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MSK II: Test 1 > Mm/Nn/Bone Buzzin > Flashcards

Mm/Nn/Bone Buzzin Flashcards

1
Q

anti-mi2 abs

A

dermatomyositis

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2
Q

perifascicular atrophy

A

myofiber atrophy at edges of fascicles = dermatomyositis

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3
Q

campylobacter infection

A

GB

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4
Q

ascending paralysis/areflexia and infection

A

GB

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5
Q

onion bulb neuorpathy

A

chronic inflammatory demyelinating polyneuropathy

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6
Q

sexual dysfunction, tingling hands

A

DM

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7
Q

distal symmetric neuropathy, renal failure

A

uremic neuropathy

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8
Q

foot looks like its in a high heel

A

CMT - inherited peripheral neuropathy - mm. atrophy, sensory loss, foot deformities

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9
Q

painless weakness, thymom

A

MG

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10
Q

extremity weakness, neuroendocrine carcinoma

A

LEMS

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11
Q

mm. effect from corticosteroids

A

type II atrophy

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12
Q

heliotrope rash

A

dermatomyositis - proximal mm. weakness first - perifascicular atrophy

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13
Q

proximal mm. weakness first?

A

think dermatomyositis or polymyositis

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14
Q

endomysial inflamm. cells in mm?

A

polymyositis

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15
Q

quad weakness, age 70

A

inclusion body myositis

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16
Q

drug given for high cholesterol

A

= statin

- worry about myopathy!!!

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17
Q

dystrophin gene

A

completely gone in duchene
reduced in becker’s muscular dystrophy

on x chromosome

walking delayed

see atrophic myofibers, variation in mm. size, fatty replacement!!!

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18
Q

sustained mm. contractions

A

myotonic dystrophy - skeletal mm. weakness, cataracts, endocrinopathy, cardiomyopathy

CTG triplet repeats

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19
Q

glucose accum. in mm. cells

A

mcArdles disease - glycogen storage disease

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20
Q

ragged red fibers

A

mitochondrial myopathies

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21
Q

schwanomma

A

loss of merlin gene

cause sx by local compression: CPA –> problems with eigth nerve = acoustic neuroma

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22
Q

neurofibroma

A

have schwannoma (perineural) components but also fibroblasts, mast cells and spindle cells

superficial cutaneous = pedunculated

diffuse neurofibromas = plaque like

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23
Q

MPNST

A

malignant peripheral nerve sheath tumor - 1/2 arise in NF1 pts. d/t transformation of plexiform neurofibroma

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24
Q

HOXD13

A

brachydactylyl - short boroad terminal phalanges of first digits

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25
Q

FGFR3 mutation

A

achondrolplasia = short stature, short limbs, frontal bossing

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26
Q

COL1A1 mutation

A

osteogeneisis imperfecta –> bone fragility

“brittle bone disease” problem w/ type 1 collagen

poor teeth, blue sclera, fractures

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27
Q

marble bone diseease

A

prob. w/ metabolic pathway –> bad fn. in osteoclasts = oste0petrosis

chalky bones w/ earl myer flask shape

see anemia, thrombocytopenia, leukopenia

d/t CA2 mutation = no carbonic anydrase = inability for osteoclasts to produce acidic environment

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28
Q

osteopenia

A

idiopathic, postmenopause, hypothyroid overtreatment (too much T4)

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29
Q

cement lines

A

paget disease = overworking osteoclasts, osteoblasts can’t keep up

see mosaic pattern of lamellar bone = “cement lines”

pain in affected bone, d/t microfractures, increased heat

“saber bone”

increased risk of sarcoma

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30
Q

rosary, no vit D

A

rickets in kids, osteomalacia in adults

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31
Q

dissecting osteitis

A

hyperPTH - “brown tumor”

most commonly PTH adenoma

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32
Q

chronic renal failure

A
  1. uremic neuropathy = distal, symm. neuropathy

2. renal osteodystrophy = d/t acidosis –> osteopenia ; no vit D –> osteomalacia

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33
Q

too much corticosteroids?

A
  1. type II mm. atrophy
  2. avascular necrosis/ osteonecrosis
    - w/ avascular necrosis see saponification and the head of the femur looks yellow
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34
Q

cause of osteomyelitis

A

** systemic sx **

staph aureus in cases where organism can be isolated ; another less common cause is TB (pott disease)

sequestrum = inflamm. –> dead bone

involcrum = osteoblasts surround infected bone, wall it off

35
Q

most common bone malignances?

A

i. Mets
ii. Multiple Myeloma
iii. osteosarcoma – younger than 25
iv. chondrosarcoma – older than 40
v. Ewing sarcoma

most tumors arise from metaphysis (Giant cells from epiphysis, Ewing sarcoma from diaphysis)

36
Q

tumor in epiphysis?

A

giant cell tumor

37
Q

tumor in diaphysis?

