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MSK Flashcards

1
Q

Erb-Duchenne Palsy (“Waiter’s Tip”)

Def’n, Pres?

A

Superior Trunk (C5-C6) Brachial Plexus injury.

PRES:
- “Neonate with ARM PARALYSIS following difficult birth”

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2
Q

“Fall on an outstretched hand”

Bone + Nerve damaged?

A

Hook of Hamate -> Ulnar nerve

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3
Q

Bone Disease

Enzyme↑?

A

Alkaline phosphatase

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3
Q

Skeletal Muscle Injury / Damage

Enzymes↑(2)?

A
  • CKMB (SEVERE injury)

- LD4 + LD5 (damage)

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4
Q

Carpal Tunnel Sx

Def’n, Pres (3)?

A

Entrapment of Median nerve in carpal tunnel -> nerve compression.

PRES:

  • Paresthesia (Tinel sign)
  • Pain
  • Numbness in distribution of Median nerve
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5
Q

Acute Carpal Tunnel Sx

Cause?

A

CAUSE = Dislocation of Lunate

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6
Q

Guyon Canal Sx

Def’n, Pres (Epi)?

A

Compression of Ulnar nerve at wrist / hand.

PRES: Cyclists

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7
Q

Tetany

Mech, Causes (Electrolytic)?

A

Activation of all nerve cells in body -> muscle overstimulation ->
muscle spasms + cramps.

CAUSES:

  • ↓Ca
  • ↓Mg
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8
Q

Muscular Dystrophy

Inher, Def’n, Pres?

A

XR.

XR deletion of dystrophin gene.

PRES:
- Calf pseudohypertrophy

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9
Q

Duchenne Muscular Dystrophy

Def’n, Inher, Genetics, Pres (2)?

A

Deletion of dystrophin gene.

XR.

Frameshift DNA mutation.

PRES:

  • Calf pseudohypertrophy
  • “Child uses arms to stand up from squat”
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10
Q

Becker Muscular Dystrophy

** LESS severe than Duchenne **

Def’n, Inher, Pres (Epi + 1)?

A

Missense mutation in dystrophin gene.

XR.

PRES: Boys
- Slow, progressive muscle weakness

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11
Q

McArdle Disease

Def’n, Pres (5), Urine?

A

Muscle Glycogen Phosphorylase deficiency.

PRES:

  • Chronic exercise intolerance
  • Fatigue
  • Myalgia
  • Cramps

URINE:
- Myoglobinuria

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12
Q

Achondroplasia

Mech (2 steps), Inher (2), Genetics, Pres (2)?

A

MECH:
Impaired chondrocyte / cartilage prolif in growth plate ->
Failure of Endochondral Ossification = longitudinal bone growth.

INHER:

  • AD
  • > 85% mutations sporadic and assoc with increased paternal age

FGFR3 Activating Mutation (-> overexpression -> growth inhib).

PRES:

  • Short limbs / Dwarfism
  • “Large head relative to limbs” (b/c membranous ossification NOT affected)
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13
Q

McCune-Albright Sx (form of Polyostotic Fibrous Dyplasia)

Def’n, Assoc, Pres (2)?

A

Bone is replaced by fibroblasts, collagen and irregular bony trabeculae.

ASSOC:
- Precocious Puberty

PRES:

  • Multiple unilateral bone lesions
  • Cafe-au-Lait spots
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14
Q

Osteoporosis

Def’n / Mech (3 steps), 2 Types, Comp (2), Prev (2), Rx (3), CI?

A

↓TRABECULAR bone mass / density / interconnections ->
Porous bone ->
↑risk of fracture + thin cartilage between vert.

  • Type I = Postmenopausal (↓Estrogen -> ↑bone resorption)
  • Type II = Senile

COMP:

  • Compression / Vertebral Crush fractures
  • Colles fracture (fracture of distal radius)

PREV:

  • Regular WEIGHT-BEARING exercise
  • Adequate Ca + Vit D intake throughout adulthood

RX:

  • Calcitonin (inhibits osteoclasts)
  • Estrogen (inhibits bone resorption)
  • For severe cases: PTH or Bisphosphonates

CI:
- Glucocorticoids

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15
Q

Vertebral Crush Fractures

Def’n / Seen In, Pres (4: 3 + 1 sign)?

A

Possible comp of Osteoporosis.

PRES:

  • Acute back pain
  • Loss of height
  • Kyphosis
  • ‘Dowager’s Hump’
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16
Q

Paget’s Disease of Bone

Pres (6, incl Epi), Labs, Biopsy Finding, Comp (2)?

