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MSK Flashcards

1
Q

What is McCune Albright Syndrome?

A

A form of polyostotic fibrous dysplasia of bones assoc. with caf? au lait spots and endocrine abnormalities – precocious puberty? Genetic mosaicism

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2
Q

Describe an Erb-Duchenne palsy. Nerve roots?

A

Arm hangs by side (abductors affected), internally rotated and forearm pronated (C5-6)

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2
Q

Regarding Common peroneal nerve 1) nerve roots 2) typical injury 3) motor deficit 4) sensory deficit

A

1) L2-L4 (from sciatic) 2) lateral leg trauma, fibular head fracture 3) foot eversion, dorsiflexion 4) anterolateral leg and dorsal aspect of foot

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3
Q

Where do osteochondromas usually arise?

A

Metaphysis

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3
Q

Which type of hypersensitivity causes rheumatoid arthritis?

A

Type III

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4
Q

Name 4 predisposing factors to osteosarcoma

A

Paget’s disease of bone, Bone infarction, radiation, familial retinoblastoma

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4
Q

What is the most likely cause of death in scleroderma?

A

pulmonary (due to the sclerosis)

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5
Q

Sebaceous glands utilize this mode of secretion

A

holocrine

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5
Q

What is the triad of Sjogren’s?

A

dry eyes, dry mouth, arthritis

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6
Q

Regarding musculocutaneous nerve 1) nerve roots 2) typical injury 3) motor deficit 4) sensory deficit

A

1) C5-C7 2) upper trunk or bullet shot to biceps 3) biceps, brachialis, and coracobrachialis 4) lateral forearm

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6
Q

Which part of the sarcomere remains the same length?

A

A band

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6
Q

Which drugs are contraindicated in osteoporosis?

A

CORTICOSTEROIDS

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7
Q

Chronic Tx of gout (2)

A

allopurinol and febuxostat? These are xanthine oxidase inhibitors

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8
Q

Name the 3 muscles of the hypothenar eminence

A

opponens digiti minimi, abductor digiti minimi brevis, and flexor digiti minimi

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10
Q

What is the terrible triad of the knee?

A

Damage to the medial meniscus, MCL, and ACL from a lateral force

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10
Q

What may be a sequala to scaphoid fracture? What about lunate dislocation?

A

Avascular necrosis of the scaphoid; acute carpal tunnel syndrome from lunate dislocation

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10
Q

What is the cell type of Ewing sarcoma and what translocation is it involved with?

A

Anaplastic blue cell? t(11;22)

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11
Q

Regarding superior gluteal nerve 1) what roots 2) cause of injury 3) motor deficit

A

1) L4-S1 2) posterior hip dislocation (or polio??? Idk about that, affects anterior horn cells) 3) thigh abduction i.e. Trendelenberg sign from Gluteus medius

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12
Q

This bone tumor is associated with onion skinning on x-ray

A

Ewing Sarcoma

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12
Q

Which disease inflames the endomysium? Perimysium?

A

endomysium = polymyositis with CD8? Perimysium = dermatomyositis with CD4

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13
Q

Which disease is associated strongly with polymyalgia rheumatica?

A

giant cell temporal arteritis —NO MUSCLE WEAKNESS

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14
Q

What do the crystals of pseudogout look like?

A

Calcium pyrophosphate, rhomboid shaped positively birefringent under plane polarized light

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15
Q

Most common cause of death in lupus? Histology?

A

nephropathy, wire-loop lesions? If nephritic –diffuse proliferative glomerulonephritis? If nephrotic–membranous

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16
Q

What is the function of the dorsal interossei?

A

abduct fingers

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18
Q

Where will you find eccrine sweat glands?

A

everywhere

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18
Q

Defective cell in osteopetrosis

A

osteoclast

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19
Q

which antibody is associated with CREST syndrome scleroderma?

A

anti-centromere antibodies

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20
Q

Regarding femoral nerve 1) Nerve roots 2) typical injury 3) motor deficit 4) sensory deficit

A

1) L2-L4 2) pelvic fracture 3) thigh flexion, leg extension 4) anterior thigh and medial leg

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22
Q

What nerve may be affected by a dislocated lunate?

A

median nerve, lunate dislocation can cause acute carpal tunnel

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22
Q

What is a bone tumor that is characterized by double bubble or soap bubble sign? Cell type?

A

Giant cell tumor of bone; osteoclast

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24
Q

What are tight junctions composed of?

A

claudins and occludins

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24
Q

What is osteitis deformans?

A

Paget’s disease of bone

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26
Q

A fracture of the hook of the hamate will affect this nerve

A

ulnar

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28
Q

What aspect of cancer is promoted by the loss of E-cadherin?

