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STEP 1 > 06: MSK > Flashcards

06: MSK Flashcards

1
Q

List two common pediatric bone fractures.

A
  1. Greenstick (bending stress; incomplete extension through bone width)
  2. Torus (axial force; simple buckle fracture of cortex)
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2
Q

Knee: Unhappy triad involves damage to which structures?

A
  1. MCL
  2. ACL
  3. Medial meniscus
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3
Q

Nerve supply to “SITS” muscles

A
  1. Supraspinatus (suprascapular n)
  2. Infraspinatus (suprascapular n)
  3. Teres minor (axillary n)
  4. Subscapularis (upper and lower subscap nn)
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4
Q

Which muscles play pivotal roles in arm abduction below 90 degrees?

A

Supraspinatus (0-15o) then deltoid (15-100o)

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5
Q

Which muscles play pivotal roles in arm abduction above 90 degrees?

A
  1. Deltoid (15-100o)
  2. Traps
  3. Serratus anterior
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6
Q

Most commonly fractured carpal bone

A

Scaphoid (typically due to fall of outstretched hand)

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7
Q

Acute carpal tunnel syndrome may be a result of (X) carpal bone dislocation

A

X = lunate

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8
Q

Which carpal bone is palpable in anatomical snuff box?

A

Scaphoid

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9
Q

Humerus surgical neck fracture: (X) muscle will become flattened and (Y) movements will be compromised.

A 
X = deltoid
Y = abduction over 15o

(Axillary n injury)

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10
Q

Humerus surgical neck fracture: sensation is lost in which areas?

A

Over deltoid and lateral aspect of upper arm (axillary n injury)

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11
Q

Pitcher presents with shoulder pain and loss of sensation over lateral forearm. What movements would you expect to be compromised?

A

Forearm flexion and supination (musculocutaneous n injury)

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12
Q

Humerus fractures: surgical neck injures (X) n, midshaft injures (Y) nerve, supracondylar injures (Z) n.

A 
X = Axillary
Y = Radial
Z = Median (if anteromedial displacement of proximal humerus)

(“ARM” from proximal to distal fractures); if humerus displaced anterolateral in supracodylar fracture, RADIAL N injured

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13
Q

67 yo M presents with finger drop on R hand. He denies history of trauma, is a retired police officer, and spends his days doing work around the house/yard. Sensation intact, and both elbow and wrist flexion/extension intact. Likely diagnosis/mechanism of injury?

A

Injury to posterior interosseous nerve (deep branch of radial) in supinator canal

(potentially due to repetitive pronation/supination such as excessive screwdriver use)

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14
Q

Use of crutches may compress (X) nerve.

A

X = radial

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15
Q

Which nerve travels with brachial artery between (X) upper arm muscles?

A

X = biceps and brachialis

Median n

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16
Q

Median nerve enters forearm and travels between which muscles?

A
  1. Two heads of pronator teres

2. Then between FDS and FDP

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17
Q

(X) nerve passes in Guyon’s canal, between which bones?

A

X = ulnar

Hook of hamate and pisiform

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18
Q

A superficial palm laceration will likely compromise which sensation/muscle movements?

A

Recurrent branch of median nerve damage most likely;
Sensation intact
“OAF” (from 1/2 LOAF) will be compromised (loss of thenar muscle group - opposition, abduction, flexion of thumb; ape hand)

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19
Q

“Waiter’s tip”, aka (X) palsy, is due to which injury?

A 
X = Erb's
Upper trunk (C5-6) of brachial plexus
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20
Q

“Total claw hand”, aka (X) palsy, is due to which injury?

A 
X = Klumpke
Lower trunk (C8-T1) of brachial plexus
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21
Q

Lumbricals have which actions and which joints?

A

Flex at MCP

Extend at PIP, DIP

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22
Q

Clawing of hand (median or ulnar claws) is more prominent with (proximal/distal) nerve lesions.

A

Distal (clawing of fingers evident at rest)

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23
Q

Housemaid’s knee: (X) is affected

A

X = pre-patellar bursa (bursitis due to repetitive kneeling)

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24
Q

Carpal tunnel: excision of (X) improves symptoms.

A

X = transverse carpal ligament (aka flexor retinaculum)

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25
Q

Aside from median nerve, which structures travel in carpal tunnel?

A

Tendons of FDP, FDS, and FPL

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26
Q

Thoracic outlet syndrome most commonly occurs in (X) triangle.

