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MSK Flashcards

1
Q

Order of carpal bones (lat to med by row)

A

scaphoid/lunate/triquetrum/pisiform

trapezium/trapezoid/capitate/hamate

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2
Q

Rotator cuff muscles and action

A

Supraspinatus-abduct
Infraspinatus-lat rotation
Teres minor-adduct/lat rotation
Subscapularis-adduct/med rotation

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3
Q

Brachial plexus segments

A 
Roots-C5 to T1
Trunks-upper/mid/lower (Erb-Duchenne/Klumpke's lesion)
Divisions
Cords-lat/post/medial (wrist drop)
Branches-MC/median/ulnar
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4
Q

Brachial plexus protection from clavicle fracture

A

Subclavius muscle

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5
Q

Dislocation of humeral head

unable to abduct the arm

A

Axillary n. (C5/C6)

dislocation or surgical neck fracture

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6
Q

Midshaft humeral fracture

unable to extend wrist

A

Radial n. (C5-T1)
brachioradialis/supinator/triceps/extensors
post arm/dorsal thumb & hand sensory deficit

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7
Q

Fracture of supracondylar humerus
unable to grab objects with hand
weak wrist flexion

A

Median n. (C5-C8, T1)
opposition of thumb/lat finger flexion/wrist flexion
palmar lat hand sensory deficit
Ape Hand/Pope’s blessing

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8
Q

Fracture of medial epicondyle of humerus

weak wrist flexion

A

Ulnar n. (C8, T1)
medial finger flexion/wrist flexion
hypothenar eminence sensory deficit
radial deviation on wrist flexion

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9
Q

Traumatic delivery of newborn

No abduction/lat rotation/pronation

A

Erb-Duchenne palsy

C5/C6 upper trunk

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10
Q

Thenar/hypothenar eminence atrophy

sensory deficit on medial forearm/hand

A

Klumpke’s palsy

C8/T1 inf trunk

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11
Q

Lesion with ulnar claw

A

loss of medial lumbrical function
cannot extend 4th/5th digits
due to ulnar nerve

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12
Q

Lesion with median claw

A

dislocated lunate/carpal tunnel
cannot extend 2nd/3rd digits
distal median n.

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13
Q

Pope’s blessing lesion

A

proximal median n. lesion

loss of lat finger flexion/thumb opposition

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14
Q

Ape hand lesion

A

proximal median nerve lesion

loss of opponens pollicis m. fxn

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15
Q

Winged scapula

lymphedema on ipsilateral side

A

Long thoracic n. (C5-C7)

loss of serratus ant fxn

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16
Q

Hand muscles innv by median n.

A

Opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

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17
Q

Hand muscles innv by ulnar n.

A

Opponens digiti minimi
abductor digiti minimi
flexor digiti minimi

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18
Q

Loss of thigh adduction

A

obturator (L2-4) n.

ant hip dislocation

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19
Q

Loss of thigh flexion/leg extension

A

femoral (L2-4) n.

pelivc fracture

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20
Q

Foot drop

A 
Common peroneal (L4-S3)
knee trauma
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21
Q

Loss of thigh abduction

A 
Sup gluteal (L4-S1)
post hip dislocation
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22
Q

Trouble walking up stairs

can’t jump

A 
Inf gluteal (L5-S2)
post hip dislocation
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23
Q

Which band of sarcomere shortens with contraction?

A

H and I bands

A band remains constant

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24
Q

Skeletal m. contraction sequence

A

depolarization moves down T tubule
voltage sensitive dihydropyridine receptor/ryanodine receptor releases SER Ca2+
Ca2+ binds troponin C/myosin free to bind
mysosin releases ADP/power stroke

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25
Q

Fast twitch muscles

A

white color
anaerobic glycolysis
decreased myoglobin/mitochondria

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26
Q

Endochondral ossification

A

in axial/appendicular skeleton/base of skull bones
cartilage made first by chondrocytes
later replaced by lamellar bone (via osteoblasts/osteoclasts)