A

metastasis as cadherins are calcium dependent adhesion molecules

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28
Q

What is the function fo the palmar interossei?

A

adduct fingers

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29
Q

2 times you see woven bone in adults

A

after fractures, Paget’s disease of bone

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30
Q

Regarding Ulnar nerve 1) nerve roots 2) common injury 3) motor deficit 4) sensory deficit 5) sign

A

1) C8, T1 2) fracture of medial epicondyle 3) medial finger flexion and wrist flexion 4) medial 1.5 fingers and hypothenar 5) radial deviation of wrist in wrist flexion

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31
Q

What happens to the alkaline phosphatase levels in osteomalacia/Rickett’s and why?

A

Since there is defective mineralization of the osteoid, the osteoblasts are hyperactive by trying to build more bone, thus there is a lot of alkaline phosphatase since they need alkaline environment to build bone

32
Q

What enzymes are used to produce the alkaline environment for bone production and the acidic one for bone resorption?

A

alkaline = alkaline phosphatase from blasts; acidic = carbonic anhydrase II in clasts, defective in osteopetrosis

32
Q

T/F osteoarthritis commonly involves the MCP

A

FALSE rheumatoid involves the MCP; hence, the ulnar deviation

33
Q

Suspicious mass presenting at the sight of known trauma

A

myositis ossificans, a muscle to bone metaplasia that occurs with injuries

34
Q

Why do SLE pts have false positve syphilis tests (RPR and VDRL)?

A

Anti-phospholipid antibodies cross-react with the cardiolipin used in tests

34
Q

Define CREST

A

calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangiectasias

35
Q

Pencil-in-cup deformity on hand X ray

A

psoriatic arthritis

37
Q

What is the significance of the fact that membranous ossification is not affected in achondroplasia but endochondral is?

A

Any bones that undergo membranous ossification will develop normally i.e. the limbs and trunk are small but they have a normal head

37
Q

What is the effect of low levels of PTH on bone vs. high levels?

A

low levels = anabolic effect on blasts; high levels = catabolic effect by stimulating clasts

38
Q

Acute Tx of Gout (2)

A

NSAIDs (indomethacin) and glucocorticoids

39
Q

What is the initial lesion of Paget’s disease of bone? What visceral problem can they die from? What cancer are they at risk of?

A

osteoclast; high output cardiac failure from the arteriovenous malformations; osteosarcoma

40
Q

Which 3 bands in the sarcomere shrink?

A

H zone, I band, and Z line

41
Q

Regarding tibial nerve 1) what roots 2) cause of injury 3) motor deficit 4) sensory deficit

A

1) L4-S3 2) knee trauma 3) foot inversion and plantarflexion 4) sole of foot

42
Q

Sarcoidosis classically involves increased serum levels of ___________-

A

ACE

44
Q

What nerve is affected in a midshaft humerus fracture?

A

radial nerve

46
Q

What effect does estrogen have on osteoblasts and osteoclasts?

A

inhibits apoptosis in osteoblasts and induces apoptosis in osteoclasts (i.e. osteoporosis)

47
Q

Anti-Jo-1 antibodies are associated with these

A

polymyositis and dermatomyositis

48
Q

What is the clinical pattern of gonococcal arthritis?

A

migratory with asymmetrical pattern

50
Q

What nerve is affected by a fracture of the surgical neck of the humerus?

A

Axillary (C5-C6)

51
Q

Reiter’s syndrome is secondary to what 2 infections

A

campylobacter, chlamydia

53
Q

What diseases are caused by autoantibodies to A) desmosomes and B) hemidesmosomes?

A

A) pemphigus vulgaris and B) Bullous pemphigoid

54
Q

Why are sarcoidosis patients hypercalcemic?

A

The giant cells of their granulomas produce 1-alpha-hydroxylase which activates vitamin D to increase calcium

56
Q

What is this triad? Acute back pain, loss of height, and kyphosis

A

Osteoporotic crush fracture

57
Q

Schaumann and Asteroid bodies are very typical of______________

A

Sarcoidosis

57
Q

Why would scleroderma patients have HTN?

A

scarring of renal vasculature activates RAAS

59
Q

The long thoracic nerve contains these fibers _________. Injured in this surgery _____________.

A

C5-7, mastectomy (radical)

60
Q

What is the landmark for a pudendal nerve block?

A

Ischial spine where the pudendal nerve crosses over

60
Q

Which malignant tumor may be described as a glistening mass within the medullary cavity?

A

Chondrosarcoma

61
Q

Integrins bind this molecule to the basement membrane

A

laminin

62
Q

Why are ppl with osteoarthritis bow-legged?

A

cartilage loss begins medially

63
Q

What enzyme is defective in osteopetrosis? Why are there cranial nerve palsies?