A

X = Scalene

Formed by anterior and middle scalenes and the first rib

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27
Q

A patient with a cervical rib experiences exertional arm pain due to:

A

Compression of Subclavian artery

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28
Q

Scaphoid fractures are at risk for which key complication?

A

Avascular necrosis (blood supply from radial a branch easily interrupted by fracture)

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29
Q

Most of the space in greater sciatic foramen is occupied by:

A

Piriformis (hence potential compression of sciatic nerve in this foramen = piriformis syndrome)

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30
Q

Abdominal surgery (like appendectomy) can cause injury to (X) nerve, which would manifest with which Sx?

A

X = iliohypogastric (T12-L1)

Burning/tingling pain radiating to inguinal/suprapubic region

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31
Q

Absent cremaster reflex is due to (X) nerve compromise. What other Sx would you expect?

A

X = genitofemoral (L1-2)

Decreased sensation to scrotum/labia majora and medial thigh

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32
Q

Sciatic nerve roots:

A

L4-S3

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33
Q

Tibial nerve primarily responsible for which muscle actions?

A

“TIP” = Tibial Inverts and Plantarflexes (if injured, can’t stand on TIP-toes)

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34
Q

Peroneal nerve primarily responsible for which muscle actions?

A

“PED” = Peroneal Everts and Dorsiflexes (if injured, foot dropPED)

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35
Q

Baker cyst would most likely compromise which nerve?

A

Tibial

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36
Q

Patient presents with hip drop on L side (when standing on R leg). Where’s the injury?

A

R superior gluteal n

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37
Q

Pt presents with hip drop upon walking and tends to lean torso toward L side as she walks. Where’s the injury?

A

L superior gluteal n (leans toward injured side to compensate for contralateral/R hip drop)

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38
Q

(X) nerve (enters/exits) pelvis via (Y) just to re-(enter/exit) via (Z).

A 
X = pudendal (S2-4)
Exits
Y = greater sciatic foramen
Re-enter
Z = lesser sciatic foramen (near ischial spine)
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39
Q

Pudendal nerve muscle innervation:

A

External urethral and anal sphincters; pelvic floor muscles

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40
Q

Most common elbow injury in kids (usually ages 1-4)

A

Radial head subluxation (“Nursemaid’s elbow”) - tear of annular ligament from periosteal attachment at radial neck

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41
Q

2 yo brought in by mom due to refusal to move his L arm. You notice it’s held close to his side, extended, and pronated. Kid doesn’t seem distressed until you try to move his arm. Diagnosis/mechanism and treatment?

A

Nursemaid’s elbow (radial head subluxation) likely due to sharp pull on arm when elbow was pronated and extended;
Can be resolved by supinating and flexing arm

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42
Q

Herniation of L3/L4 disc affects which spinal nerve(s)?

A

L4 and below (nerves inferior to site of herniation)

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43
Q

Difficulty in toe walking and loss of (X) reflex is due to injury at which disc level?

A

X = achilles

L5-S1 (weak plantar flexion)

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44
Q

Difficulty in heel walking is due to injury at which disc level?

A

L4-5 (weak dorsiflexion)

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45
Q

Loss of patellar reflex due to injury at which disc level?

A

L3-4 (weak knee extension)

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46
Q

(X) artery travels with (Y) nerve around surgical neck of humerus

A 
X = posterior circumflex
Y = axillary
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47
Q

(X) artery travels with (Y) nerve around midshaft of humerus

A 
X = deep brachial
Y = radial
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48
Q

(X) artery travels with (Y) nerve in popliteal fossa

A 
X = popliteal
Y = tibial
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49
Q

Which 3 ions determine electrical potential difference (voltage) across membrane?

A

Na, K, Cl

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50
Q

Hip drop can occur with intramuscular injection in which location?

A

Superomedial quadrant of buttock

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51
Q

Pt with back pain that’s worse with walking and relieved with bending forward and walking uphill. Diagnosis?

A

Spinal stenosis - usually due to degenerative arthritis of spine

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52
Q

Spinal stenosis can eventually lead to which changes/complications?

A
  1. Intervertebral disc degeneration and herniation
  2. Ligamentum flavum hypertrophy
  3. Osteophyte formation at facet joints
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53
Q

Osteonecrosis of the femoral head most likely due to (X) artery compromise in femoral neck fracture.