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27
Q

Membranous ossification

A

facial/calvarium bones

woven bones formed directly

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28
Q

47 y/o male
growth on tibia
glistening mass in medullary cavity

A

chondrosarcoma

malignant

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29
Q

Estrogen’s role in bone formation

A

inhibits apoptosis of osteoblasts

induces apoptosis of osteoclasts

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30
Q

AD
short limbs/lg head
assc with older father

A

Achondroplasia

FGFR3 mutation constitutive expression

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31
Q 
Calcinosis
Raynaud's
dysphagia
sclerodactyly
telangiectasia
A

CREST syndrome
esophageal dysmotility (dysphagia)
anti-Centromere Ab

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32
Q

Thick, dense bones
multiple fractures
pancytopenia
facial n. palsy

A

Osteopetrosis/marble stone disease
defective osteoclasts
mutation of carbonic anhydrase II
bone marrow space filled (pancytopenia)

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33
Q

Bowing bones

increased alkaline phosphatase

A

Osteomalacia/rickets (in children)
Vit D deficiency
defective mineralization
hyperactivity of osteoblasts

34
Q

Increased ALP
Mosaic bone pattern
chalk stick fractures

A

Paget’s disease of bone
hyperactivity of osteoblasts & osteoclasts
increased AV shunts and osteogenic sarcoma

35
Q

Osteitis fibrosa cystica

A

overproduction of PTH

brown tumors of hyperparathyroidism

36
Q

25 y/o
growth at epiphyseal end of femur
double bubble/soap bubble on x-ray

A

Giant cell tumor (osteoclastoma)
spindle shaped cells with multinculeated giant cells
benign tumor

37
Q

16 y/o male
growth at the knee
metaphysis of femur
pt has Paget’s disease

A

Osteosarcoma (osteogenic sarcoma)
Sunburst pattern on x-ray
malignant tumor
Codman’s triangle

38
Q

11 y/o male
onion skin appearance of bone
diaphysis of femur

A

Ewing’s sarcoma
highly aggressive
assc with t(11,22) translocation

39
Q

47 y/o male
growth on tibia
glistening mass in medullary cavity

A

chondrosarcoma

malignant

40
Q

Heberden’s nodes (DIP)
osteophytes
obese 60 y/o

A

osteoarthritis

Bouchard’s nodes also seen (PIP)

41
Q

Ulnar deviation of fingers
Baker’s cyst
MCP/PIP involvement
stiffness improves with use

A 
Rheumatoid arthritis
Type III HS rxn
anti-IgG
assc with HLA-DR4
tx with TNF-alpha inhibitors
42
Q

Dry eyes
dry mouth
joint pain
female 52 y/o

A 
Sjoegren's syndrome
xerophthalmia/xerostomia/arthritis
parotid enlargement
increased B cell lymphoma
Abs to riobnucleoprotein Ags
assc with RA
43
Q

Needle shaped/(-) birefringent yellow crystals
swollen joints
pain with EtOH/food
more common in men

A

Gout
monosodium urate crystals
can be from Lesch-Nyhan syndrome/Von Gierke’s diease
painful MTP joint of great toe

44
Q

Rhomboid crystals with weak (+) birefringence
knee joint pain
66 y/o

A

Pseudogout
calcium pyrophosphate crystals
blue color

45
Q

Bamboo spine
stiff spine
aortic regurg
uveitis

A

Ankylosing spondylitits
chronic inflammatory diease of spine/SI joints
assc with HLA-B27

46
Q

Conjunctivitis
urethritis
arthritis

A

Reactive arthritis/Reiter’s syndrome

post GI/chlamydia infection

47
Q

Progressive symmetric prox muscle weakness
shoulder involvement
(+) ANA and anti-Jo-1
muscle atrophy

A

Polymyositis
CD8 T cell inflammation
Dermatomyositis (CD4 T cells) if malar rash/Gottron’s papules/heliotrope rash present

48
Q

Muscle weakness, worsens with use

ptosis

A

Myasthenia gravis
Abs to ACh receptor
assc with thymoma

49
Q

Muscle weakness, imrpvoes with use

proximal muslces

A

Lambert-Eaton syndrome
Abs to presynaptic Ca2+ channels
assc with small cell lung cancer

50
Q

45 y/o women
no wrinkles
anti-Scl-70 Ab (+)