A

Carbonic anhydrase II in osteoclasts; thus, you can’t acidify the bony matrix in order to resorb? Narrowing of foramina

64
Q

Describe the crystals of gout

A

monosodium urate, negatively birefringent under plane-polarized light

65
Q

This is the classic location for pseudogout

A

knee

66
Q

Which antibody is associated with diffuse scleroderma?

A

anti-scl70

67
Q

Regarding Inferior gluteal nerve 1) what roots 2) cause of injury 3) motor deficit

A

1) L5-S2 2) posterior hip dislocation 3) cnat rise from seated

68
Q

What nerve is affected by a fracture of the humerus in a supracondylar position?

A

median nerve

69
Q

Regarding Radial Nerve 1) What roots 2) Typical injury 3) Motor Deficit 4) sensory deficit 5) sign

A

1) C5-T1 2) midshaft fracture or Saturday night palsy from crutches 3) Brachioradialis, Extensors, Supinator, Triceps (BEST) 4) Posterior arm and dorsal hand/thumb 5) wrist drop

70
Q

Name the 3 muscles of the thenar eminence

A

opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis

72
Q

Where do osteoblasts come from? Where do osteoclasts come from?

A

blasts from mesenchymal stem cells; clasts from monocytes

73
Q

Why would a person with osteopetrosis have hepatosplenomegaly? What anomalous RBC might you see on peripheral blood smear?

A

Because the marrow space is compressed leading to extramedullary hematopoiesis; dacryocyte (teardrop cell) squeezed out of marrow, myelophthisic anemia

74
Q

Why does alcohol precipitate gout attacks?

A

The same transporters that dump uric acid also dump alcohol metabolites so more uric acid stays in

76
Q

Why might chemotherapeutics precipitate gout?

A

increased cell turnover (tumor lysis syndrome) results in excess purines in the blood

77
Q

What nerve roots innervate the rotator cuff muscles? What are they?

A

C5-C6? Supraspinatus, Infraspinatus, Teres minor, Subscapularis

79
Q

Where will you find apocrine glands? (3)

A

axillae, areolae, and genitalia? Smelly secretions bc of bacteria

81
Q

What is the most specific antibody to test for in rheumatoid arthritis?

A

anti-cyclic citrullinated peptide antibodies

82
Q

Regarding Median Nerve 1) Nerve roots 2) Typical injury 3) Motor deficit 4) Sensory deficit 5) Sign

A

1) C5-T1 2) fracture of supracondylar humerus or carpal tunnel 3) lack of thumb opposition, lateral finger flexion, wrist flexion 4) Dorsal/palmar aspect of lateral 3.5 fingers and thenar eminence 5) Ape hand (and thenar wasting)

83
Q

A superficial laceration of the wrist will affect this nerve

A

recurrent branch of the median nerve

84
Q

What are the 4 seronegative spondyloarthropathies assoc. with HLA B27?

A

Psoriatic arthritis, Ankylosing spondylitis, IBD (both Crohn’s and UC), Reiter’s (campy, the clap)… PAIR

85
Q

Where else may tophi form in gout besidest he podagra (3)?

A

external ear, achilles tendon, olecranon bursa

86
Q

What protects the brachial plexus from injury in a clavicle fracture?

A

subclavius muscle

87
Q

Regarding obturator nerve 1) nerve roots 2) cause of injury 3) motor deficit 4) sensory deficity

A

1) L2-L4 2) anterior hip dislocation 3) thigh adduction 4) medial thigh

88
Q

What are 2 results of the parotid enlargement in Sjogren’s? What is causing the enlargement?

A

Dental caries and increased risk of B-cell lymphoma; it is an autoimmune attack on exocrine glands, so there is lymphocytic infiltrate that makes them big

89
Q

Regarding Axillary nerve 1) Nerve roots 2) How is it injured 3) Motor deficit 4) Sensory deficit 5) Signs

A

1) C5-6 2) Surgical neck fracture, humerus dislocation 3) defective abduction b/c deltoid knocked out 4) Sensory over deltoid lost 5) Deltoid atrophy

91
Q

Codman’s triangle or sunburst pattern on X-ray describes this bone cancer

A

osteosarcoma

92
Q

This disease is associated with a heliotrope rash and Grotton’s papules

A

dermatomyositis, inflammation of perimysium with CD4

93
Q

What molecule is affected in achondroplasia? What kind of ossification? If it is inherited how is it inherited? If it is from “environmental factors” what would that be?

A

FGFR3 constitutively active; endochondral not membranous; autosomal dominant; if sporadic assoc with ADVANCED PATERNAL AGE

94
Q

2 autoantibodies in Sjogrens

A

ribonucleoprotein antigens (SNRP’s): SS-A (Ro) and SS-B (La)

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