A

X = medial circumflex (off deep femoral a)

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54
Q

Smooth muscle contraction: key initiator is (X), which activates (Y).

A 
X = Ca (which binds calmodulin)
Y = Myosin light chain kinase
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55
Q

Smooth muscle relaxation: key initiator is (X), which comes from (Y) cells.

A 
X = NO
Y = Endothelial (Ca stimulates NO synthase and NO then diffuses into smooth muscle)
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56
Q

Smooth muscle relaxation: NO stimulates (X) which then (stimulates/inhibits) (Y).

A

X = GTP to cGMP formation
Stimulates
Y = Myosin light chain phosphatase

57
Q

Which aspect of bone formation is defective in achondroplasia?

A

Endochondrial ossification (axial, appendicular skeletons formed by cartilaginous model first, then replaced with woven/lamellar bone)

58
Q

Calvarium, facial bones, and (X) are formed by (Y) ossification. What does this process entail?

A 
X = clavicle
Y = membranous

Woven bone formed directly (no cartilage model), then remodeled to lamellar bone

59
Q

Osteoblasts differentiate from (X) and osteoclasts from (Y)

A 
X = mesenchymal stem cells (in periosteum)
Y = monocyte/macrophage precursors
60
Q

Osteoclast activity measured mainly via:

A

Urine deoxypyridinoline

61
Q

Achondroplasia: most commonly a(n) (X) mutation resulting in (activation/inhibition) of (Y)

A

X = point
Constitutive activation
Y = fibroblast growth factor (FGF) receptor (inhibits chondrocyte proliferation)

62
Q

Osteoporosis med Rx:

A
  1. Bisphosphonates (Risedronate)
  2. SERMs
  3. Denosumab (Ab against RANKL)
  4. (Rarely) calcitonin
63
Q

(X) drugs increase risk of fractures in osteoporosis patients by decreasing Ca absorption.

A

X = PPIs

64
Q

Osteopetrosis: defect in (X)

A

X = osteoclasts (incapable of producing acidic environment for bone resorption)

65
Q

Osteopetrosis: describe the characteristics of the bone

A

Thick, dense; diffuse/symmetrical sclerosis that makes bone prone to fracture

66
Q

Osteopetrosis: treatment/cure is..

A

Bone marrow transplant (since osteoclasts are derived from monocytes)

67
Q

Osteomalacia/rickets: (over/under)-activity of (X) cells and defective (Y).

A

Overactivity
X = osteoblasts (high ALP)
Y = mineralization of osteoid matrix

68
Q

Bone and liver ALP can be distinguished by which test?

A

Boiling test (bone ALP will denature)

69
Q

“Bead-like” chostochondral junction in kid is referred to as (X) rosary and is sign of:

A

X = rachitic

Rickets

70
Q

Paget’s disease: (over/under)-activity of (X) cells.

A

Overactivity

X = osteoclasts and ostoblasts (poor quality bone formation)

71
Q

T/F: Both Paget’s disease and osteoporosis present with normal serum Ca, PTH, PO4, and ALP levels.

A

False - Paget’s will have high ALP

72
Q

How might Paget’s disease affect the heart?

A

High blood flow from increased A-V shunts can cause high-output heart failure

73
Q

Paget’s: increased risk for (X) cancer

A

X = osteogenic sarcoma

74
Q

Paget’s disease Rx:

A

Bisphosphonates

75
Q

53 yo M with Hx DM II and alcoholism presents with progressive R groin/hip pain that’s exacerbated by walking. X-ray suggests osteonecrosis. What would you expect to see on microscopy?

A

Dead bony trabeculae (empty lacunae) and fat necrosis

76
Q

Osteopetrosis: (high/low) Ca, (high/low) PO4, (high/low) PTH, (high/low) ALP.

A

All normal

Note: Ca low in severe malignant disease

77
Q

Osteoblastic aka (lytic/sclerotic) bone lesions seen in which cancers?

A

Sclerotic (more indolent); prostate, SCLC, Hodgkin

78
Q

Osteolytic bone lesions seen in which cancers?

A

More aggressive lytic lesions (MM, NSCLC, NHL, RCC, Melanoma)

79
Q

Most common benign bone tumor is (X), commonly in (young/old) (M/F) population

A

X = osteochondroma

Young (under 25) males

80
Q

30 year old F with bone growth on distal femur that has soap bubble appearance on x-ray.

A

Giant cell tumor (osteoclastoma)

81
Q

Which bone tumor will have cells that express RANKL?

