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SD IV > MSK > Flashcards

MSK Flashcards

1
Q

Which MSK condition is caused by an overuse injury of repetitive strain and chronic avulsion of the secondary ossification center of the proximal tibial tubercle?

A

Osgood Schlatter Disease
AKA traction apophysitis

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2
Q

Who is more pronged to Osgood Schlatter Disease?

A

Young males after growth spurt that run or jump with progressive anterior knee pain

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3
Q

What is Patellofemoral Syndrome?

A

Overuse injury common in young females, anterior part of the knee, exacerbated by prolonged sitting or weight bearing on a flexed knee

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4
Q

What is Legg - Calve Perthes Disease?

A

Idiopathic avascular necrosis of femoral head. COMMONLY IN MALES 5 - 7 YEARS OLD presenting with a limp and insidious hip pain

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5
Q

Who will have most likely develop slipped capital femoral epiphysis?

A

Obese young adolescent with hip/knee pain and altered gait.

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6
Q

What is a greenstick fracture?

A

Incomplete fracture extending partway through width of the bone, following bending stress, bone fails on tension side

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7
Q

What is the pathophysiology of Achondroplasia?

A

Failure of longitudinal bone growth, activation of fibroblast growth factor receptor inhibits chondrocyte proliferation. They will have short limbs and normal size torso and head or large head

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8
Q

What causes Osteoporosis?

A

Decrease in bone mass, increase in bone resorption (osteoclasts) related to a decrease in estrogen and old age. Can be secondary to drugs, hyperparathyroidism, malabsorption and multiple myeloma

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9
Q

How do you diagnose Osteoporosis?

A

DEXA x-ray at the lumber spine, total hip and femoral neck with a T score of less than 2.5 or by fragility fracture at the hip or vertebrae

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10
Q

How do you prevent Osteoporosis?

A

Regular weight bearing exercises and Ca+ and vitamin D intake
Tx: Bisphosphonates, teriparatide, SERMs,

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11
Q

If a patient presents with a Colle’s fracture, kyphosis, acute back pain, loss of height, vertebral compression fractures, femoral neck and distal radial fracture, what is the likely diagnosis?

A

Osteoporosis

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12
Q

What is Osteopetrosis?

A

Failure of normal bone resorption due to defective osteoclasts, thickened, dense, brittle bones that are prone to fracture.

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13
Q

What causes Osteopetrosis?

A

Mutation (CAII) impairs the ability of osteoclast to generate acidic environment necessary for bone resorption.

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14
Q

What can Osteopetrosis result in?

A

Cranial nerve impingement and palsies due to narrowed foramina.

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15
Q

Defective mineralization of what will cause osteomalacia/rickets?

A

Osteoid or cartilaginous growth plates (children) most commonly due to a vitamin D deficiency

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16
Q

What are the clinical features of Rickets?

A

Bowlegs (genu varum), beadlike costochondral junctions, craniotabes, increase in ALP and PTH, decrease in Ca, Vitamin D and PO43

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17
Q

Which bone disease is caused by bone remodeling, increased in osteoclasts and osteoblast?

A

Paget’s Disease
Osteitis Deformans

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18
Q

What are the vital levels of Paget’s Disease?

A

Normal Serum Ca+, phosphorus and PTH levels
Increased ALP
Mosaic pattern of woven and lamellar bone, long bone chalk stick fractures

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19
Q

What can Paget’s disease lead to?

A

Increase in blood flow causing high cardiac output failure and increase in the risk of osteosarcoma

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20
Q

What are some clinical features of Paget’s disease?

A

Males, increased in hat size, hearing loss due to skull deformity

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21
Q

What are the stages of Paget’s disease?

A

First Stage: Lytic (osteoClasts)
Intermediate (mixed): Osteoclast and Osteoblast
Mosaic, Sclerotic/blastic: osteoblast

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22
Q

What is the tx for Paget’s disease?

A

Bisphosphonates

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23
Q

What is the pathophysiology of Avascular necrosis of bone?

A

Insufficiency of medial circumflex femoral artery, infarction of bone and marrow

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24
Q

What are some causes of Avascular necrosis of bone?

A

CAST Bend LEGS
Corticosteroids, Alcohol, Sickle cell, Trauma, SLE, Legg CalvePerthes, Gauchers, slipped capital femoral epiphysis

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25
Q

Brown tumors due to fibroma replacement of bone, subperiosteal thinning, idiopathic or parathyroid hyperplasia (increase in PTH), adenoma carcinoma is which disease?

A

Osteitis Fibrosa Cystica (primary hyperparathyroidism)

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25
Q

Brown tumors due to fibroma replacement of bone, subperiosteal thinning, idiopathic or parathyroid hyperplasia, adenoma carcinoma is which disease?

A

Osteitis Fibrosa Cystica

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26
Q

How does secondary hyperparathyroidism differ from primary hyperparathyroidism?

A

Secondary hyperparathyroidism has a decrease in Ca+ and Primary hyperparathyroidism has an increase in PTH

27
Q

Which primary benign bone tumor is most common in males under 25 at the metaphysis of long bones?

A

Osteochondroma

28
Q

What primary bone tumor occurs in middle-aged males at the surface of the facial bones and associated with Garner syndrome?

A

Osteoma

29
Q

What primary bone tumor presents with bone pain worse at night relieved by NSAIDs and is smaller than 2 cm?

A

Osteoid osteoma

30
Q

What primary benign bone tumor is present at the cortex of long bone?

A

Osteoid osteoma

31
Q

Which primary bone tumor is unresponsive to NSAIDS and larger than 2 cm?

A

Osteoblastoma

32
Q

What is the location of Osteoblastoma?

