndromes (stroke, chorea)
    5 Libman Sacks endocarditis (sterile cardiac valve disease)
    6. Livedo reticularis (connected string-patterned erythema)
    Diagnosis
    1. Lupus anticoagulant -->
    a) prolonged DRVVT (viper venom)
    b) prolonged PTT
    2. Elisa --> detect anti-cardiolipin antibody
    Treatment
    - systemic anticoagulation
    Beware:
    1. false positive on RPR/VDRL test
  52. 52Mixed Connective tissue diseaseFeatures of SLE, systemic sclerosis, and/or polymyositis
    assoc. w/ anti-U1 RNP antibodies (speckled ANA)
  53. 53Sarcoidosis (epidemiology, what, assoc. findings, lab findings, treatment)Epidemiology
    - Assoc. w/ Black females
    What:
    - immune-mediated widespread non-caseating granulomas
    Assoc. findings (HE BULL)
    1. Restrictive lung disease (interstitial fibrosis)
    2. Erythema nodosum
    3. Lupus pernio (skin lesions on face looking like lupus)
    4. Bell palsy
    5. Uveitis
    6. Hypercalcemia (inc. 1-a-hydroxylase-mediated Vit D activation in macrophages)
    Lab Findings
    - often asymptomatic except for:
    1. Bilateral adenopathy + coarse reticular opacities (CXR)
    2. Hilar and mediastinal adenopathy (CT)
    3. Elevated serum [ACE]
    4. Elevated CD4/CD8 ratio on BAL
    Treatment: steroids
  54. 54Polymyalgia rheumatica (epidemiology, symptoms, lab findings, assoc. w/, treatment)Epidemiology
    - common in women > 50 yrs old
    Symptoms
    1. Fever + malaise + weight loss
    2. Pain + stiffness in shoulders and hips
    3. No muscular weakness
    Lab findings
    1. Inc. ESR
    2. Inc. CRP
    3. normal CK (creatinine kinase)
    Assoc. w/ giant cell (temporal) arteritis
    Treatment
    low-dose corticosteroids --> rapid response
  55. 55Fibromyalgia (epidemiology, symptoms, treatment)Epidemiology
    - Females 20-50 yrs old
    Symptoms
    - Widespread musculoskeletal pain assoc. w/:
    1. Stiffness
    2. Paresthesia
    3. Cognitive disturbances (foggy)
    4. Poor sleep
    5. Fatigue
    Treatment
    1. Regular exercise
    2. Antidepressants (TCAs, SNRIs)
    3. Anticonvulsants (phenytoin, carbamazepine, topiramate, etc)
  56. 56Idiopathic Inflammatory Myopathies (which diseases? systemic complications? epidemiology, symptoms, disease mechanism, labs)Idiopathic Inflammatory Myopathies (IIM) (Myositis):
    1. Polymyositis
    2. Dermatomyositis
    Systemic complications:
    1. Raynaud’s phenomenon
    2. Skin rash
    3. Arthritis
    4. Cardiac dysfunction
    5. Interstitial lung disease
    Epidemiology
    1. Bimodal incidence (5-15, 35-50)
    2. Females > Males, blacks
    Symptoms
    1. Proximal muscle weakness (painless)
    2. Fatigue + fever
    3. Organ involvement
    Disease mechanisms
    Muscle cells:
    1. Express MHC I AND II → T cell interaction
    2. Express surface Fas receptor → Fas-L engagement → cell death via apoptosis
    3. Express pro-inflammatory cytokines (TNF-a, IL’s)
    Labs:
    1. Anti-Jo-1
    2. Anti-SRP
    3. Anti-Mi-2 antibodies
    4. ANA+
    5. Inc. CK (and other muscle enzymes)
  57. 57Polymyositis (what is it? pathogenesis? findings? treatment?)an idiopathic inflammatory myopathy
    Pathogenesis
    1. Endomysial CD8 infiltration --> inflammation
    Findings:
    1. Progressive symmetric proximal muscle weakness (shoulders)
    Treatment
    1. Steroids --> 2. immunosuppressant (methotrexate)
  58. 58Dermatomyositis (what is it? pathogenesis? findings? complications, treatment?)an idiopathic inflammatory myopathy
    Pathogenesis:
    1. Perivascular infiltrate (perimysial) of CD4 cells around fascicle
    Findings:
    1. Bilateral proximal muscle weakness
    2. Malar rash
    3. Gottron papules (pathognomonic)
    4. Heliotrope rash (pathognomonic)
    5. Mechanic's hands
    Complications
    1. Occult malignancy
    Treatment
    1. Corticosteroids (gold)
    2. Immunosuppressants    Dermatomyositis (what is it? pathogenesis? findings? complications, treatment?)
  59. 59Myasthenia gravis (frequency? pathogenesis? symptoms? assoc. w/? diagnosis? treatment?)Most common NMJ disorder
    Pathogenesis
    1. Autoantibodies to postysynaptic ACh receptors (blockage + destruction)
    Symptoms
    1. Ptsosis
    2. Diplopia
    3. Weakness worsening with use
    Assoc. w/
    1. Thymoma
    2. Thymic hyperplasia
    Diagnosis
    1. Edrophonium test
    Treatment
    1. Pyridostigmine
  60. 60Lambert Eaton myasthenic syndrome (frequency, pathogenesis, symptoms, assoc. w/?)uncommon
    Pathogenesis
    1. autoantibodies to presynaptic Ca channel --> dec. ACh release
    Symptoms
    1. Proximal muscle weakness
    2. Autonomic symptoms (dry mouth, impotence)
    3. Weakness improves w/ use
    Assoc. w/ (SCALP)
    1. Small cell lung cancer
    2. Cervical cancer
    3. Adenocarcinomas
    4. Lymphomas (H + NH)
    5. Prostate cancer
    Minimal effect with AChE inhibitor
  61. 61Myositis ossificansHeterotopic ossification of skeletal muscle following muscle trauma
    Most often seen in upper or lower extremity
    "suspicious mass" at site of trauma OR incidental finding
  62. 62Scleroderma (systemic sclerosis) (epidemiology, about, symptoms, types)Epidemiology
    - 75% female
    About:
    Triad of:
    1. Autoimmunity
    2. Noninflammatory vasculopathy
    3. Collagen deposition w/ fibrosis
    Symptoms
    1. Sclerosis of skin (puffy, taut skin w/o wrinkles)
    2. Fingertip pitting
    3. Renal sclerosis
    4. Pulmonary sclerosis (death)
    5. Cardiovascular sclerosis
    6. Sclerosis of GI systems
    Types:
    1. Diffuse scleroderma
    - Widespread skin involvement
    - Rapid progression, early visceral symptoms
    - Anti-Scl-70 (anti-DNA topoisomerase I)
    2. Limited scleroderma
    - Limited skin involvement confined to fingers + face, benign clinical course
    - CREST
    Calcinosis
    Raynaud phenomenon
    Esophageal dysmotility
    Sclerodactyly
    Telangiectasia
  63. 63Raynaud Phenomenon (pathogenesis, types, treatment)Pathogenesis
    - arteriolar (small vessel) vasospasm due to cold --> dec blood flow to skin --> color change (white, blue, red)
    - often in fingers and toes
    if 1* --> Raynaud disease
    if 2* --> Raynaud syndrome
    1. Mixed connective tissue disease
    2. SLE
    3. CREST (limited scleroderma)
    - digital ulceration seen
    Treatment
    1. Ca channel blockers
  64. 64Skin Layers, epidermis layersSkin: epidermis, dermis, subcutaneous fat
    Epidermal layers (surface to base):
    Californians Like Girls in String Bikinis
    1. Corneum
    2. Lucidum
    3. Granulosum
    4. Spinosum
    5. Basale    Skin Layers, epidermis layers
  65. 65Epithelial cell junction proteins (tight junction? adherens junction? desmosome? gap junction? integrins? hemidesmosomes?)Epithelial cell junction proteins (tight junction? adherens junction? desmosome? gap junction? integrins? hemidesmosomes?)
  66. 66—
  67. 67What is: hyperkeratosis Parakeratosis Hypergranulosis Spongiosis Acantholysis AcanthosisWhat is: hyperkeratosis Parakeratosis Hypergranulosis Spongiosis Acantholysis Acanthosis
  68. 68—
  69. 69—
  70. 70—
  71. 71angiosarcoma? glomus tumor? kaposi sarcoma?angiosarcoma? glomus tumor? kaposi sarcoma?angiosarcoma? glomus tumor? kaposi sarcoma?
  72. 72—A) - impetigo
    - superficial skin infection
    - S. aureus OR S. pyogenes
    - highly contagious
    B) - Bullous impetigo
    - has bull
    - usually caused by S. aureus
    C) - Erysipelas
    - infection of upper dermis + superficial lymphatics
    - S. pyogenes
    - well-defined demarcation between infected + normal skin
    D) - Cellulitis
    - acute/painful spreading infection of deeper dermis and subcutaneous tissues
    - S. aureus or S. pyogenes
    E) Abscess
    - collection of pus from a walled-off infection within deeper skin
    - almost always S. aureus
    F) - necrotizing fasciitis
    - Deeper tissue injury
    - anaerobes or S. pyogenes
    - crepitus from methane/CO2 production
    G) - Staph scalded skin syndrome
    - exotoxin destroys keratinocyte attachments in strum granulosum ONLY
    - there's fever
    - erythematous rash + sloughing off upper epidermis    A) - impetigo - superficial skin infection - S. aureus OR S. pyogenes - highly contagious B) - Bullous impetigo - has bull - usually caus...