A

Giant cell tumor

82
Q

Pt with Hx Paget’s disease has unilateral knee pain and sunburst pattern on x-ray

A

Osteosarcoma

83
Q

Anaplastic small blue cell malignant tumor

A

Ewing sarcoma, t(11;22)

84
Q

Which hand joints are affected in osteoarthritis? Star the ones also affected in Rheumatoid arthritis.

A
  1. DIP (Heberden nodes)
  2. PIP* (Bouchard nodes)
  3. 1st CMC
85
Q

Which hand joints are commonly affected in rheumatoid arthritis and not in osteoarthritis?

A

MCP, wrist

86
Q

Rheumatoid arthritis: risk factors

A
  1. Female
  2. HLA-DR4
  3. Smoking
  4. Silica exposure
87
Q

Rheumatoid nodules histology

A

Fibrinoid necrosis with palisading histiocytes

88
Q

Patient with Hx of Rheumatoid arthritis presents with dyspnea and cough. Which lung complications of RA would you be considering?

A
  1. RA nodules (plus pneumoconiosis; Caplan syndrome)
  2. Interstitial lung disease (pulm fibrosis)
  3. Pleuritis
89
Q

Pannus versus osteophyte formation. Which is seen in RA?

A

Pannus (proliferative granulation tissue that erodes cartilage/bone);

Osteophytes (bone spurs) seen in osteoarthritis

90
Q

List two key facts in pt Hx that help distinguish gout from septic arthritis

A
  1. Timeline (hours versus days/weeks)
  2. Age
  3. EtOH use (can precipitate gout)
91
Q

Synovial fluid analysis: WBCs seen in (gout/septic arthritis).

A

Both (but much greater, over 100,000, in septic arthritis)

92
Q

Rx for tumor lysis syndrome.

A

Hydration, urine alkalinization

Allopurinol for prophylaxis

93
Q

Patient with Sjogern syndrome is at risk for which cancer?

A

MALT lymphoma (presents as parotid enlargement)

94
Q

Pencil-in-cup deformity of DIP on X-ray

A

Psoriatic arthritis

95
Q

Symmetric joint fusion, uveitis, and aortic regurgitation in 30 yo male

A

Ankylosing spondylitis

96
Q

Presence of which Ab in SLE plays a role in prognosis?

A

Anti-dsDNA (poor prognosis; renal disease present)

97
Q

List the three common causes of death in SLE

A
  1. CV disease (accelerated atherosclerosis, early MI)
  2. Infections
  3. Renal disease
98
Q

40 yo female with cough, elevated serum ACE levels, and elevated CD4/CD8 ratio in bronchoalveolar lavage.

A

Sarcoidosis

99
Q

Pt with history of sarcoid presents with hepatomegaly. What do you expect to see on liver biopsy?

A

Scattered granulomas

100
Q

Sarcoidosis Rx:

A

Steroids (if symptomatic)

101
Q

T/F: Polymyalgia rheumatica symptoms include pain/stiffness in shoulders/hips, fever, weight loss, and proximal muscle weakness.

A

False - no muscle weakness

102
Q

Progressive muscle weakness and endomysial inflammation with CD8 T cells.

A

Polymyositis

103
Q

Malar rash and perimysial inflammation/atrophy with CD4 T cells.

A

Dermatomyositis

104
Q

(X) gland type secretes via membrane-bound vesicles. Give example

A

X = apocrine (“pig snouting”)

Mammary glands

105
Q

Patient presents with severe acne. Their disease involves (X) gland secretion via (exocytosis/vesicles/lysis).

A

X = sebaceous (holocrine)

Cell lysis

106
Q

Which epithelial cell junction includes cytokeratin in structure?

A

Desmosome (macula adherens)

107
Q

Which epithelial cell junction includes Ca-dependent proteins and actin filaments?

A 
Adherens junction (zonula adherens); 
Cadherin proteins
108
Q

Hypergranulosis is seen in which disease?

A

Lichen planus

increased thickness of stratum granulosum

109
Q

Albinism: what’s the defect?

A

Low tyrosinase activity OR defective tyrosine transport (so low melanin production)

110
Q

Hyperpigmentation associated with pregnancy or OCP use

A

Melasma (“mask of pregnancy”)

111
Q

Eczema, aka (X), cannot be diagnosed without which symptom/feature?

