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Question 1

Osteomyelitis va a vascular necrosis
- pathophysiology
- osteomyelitis (MC bug, diag, X-ray results)

Answer 1

O- bacterial infection of bone marrow and bone;
- s. Aureus
- blood culture
- X-ray - sclerosis surrounds necrosis
A- ischema induced necrosis of bone marrow and bone
- MCC: fracture
- other causes: trauma, sickle cell, steroids, caisson disease

Question 2

Osteoma
- pathophysiology
- associated GI manifestation
- MC location

Answer 2

Benign tumor of bone
-Associated with Gardner (FAP plus osteoma plus fibromatosis
- surface of facial bones

Question 3

Osteoid osteoma vs osteoblastoma
- benign or malignant
- MC location
- treatment(osteoid osteoma)
- findings on imaging

Answer 3

Osteoid osteoma
- benign tumor of osteoblasts ( 25 yo male)
- cortex of the diaphysis of long bones such as femur
- aspirin relieves bone pain
- X-ray: sclerotic bone surrounds osteoma (radiolucent)

osteoblastoma
- malignant
- location vertebrae
- does not respond to aspirin

Question 4

Osteochondroma
- pathophysiology
- complication (

Answer 4

Benign tumor of bone with overlying cartilage

May transform to a chrondrosarcoma (malignant tumor of cartilage in medulla of pelvis or central skeleton

Question 5

Chondroma vs chondrosarcoma

Answer 5

chrondrosarcoma (malignant tumor of cartilage in medulla of pelvis or central skeleton

Chondroma- benign tumor of cartilage in the medulla of small bones in the hands and feet

Question 6

Osteosarcoma
- pathophysiology
- RF
- location
- presentation
- X-ray findings

Answer 6

• malignant tumor of osteoblasts
• RF: familial retinoblastoma, paget , and radiation exposure
• netaphysis of long bones (proximal tibia and distal femur ) —knee
• presents as bone pain with swelling and pathological fractures
• X-ray- Codman triangle, sunburst

Question 7

Giant cell tumor
- pathophysiology
- location
- X-ray findings

Answer 7

Tumor consists of giant cells
- epiphysis of distal femur and proximal tibia - knee
- soap bubbles (reactive bone forms in reaction to the tumor

Question 8

Ewing sarcoma
- pathophysiology
- location
- biopsy findings

Answer 8

Malignant proliferation of cells from neuroectoderm origin (11;22) in mal <15 yo

diaphysis of long bones

Biopsy - small blue cells that look like lymphocytes so can be confused with lymphoma ; if hace fever and swelling can be confused with osteomyelitis

X-ray: onion skin - bone layering near the periosteum

Question 9

OA vs RA
- pathophysiology (+Hladr4 )
- affected joints
- sxs
- complications

Answer 9

RA - inflammation of the synovial joint space leads to increased amour of inflammation cells like myofibroblast therefore
- joints move (ulnar. Deviation)
- inflammation damages the articular Cartilage
- joints fuse(anklyosing )

• symmetrical PIP of hands, wrists, knees , elbows, ankles
• sxs - vasculitis , no specific symptoms such as fever malaise weight loss myalgias, rheumatoid nodules, baker cyst , pleural effusion, lymphadenopathy, interstitial lung fibrosis
• complications : ACD AND Secondary systemic amyloidosis

OA- wear and tear of articular cartilage bc of age or obesity vs trauma
- affects hip, lower lumbar spine , knees , and PIP AND DIP
- osteocytes, polishing of joints (eburnation)

Question 10

Seronegative spondylo
- location:
- types:
- complications

Answer 10

• axial skeleton
• ankylosing
  • sacroiliac joints and spine(bamboo(
  • complications: uveitis (redness blurring or blindness or aortitis leading to aortic regurgitation

Reiter
- uveitis, conjunctivitis, arthritis
- due to GI or chlamydia

Psoriatic arthritis
- axial or peripheral joints
‘Especially dip joint of hands and feet leading to sausage finger and toes

Question 11

Infectious arthritis
/ cause
- location
- symptoms

Answer 11

Bacterial (usually n. Gonorrhea ) if young adult; sauté us in children and adults

• single joint especially the kneee
• warm joint and systemic symptoms such as fever , increased wbc and esr

Question 12

Gout (types / triggers) vs pseudogout
- pathophysiology
-synovial fluid and polarized light results

Answer 12

Gout - hyperuricemia due to Lesch , unknown etiology , renal issue, leukemia or myeloproliferative disorder
-acute- uric crystals deposit and lead to arthritis of big tor
- chronic- can be triggered by meat( increase dna and rna hence increased uric acid and alcohol competes with uric acid acid for excretion leading to chalky white aggregates of uric acid called to phi in joints and tissue
- needle shape and negative (yellow parellel