  73. 73—H) herpetic whitlow
    I) molluscum contagiosum
    - umbilicate papule caused by poxvirus
    - pox virus
    J) - hairy leukoplakia
    - lateral tongue painless plaques
    - can't be scraped off
    - EBV + HIV
    - not thrush (scrapable) or leukoplakia (precancerous)    H) herpetic whitlow I) molluscum contagiosum - umbilicate papule caused by poxvirus - pox virus J) - hairy leukoplakia - lateral tongue p...
  74. 74—
  75. 75—
  76. 76—Basal Cell Carcinoma
    - most common skin cancer
    - sun-exposed areas of body
    - locally invasive, but rarely metastasizes
    A) rolled borders + central ulceration + telangiectasia
    OR
    B) non healing ulcers w/ infiltrating growth
    OR
    C) Scaling plaque (superficial BCC)
    D) BCC has palisading nuclei    Basal Cell Carcinoma - most common skin cancer - sun-exposed areas of body - locally invasive, but rarely metastasizes A) rolled borders ...
  77. 77—Squamous cell carcinoma
    Second most common skin cancer
    Assoc. w/
    1. Excessive exposure to sunlight
    2. Immunosuppression
    3. Arsenic exposure
    Characteristics
    1. Locally invasive
    2. May spread to lymph node
    3. RARELY metastasize
    G) - keratin pearls
    Actinic keratosis - scaly plaque --> precursor to squamous cell carcinoma
    Keratoacanthoma - a variant that grows rapidly (4-6 weeks) and may regress spontaneously over months    Squamous cell carcinoma Second most common skin cancer Assoc. w/ 1. Excessive exposure to sunlight 2. Immunosuppression 3. Arsenic exposu...
  78. 78—I) - flat melanoma
    J) - nodular melanoma (more dangerous)
    K) - lentigo maligna
    L) - aural lentiginous (in asians and blacks)
    Pathogenesis
    1. Often - BRAF kinase driving mutation
    Risk factors
    1. pale skin
    2. sunlight exposure
    Prognosis
    1. Depth of tumor correlates w/ risk
    2. Significant risk of metastasis
    ABCDE's
    Asymmetry
    Border irregularity
    Color variation
    Diameter > 6 mm
    Evolution over time
    Treatment
    1. Excision with wide margins
    2. If BRAF V600E mutation --> vemurafenib    I) - flat melanoma J) - nodular melanoma (more dangerous) K) - lentigo maligna L) - aural lentiginous (in asians and blacks) Pathogenesis...
  79. 79osteogenesis imperfecta (causes, genetics, findings)Autosomal dominant defect in collagen type I synthesis --> structurally weak bone
    Findings
    1. Multiple fractures of bone (can mimic child abuse, but bruising is absent)
    2. Blue sclera (thinning of scleral collagen)
    3. Hearing loss (bones of middle ear fracture easily)
  80. 80Osteomyelitis (about, pathogenesis, causes, symptoms, diagnosis)About
    infection of marrow + bone (mostly in children)
    Pathogenesis
    transient bacteremia (children) --> seeds metaphysis
    open-wound bacteremia (adults) --> seeds epiphysis
    Causes:
    S. aureus - most common cause
    N. gonorrhoeae - sexually active young ppl
    Salmonella - sickle cell patients
    Pseudomonas - diabetics/IV drug users
    Pasteurella - cat/dog bites
    My. tuberculosis - Pott's disease
    Symptoms
    1. Bone pain w/ signs of infection (fever)
    2. Lytic focus (abscess) surrounded by sclerosis of bone on x-ray
    Diagnosed via blood culture
  81. 81Osteoid osteoma + osteoblastomaOsteoid osteoma
    - benign tumor of osteoblasts
    - young adults
    - bony mass < 2 cm in diaphysis w/ radiolucent core
    - bone pain that resolves w/ aspirin
    Osteoblastoma
    - bony mass > 2 cm in vertebrae
    - bone pain that does not resolve w/ aspirin
  82. 82chondroma (what? where?)- benign tumor of cartilage
    - arises in the medulla of small bones of the hands and feet
  83. 83chondrosarcoma (what? where?)- malignant cartilage-forming tumor
    - arises in medulla of pelvis or central skeleton
  84. 84X-linked muscular dystrophy (types? presentation?)Causes
    Spontaneous mutation --> Deletion of dystrophin --> muscle cytoskeleton can't be anchored to extracellular matrix
    A) Duchenne muscular dystrophy
    - dystrophin deletion
    1. proximal muscle weakness at 1 yr -->
    2. Cal pseudhypertrophy (replacement of calf muscle w/ fat)
    3. Serum creatinine kinase elevated (meaning there's damaged muscles)
    Death:
    - cardiac failure (myocardium affected)
    - respiratory failure
    B) Becker muscular dystrophy
    - mutated dystrophin
    - milder presentation

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Organ modules Flashcards on MSK-Connective tissue, created by Eric Zhang on 27/02/2017.
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Eric Zhang
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