A

ewing sarcoma

38
Q

osteoblastomas

A

osteoid osteoma = tumor in the heel, 2 cm

  • can become large, not much relief from NSAIDs
  • seen in spine

Morphology:
• round-to-oval masses of hemorrhagic gritty tan tissue
• well circumscribed and composed of randomly interconnecting trabeculae
• benign cytologic features

39
Q

osteosarcoma

A

most common primary bone malig.

younger than 20 years

metaphysis, knee - or other larger bones

painful

“codman triangle”

spread to lungs!!!!!!!

40
Q

older person, central pelvic lesion

A

chondrosarcoma

41
Q

sessile stalk growing out of bone

A

osteochondroma - bone follows the mm. line, resected and have bone covered w/ cartilage

almost always benign

42
Q

chondromas

A

benign tumors of hyaline cartilage that usually occur in bones of enchondral origin.

enchondromas = arise within the medullary cavity (seen on right)

  • most common of the intraosseous cartilage tumors and are usually diagnosed in individuals 20 to 50 years of age.
  • Typically, they appear as solitary metaphyseal lesions of tubular bones of the hands and feet.

juxtacortical chondromas = surface of bone
- The radiographic features consist of circumscribed lucencies with central irregular calcifications, a sclerotic rim and an intact cortex.

well circumscribed!

mafuccii syndrome: lots of endchondromas

43
Q

endosteal scalloping

A

chondrosarcoma - 40 years +

  • see cartilage malignant tumors - calcified matrix with flocculent densities

“scalloping with flocculent densities”

axial skeleton

grade 3 –> spread to lungs

44
Q

child w/ swollen leg

A

ewing sarcoma - small round blue cell tumor in “rosetic balls”

“onion skinning”

diaphysis of long bones

often have systemic findings as well!

onion skinning/starburst pattern - stain shows its rich in glycogen

45
Q

soap bubble

A

giant cell tumor - epiphyseal location

46
Q

fluid fluid levels on CT

A

aneurysmal bone cyst - metaphysis of long bones

47
Q

fibroblasts in pinwheel formation

A

Fibrous Cortical Defect and Nonossifying Fibroma (same tumor):
• Fibrous cortical defects (also known as metaphyseal fibrous defects) are extremely common, present in 30% to 50% of children older than 2 years.
• The vast majority arise eccentrically in the metaphysis of the distal femur and proximal tibia, and almost half are bilateral or multiple.
• Fibrous cortical defect: most common, they are small, about 0.5 cm in diameter.
• Nonossifying fibroma: Those that grow to 5 or 6 cm in size; these are usually not detected until adolescence or adulthood

asymptomatic, biopsy rarely necessary

48
Q

ground glass stopper appearance in bone

A

chinese character pattern = fibrous dysplasia thats intramedullary and well circumscribed

localized develop. arrest - see hazy on xray

monostotic fibrous dysplasia: boys and girls, femur, tibia, jaw bones, usually stops enlarging and cured by curettage

polyostotic fibrous dysplasia: seen at younger age, femur, craniofacial involved, results in severe progressive disease and deformities –> sometimes goes to sarcoma rarely

49
Q

mccune albright syndrome

A

fibrous dysplasia associated with café-au-lait skin pigmentations and endocrine abnormalities, especially precocious puberty

50
Q

onion skinning

A

ewing sarcoma

vs. onion bulbing - chronic inflammatory demyelinating polyneuropathy

51
Q

pseudohypertrophy

A

muscular dystrophy/ Becker/Duchenne = enlargement of the lower leg

note: duchenne is more common that Becker’s

52
Q

rash around the eyes - violet rash

A

= dermatomyositis - proximal mm. weakness
perfifascicular inflammation
gottron’s papules
- can lead to interstitial lung disease or cardiac failure

53
Q

seum protein gamma spike

A

think multiple myeloma - bence jones proteins in urine, lytic lesions in the back, bone marrow biopsy shows “clock faced nuclei”

54
Q

osteoarthritis

A

problem of repair, seen in late 50’s, insiduous
articular cartilage looks rough, bony spur, subchondral cysts, subchondral sclerosis, osteophyte, thinned cartilage

affects hips, knees, large joints first

55
Q

rheumatoid arthritis

A

clinical course: slowly insidious malaise, fatigue, MSK pain, smmetric involvement of small joints

inflammation, pannus, fibrous/bony ankylosis, eroding cartilage

AI disorder of CD4 T helper cells - TNF plays major role!!!

symmetric arthritis of small joints in hands and feet: large PIPs, ulnar deviated fingers

looks red and ragged - turbid synovial fluid

its a systemic disease: have skin granulomas (nodule on elbow) and developing vasculitis

high RF = high chance of vasculitis
CCP test = screening for RA

56
Q

HLA-DRB1

A

RA

** NOTE: TNF plays a major role and antagonists of TNF are central to tx!

57
Q

ANA +

A

think juvenile idiopathic arthritis OR SLE

  • in JIA - see systemic disease,
58
Q

maffucci syndrome

A

multiple enchondromas - hyaline cartilage thats benign w/in the finger joints

also worry about ollier disease

59
Q

chinese characters

A

fibrous dysplasia - see ground glass appearance - see fibrous tissue w/in the bone