Question 13

Polymyositis vs dermatomyositis
- Lab
- biopsy
- association (dermatomyositis

Answer 13

• both bilateral proximal muscle weakness but poly doesn’t involve the skin
  
  • malar rash
  • heliotrope rash ( rash around eyes )
• red pápales rash on knuckles , knees and elbows
• labs : Ana and anti Jo antibodies ; increased ck because Muscle breakdown
• biopsy- d has periwndomysial inflammation and peri vascular atrophy while p has endomysial inflammation

Association gastric carcinoma or other carcinomas

Question 14

Criteria for Kawasaki

Answer 14

Kawasaki disease is a systemic vasculitis that is most common in children age <5 of East Asian ancestry. In addition to prolonged fever (25 days), patients have at least 4 of the 5 following mucocutaneous findings:
• Conjunctivitis: bilateral, nonexudative, limbus sparing
• Oral mucosal changes: erythema, fissured lips, strawberry tongue
Polymorphous rash: often begins in perineal area
• Distal extremity changes: erythema, edema, desquamation of the hands and feet
• Cervical lymphadenopathy: >1.5-cm node

Question 15

Definitive diagnosis for neuroblastoma

Answer 15

Tissue biopsy (also check urine and serum catecjolamines

May have horners

Question 16

A 78-year-old man comes to the office due to a 6-month history of progressive bilateral buttock pain that radiates to his thighs and calves. The pain is worse with ambulation but improves with leaning on a cane or sitting; the patient has had to limit his activity as he is unable to walk more than 2-3 blocks. He has no pain at night and no problems with bowel or bladder function. Over-the-counter ibuprofen has provided moderate relief. The patient has a history of coronary artery bypass grafting 6 years earlier for 3-vessel coronary artery disease. His other medical conditions include fype 2 diabetes mellitus, hypertension, and hypercholesterolemia. Physical examination shows normal strength, reflexes, and sensation in his legs. A straight leg raise test does not reproduce the pain. Ankle-brachial index is 1.1 on the right and 1.2 on the left (normal 0.9-1.3). Hemoglobin A 1c is 8%. Which of the following is most likely responsible for this patient’s current condition?
O A. Aertoiliae-athereselerosis

duo patelts current condition?
O A. Aortoiliae-atherosclerosis
B. Diabetic neuropathy
O C. Malignant-spinal-cord-cempressien
• D. Osteoarthritis of the spine [57%]
O E. Seronegative-spondyloarthropathy
O F. Vertebral-compression fracture [8%]
O G. Vertebral-metastasis

Answer 16

Osteoarthritis of spine

Although this patient’s pain likely reflects spinal stenosis/neurogenic claudication, bot spinal stenosis/neurogenic claudication and vascular claudication can be seen in old patients with multiple atherosclerotic risk factors. In contrast to the pain of vascular claudication, that of neurogenic claudication is postural rather than exertional. It car persist at rest if the spine remains extended but is lessened by spine flexion (eg, walking uphill, leaning on an assistive device), often referred to as the “shopping ca
“ In this patient, the pattern of the pain (eg, improves when leaning on cane) € the normal ankle-brachial index are more consistent with neurologic than vascular claudication (Choice A).

Neurogenic & vascular claudication
Neurogenic claudication (pseudoclaudication)
Posture-dependent pain
• Lumbar extension worsens pain (eg, walking downhill)
• Lumbar flexion relieves pain (eg, walking while bent forward)
• Lower extremity numbness & tingling
• Lower extremity weakness
• Low back pain

Question 17

A 55-year-old man comes to the hospital due to exertional dyspnea and orthopnea for 24 hours. A week ago, the patient underwent coronary artery bypass surgery for exertional chest pain and was discharged in stable condition. He started physical therapy but had to stop due to dyspnea. He has no cough but is unable to sleep well.
Prior to surgery, the patient never had respiratory difficulty. He has a 20-pack-year smoking history but quit just before the surgery. Temperature is 37 C (98.6 F), blood pressure is 120/80 mm Hg, pulse is 88/min, and respirations are 18/min. Oxygen saturation is 95% on room air. Examination shows normal jugular venous pressure, clear lung sounds, and normal heart sounds. The sternal wound is clean and dry.
When the patient is placed supine on the examination table, he reports worsening dyspnea and has paradoxical movement of the abdomen during inspiration. There is no peripheral edema. Neurologic examination is normal. What is the most likely cause of this patient’s symptoms?
O A. Bronchospasm
O B. Pericardial effusion
O C. Phrenic nerve injury
O D. Pleural effusion
X © E. Pulmonary edema
O F. Pulmonary embolism

Answer 17

Phrenic nerve injury- paradoxical