A

Vertebrae

33
Q

What primary benign cartilage disorder is located at the medulla of small bones of the hand and foot?

A

Chondroma

34
Q

What is a Giant cell tumor?

A

Locally aggressive benign tumor, neoplastic mononuclear cells that express RANKL and reactive multinucleated giant cells

35
Q

What will a Giant cell tumor appear as on an x ray and where is it located?

A

Soap bubble appearance
Epiphysis of long bones (knee)

36
Q

What is Osteosarcoma?

A

Pleomorphic osteoid producing cells (malignant osteoblasts)
Presenting with pain and fractures

37
Q

What is the location of Osteosarcoma?

A

Metaphysis of long bone, knee

38
Q

What are the predisposing risks of Osteosarcoma?

A

Paget’s, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome, typically less than 20-year-old males

39
Q

Where is Chondrosarcoma located?

A

Medulla of the pelvis, proximal femur and humerus, in pts older than 50

40
Q

Which malignant bone tumor is common in white males less than 15 years old?

A

Ewing’s Sarcoma

41
Q

What is the translocation of Ewing’s sarcoma?

A

11:22, 11 + 22 = 33 (Patrick Ewing’s Jersey #)

42
Q

What is Ewing’s Sarcoma?

A

Anaplastic small blue cells of neuroectodermal with an onion skin periosteal

43
Q

Which site of the bone is Ewing’s Sarcoma most likely to be located at?

A

Diaphysis of long bone, femur, pelvic

44
Q

What is the pathogenesis of Osteoarthritis?

A

Mechanical- wear and tear destroying the articular cartilage, degenerative joint disorder
Inflammation with inadequate repair

45
Q

What are the predisposing factors of Osteoarthritis?

A

Age, female, obesity and joint trauma

46
Q

What is the pathogenesis of Rheumatoid arthritis?

A

Autoimmune- inflammation induces a formation of a pannus (proliferative granulation tissue) that erodes articular cartilage and bone

47
Q

What is the RF factor?

A

IgM antibody that targets IgG Fe region, anti-citrullinated

48
Q

What are the predisposing factors for Rheumatoid Arthritis?

A

Female, HLADR4, tobacco smoking and positive RF factor

49
Q

What are the clinical presentations of Osteoarthritis?

A

Pain in weight bearing joints after use (at night) improving with rest
Asymmetric joint involvement
Knee cartilage loss begins medially (bow leg)
No systemic symptoms

50
Q

What are the clinical presentations of Rheumatoid Arthritis?

A

Pain, fever, fatigue, weight loss, swelling and morning stiffness lasting long than 1 hour/ 30 minutes improving with use, systemic joint involvement

51
Q

What are additional findings in RA?

A

1.) fibrinoid necrosis with palisading histocytes
2.) pneumonoconiosis- Caplan’s syndrome
3.) ILD
4.) pleuritis
5.) Pericarditis
6) anemia
7.) neutropenia + splenomegaly = Felty syndrome
8.) AA amyloidosis
9.) Sjogren syndrome
10.) Scleritis
11.) Carpal tunnel

52
Q

What are the predisposing factors of Gout?

A

1.) Obesity
2.) Alcohol/dehydration
3.) Thiazides
4.) HT
5.) Males
6.) Red meats and seafood
7.) Diabetes
8.) Dyslipidemia
9.) Hyperuricemia
-caused by under excretion of uric acid of renal failure
-caused by hyper excretion of uric acid by Lesch Nyhan syndrome and Von Gierke
) trauma/surgery

53
Q

What are the symptoms of Gout?

A

Asymmetric joint distribution, swollen, red and painful, usually of the big toe MTP, TOPHUS FORMATION,

54
Q

What is tx for acute Gout?

A

NSAIDs such as indomethacin, glucocorticoids, colchicine

55
Q

What is the tx for chronic Gout?

A

Xanthine oxidase inhibitors such as allopurinol, febuxostat

56
Q

What is Pseudogout/ calcium pyrophosphate deposition disease?

A

Occurs in patients over 50 yrs old in both sexes. Pain, swelling and acute inflammation around the knee

57
Q

What other conditions can be associated with pseudogout/ calcium pyrophosphate?

A

Hemochromatosis, hyperparathyroidism, joint trauma

58
Q

What would you see under a polarized light for Pseudogout/ calcium pyrophosphate?

A

cartilage calcification, blue rhomboid crystals

59
Q

What is the tx for acute pseudogout/calcium pyrophosphate?

A

NSAIDs, colchicine, glucocorticoids

60
Q

If a young male presents with daily spiking fevers, salmon pink macular rash, arthritis, anterior uveitis, leukocytosis, thrombocytosis, anemia, increased ESR and C reactive protein, what is the likely diagnoses?

A

Systemic juvenile idiopathic arthritis

61
Q

What is the tx for systemic juvenile idiopathic arthritis?

A

NSAIDS, steroids, methotrexate, TNF inhibitors

62
Q

What autoimmune disorder is characterized by the destruction of exocrine glands (lacrimal and salivary) by lymphatic infiltration, predominantly in 30-40 yrs old females?

A

Sjogren’s Syndrome

63
Q

What are the clinical features of Sjogren’s Syndrome?

A

Inflammation joint pain, keratoconjunctivitis sicca (decreased tears), Xerostomia (decreased salvation), Rf factor and can be present with RA, enlarged parotoid gland

64
Q

What are common causes of Septic Arthritis?

A

S. Aureus, Streptococcus, and Neisseria gonorrhea, unilateral, affected joint is swollen, red and painful. Synovial fluid is turbid/purulent

SD IV (1 decks)

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