A

Scleroderma
sclerosis of organs
rapid progression

51
Q 
Calcinosis
Raynaud's
dysphagia
sclerodactyly
telangiectasia
A

CREST syndrome
esophageal dysmotility (dysphagia)
anti-Centromere Ab

52
Q

MOA of bisphosphonates

A

bind hydroxyapatite in bone

inhibit osteoclast activity

53
Q

47 y/o male
growth on tibia
glistening mass in medullary cavity

A

chondrosarcoma

malignant

54
Q

11 y/o male
onion skin appearance of bone
diaphysis of femur

A

Ewing’s sarcoma
highly aggressive
assc with t(11,22) translocation

55
Q

16 y/o male
growth at the knee
metaphysis of femur
pt has Paget’s disease

A

Osteosarcoma (osteogenic sarcoma)
Sunburst pattern on x-ray
malignant tumor
Codman’s triangle

56
Q

25 y/o
growth at epiphyseal end of femur
double bubble/soap bubble on x-ray

A

Giant cell tumor (osteoclastoma)
spindle shaped cells with multinculeated giant cells
benign tumor

57
Q

Osteitis fibrosa cystica

A

overproduction of PTH

brown tumors of hyperparathyroidism

58
Q

Increased ALP
Mosaic bone pattern
chalk stick fractures

A

Paget’s disease of bone
hyperactivity of osteoblasts & osteoclasts
increased AV shunts and osteogenic sarcoma

59
Q

Bowing bones

increased alkaline phosphatase

A

Osteomalacia/rickets (in children)
Vit D deficiency
defective mineralization
hyperactivity of osteoblasts

60
Q

Thick, dense bones
multiple fractures
pancytopenia
facial n. palsy

A

Osteopetrosis/marble stone disease
defective osteoclasts
mutation of carbonic anhydrase II
bone marrow space filled (pancytopenia)

61
Q

Tx for senile osteoporosis

A

weight lifting/Ca2+/Vit D

Estrogen/Calcitonin/bisphosphonates/pulsatile PTH

62
Q

AD
short limbs/lg head
assc with older father

A

Achondroplasia

FGFR3 mutation constitutive expression

63
Q

Estrogen’s role in bone formation

A

inhibits apoptosis of osteoblasts

induces apoptosis of osteoclasts

64
Q

Origin of osteoclasts

A

macrophages/monocytes

65
Q

Membranous ossification

A

facial/calvarium bones

woven bones formed directly

66
Q

Endochondral ossification

A

in axial/appendicular skeleton/base of skull bones
cartilage made first by chondrocytes
later replaced by lamellar bone (via osteoblasts/osteoclasts)

67
Q

Fast twitch muscles

A

white color
anaerobic glycolysis
decreased myoglobin/mitochondria

68
Q

Skeletal m. contraction sequence

A

depolarization moves down T tubule
voltage sensitive dihydropyridine receptor/ryanodine receptor releases SER Ca2+
Ca2+ binds troponin C/myosin free to bind
mysosin releases ADP/power stroke

69
Q

Which band of sarcomere shortens with contraction?

A

H and I bands

A band remains constant

70
Q

Trouble walking up stairs

can’t jump

A 
Inf gluteal (L5-S2)
post hip dislocation
71
Q

Loss of thigh abduction

A 
Sup gluteal (L4-S1)
post hip dislocation
72
Q

Foot drop

A 
Common peroneal (L4-S3)
knee trauma
73
Q

Loss of thigh flexion/leg extension

A

femoral (L2-4) n.

pelivc fracture

74
Q

Loss of thigh adduction

A

obturator (L2-4) n.

ant hip dislocation

75
Q

Hand muscles innv by ulnar n.

A

Opponens digiti minimi
abductor digiti minimi
flexor digiti minimi

76
Q

Hand muscles innv by median n.

A

Opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

77
Q

Winged scapula

lymphedema on ipsilateral side

A

Long thoracic n. (C5-C7)

loss of serratus ant fxn

78
Q

Ape hand lesion

A

proximal median nerve lesion

loss of opponens pollicis m. fxn

79
Q

Pope’s blessing lesion

A

proximal median n. lesion

loss of lat finger flexion/thumb opposition

80
Q

Lesion with median claw

A

dislocated lunate/carpal tunnel
cannot extend 2nd/3rd digits
distal median n.

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