60
Q

t 11;22

A

think PNET - Ewing sarcoma

61
Q

HLA-B27

A

think seronegative spondyloarthropathies - involve SI joint - absence of rheumatoid factor

  • ankylosing spondylitis
  • reactive arthritis (reiter syndrome)
62
Q

SI joint fushion

A

ankylosing spondylitis - HLAB27 - bamboo spine - destruction of articular cartilage, starts at SI joints

63
Q

conjunctivitis

A

think reactive arthritis - reiter syndrome
HLAB27
arthritis in PIPs, and dips

conjunctivitis, urethritis, arthritis

think chalmydia, shiella, salmonella, campylobater — assoc. w/ GB

64
Q

CD

A

enteritis associated arthritis

yersinia, salmonelal, shigella, campylobacter

arthritis involves knes and ankles

65
Q

pencil cup deformity

A

psoriatic arthritis - see psoriasis over the wrists - DIPs are first to be affected symmetrically

66
Q

fever and painful swollen joint

A

infectious/suppurative arthritis

  • see leukocytosis and elevated sed rate
  • joint aspiration is purulent
  • think staph aureus in adults (or gonorrhea)
  • salmonella (SS disease), or pneumococcal in kids
67
Q

erythema multiforme

A

lyme arthritis - borrelia burgdorferi

arthritis of large joints that migrates

68
Q

gout

A

acute arthritis d/t monosodium urate (MSU) — always see elevated plasma urate levels!!!

  • see overproduction in leukemia, with very elevated levels
  • see normal levels in CKD, with decreased uric acid excretion

YIPA

think alcohol, older, obese, metabolic syndrome

defined x-linked HGPRT

69
Q

psuedogout

A

less symptomatic - see calcium pyrophosphate dehydrate
** older than 50 years, can be confused w/ osteoarthritis

  • rhomboid dimension - effects knes, wrists, elbows, shoulders, ankles
70
Q

seronegative spondyloarthropathies

A

involve SI and vertebral joints - often assoc. w/ HLAB-27

  1. ankylosing spondylitis = bamboo spine, HLA b27
  2. Reactive arthritis = chlamydia
  3. enteritis arthritis = GB
  4. psoriatic arthritis = psoriasis on wrist
71
Q

fluctuant cyst on the wrist

A

ganglion/synovial cyst - small cyst lacking a cell lining near joint capsule/tendon sheath

synovial cyst = herniation of synovium through a joint capsule

baker cyst = synovial cyst in popliteal fossa, with RA

72
Q

tiger striping finger like projectons

A

tenosynovial giant cell tumor

  • benign neoplasm of joint
  • diffuse type - see tiger striping - larger joints
  • localized type - see discrete nodule

tx: M-CSF antagonist

73
Q

pinwheel swirling pattern

A

= undifferentiated pleomorphic sarcoma = malignant fibrous histiocytoma

***** most often seen tumor in older patient in deep thigh - presents w/ nodule or pain

TUMOR CELLS LACK DIFFERENTIATION ALONG NORMAL LINES!!

gray white fleshy mass, shows pinwheel formation and things that looks like weird giant cells.

74
Q

herring bone

A

fibrosarcoma tumor
- 52 y/o man, poweterior arm
large, ugly, gray

75
Q

biphasic appearance

A

synovial sarcoma - occurs usually around knee w/ dystrophic calcification and spindle cells

kiss of death. 25% survival

76
Q

soft, mobile painful tumor on triceps

A

lipoma = benign fat tumor

77
Q

27 y/o w/ mass in thing, below fascial plane, shows lipids

A

liposarcoma

78
Q

hx of trauma, young adult, upper extremity

A

nodular fasciitis - go along anterior fascial plane - circumscribed, benign

79
Q

dupuytren contracture

A

superficial fibromatosis = nodular thickening of palmar fascia

on biopsy see lots of fibroblasts

80
Q

large infiltrative mass, in 20 y/o woman, circumscribed, along fascial plane

A

deep fibromatosis - desmoid tumor - infiltrate but DONT metastastasize

gray, white, rubbery, histology has lots of collagen

81
Q

tumor in child coming out of orifice/mucosal surface

A

rhabdomyosarcoma = malignant mesenchymal tumor

  1. alveolar
  2. embryonal - small round blue cells = sarcoma bortyroides (vagina)

adult form = pleomorphic rhabdomyosarcoma - always bad!!!

82
Q

benign, fatty tumor in uterus

A

leiomyoma = smooth mm. tumor

83
Q

+actin/desmin stain

A

leimoyosarcoma = deep soft tissues, retroperitoneal tumor

painless firm mass

mets to lungs

MSK II: Test 1 (7 decks)

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