A

X = atopic dermatitis

Pruritis

112
Q

How can you distinguish an intradermal nevus from compound/junctional nevi?

A

Intradermal is colorless (older; loses tyrosinase activity)

113
Q

Painful, itchy, hyperpigmented papules on jaw/neck after shaving

A

Pseudofolliculitis barbae

114
Q

Histology: decreased thickness of stratum granulosum, hyperkeratosis, and PMN clusters in superficial dermis.

A

Psoriasis

PMN clusters called “Munro microabscesses” and hyperkeratosis is characterized by rete ridges that extend to same level

115
Q

Facial flushing in response to heat/alcohol and bulbous nose

A

Rosacea

116
Q

Where along respiratory tract would you expect to find verrucae?

A

Verrucae = warts (HPV 6, 11)

True vocal cords (only place with SSE)

117
Q

Chronic post-mastectomy lymphedema associated with increased risk of which tumor?

A

Angiosarcoma

118
Q

Skin finding commonly mistaken for Kaposi’s sarcoma in (X) patient population. Which characteristic distinguishes the two?

A

X = AIDs

Bacillary angiomatosis (cuased by B. henselae)

PMN infiltrate in bacillary angiomatosis versus lymphocytic in Kaposi

119
Q

Cystic hygroma seen in (X) location and associated with (Y) patient population

A 
X = neck
Y = Turner's
120
Q

Tumor found under nailbed differential diagnosis:

A
  1. Subungal melanoma

2. Glomus tumor

121
Q

A glomus tumor arises from which cell type?

A

Modified smooth muscle cells (of glomus body, involved in thermoregulation)

122
Q

T/F: Both Kaposi and Bacillary angiomatosis are pruritic and painful.

A

False - neither tumors have these characteristics

123
Q

Erysipelas is caused by (X) and usually involves which layers/structures in skin?

A

X = S. pyogenes infection

Dermis and superficial lymphatics

124
Q

Abscess formation: which organism most likely the cause?

A

Almost always S. aureus

Note: abscess caused by lysosomal enzyme release from PMNs and macros

125
Q

Crepitus in (X) skin finding is the result of which substances?

A

X = necrotizing fasciitis

CO2 and methane production

126
Q

Staph scalded skin syndrome versus toxic epidermal necrolysis: what part of epithelium is being targeted?

A

SSS: keratinocytes attachment to stratum granulosum
TEN: dermal-epidermal junction

127
Q

IgA deposits at tips of dermal papillae

A

Dermatitis herpetiformis

128
Q

Painful red inflammatory lesions of subcutaneous fat (panniculitis)

A

Erythema nodosum (usually on anterior shins)

129
Q

List some infections associated with erythema nodosum

A
  1. Coccidioidomycosis
  2. Histoplasmosis
  3. TB
  4. Leprosy
  5. Strep
130
Q

Pt with Hx hep C presents with itchy red-purple papules on anterior wrist. What’s the next step in examination/management?

A

Likely Lichen Planus (Pruritic, Purple, Polygonal, Planar Papules/plaques), so check mouth mucosa for Wickham striae (reticular white lines)

131
Q

UV(A/B) dominant in sunburn. UV(A/B) dominant in photoaging.

A

B (sunBurn)

A (photoAging)

132
Q

T/F: Basal and squamous cell carcinoma are locally invasive but rarely metastasize.

A

True (unlike melanoma, with significant risk of metastasis)

133
Q

Skin cancer with “palisading” nucleus

A

BCC

134
Q

Skin cancer that’s S-100 positive

A

Melanoma

135
Q

Skin cancer associated with chronically draining sinuses and arsenic exposure

A

SCC

136
Q

Melanoma: (activating/inhibiting) mutation in (X). Which drug treatment may be helpful with this mutation?

A

Activating
X = BRAF kinase (V600E)

Vemurafenib (VE-mutation-Raf-enib), a BRAF kinase inhibitor

137
Q

(X) drugs both inhibit phospholipase A2 and stimulate (Y). What’s the function of (Y)?

A 
X = corticosteroids
Y = IKB2

Inhibitor protein of NF-KB, which originally activates COX2

138
Q

Osteoporosis Rx that’s a recombinant PTH analog (subQ)

A

Teriparatide

139
Q

Teriparatide should be avoided in which patient populations? What are its side effects/risks?

A

Paget’s or prior cancer/radiation patients (high risk of osteosarcoma)

STEP 1 (21 decks)

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