A

PRES: Avg age > 60

  • “↑hat size” (bone enlargement that commonly affects skull)
  • “Lion-like facies”
  • Hearing loss (auditory foramen narrowing)
  • Bone pain (due to microfractures)
  • Arthritis

LABS:
- ALP ↑

FINDING:
- “Mosaic” / “Woven” pattern of lamellar bone

COMP:

  • High-Output Cardiac Failure (formation of A-V shunts in bone -> ↑blood flow)
  • Osteosarcoma
17
Q

Osteomyelitis

Pres (2)?

A

PRES:

  • Bone pain w systemic signs of infection
  • Lytic abscess surrounded by sclerosis on bone
18
Q

Osteitis Fibrosa Cystica

Cause, Pres?

A

CAUSE = Hyperparathyroidism

PRES = “Brown tumors” (due to deposited hemosiderin from hem)

19
Q

Giant Cell Tumor of Bone (Osteoclastoma)

Location, XR Finding?

A

Long bones (epiphysis): KNEE region- distal femur / proximal tibia.

XR FINDING:
- “Soap bubble” appearance on XR (lytic expansile lesion)

20
Q

Ewing Sarcoma

Def’n, Locations (4), Genetics, Pres (Epi)?

A 
Anaplastic malignant (aggressive with early metastases) small 
round / blue-cell tumor.

Long bones (diaphysis), Scapula, Ribs, Pelvis.

11;22 translocation.

PRES: Boys

21
Q

Osteosarcoma

Assoc (6), Location, Pres (Epi), XR Findings (2 possible)?

A

ASSOC: (Predisposing factors)

  • Rb suppressor gene
  • Familial Retinoblastoma
  • Li-Frameuni Sx (germline p53 mutation)
  • Paget’s Disease of Bone
  • Bone infarcts
  • Radiation

Long bones (metaphysis). ** Often around KNEE **

PRES: Men 10-20

XR FINDING:
- “Codman’s Triangle” or “sunburst pattern”

22
Q

Infectious Arthritis

2 Types?

A
  • Septic

- Chronic

23
Q

Septic Infectious Arthritis

Causative Agents (3)?

A
  • S aureus
  • Strep
  • Neisseria gonorrhoeae
24
Q

GONOCOCCAL Septic Infectious Arthritis /
Disseminated Gonococcemia

Def’n, Pres (2)?

A

STD (Gonococcemia) in person that is missing C5-C9
-> Disseminated -> MIGRATORY arthritis.

PRES: Asymmetrical. * “STD” *

  • Monoarticular arthritis
  • Pustules on palm
25
Q

Chronic Infectious Arthritis

Causative Infections (2)?

A
  • Lyme Disease

- TB ( -> mycobacterial dissemination)

26
Q

Reactive Arthritis / Reiter’s Sx

HLA, Mech, Pres (Triad)?

A

HLA-B27.

MECH: HLA-B27 -> envir trigger = Chlamydia or GI infection.

PRES: Male

  1. Arthritis (“Achilles pain”)
  2. Conjunctivitis + Ant Uveitis (sterile)
  3. Urethritis
28
Q

Osteoarthritis

Joints Affected, Pres, Joint Findings (4)?

A

PIP + DIP.

PRES: “Swollen, hard + painful FINGER joints”
- Pain in weight-bearing joints after use & improving with rest

JOINT FINDINGS:
- Osteophytes (bone spurs = rx to injury)
- Heberden nodes: Osteophytes on DIP
- Bouchard nodes: Osteophytes on PIP
- Eburnation (polished “ivory-like” appearance of bone at
site of cartilage erosion)
- Subchondral Cysts
- Sclerotic bone (close to joint)

29
Q

RA

Mech (incl H-S types), Antibodies (2), HLA Assoc, Joints Affected,
Pres (Epi + CLUE + 6), Comp (2), Rx?

A

Inflammation. Type 3 + 4 H-S.

  • Rheumatoid factor (80% of patients)
  • Anti-Cyclic Citrullinated Peptide antibody (more specific)

HLA-DR4.

MCP + PIP.

PRES: Often symmetrical. MC in Females.
“Morning stiffness lasting > 30 min and improving with use.”
- Systemic infl
- Joint Pannus
- Boutonniere Deformity
- Baker Cyst (behind knee / in popliteal fossa)
- Subcutaneous rheumatoid nodules (fibrinoid necrosis)
- Ulnar deviation of fingers

COMP:

  • Sjorgen’s Sx
  • Pericarditis

RX:
- Methotrexate

30
Q

Sjogren’s Sx

Def’n, Assoc, Pres (Epi + 4), Labs, Comp (2)?

A

Autoimmune disorder char by destruction of EXOCRINE GLANDS (esp lacrimal +salivary glands).
Can be a primary disorder or a secondary disorder assoc with another autoimmune disorder (eg RA).

ASSOC:
- RA

PRES: Females 40-60. “Dry eyes, dry mouth, arthritis.”
- Xerophthalmia (↓tear production -> corneal damage):
“Sand in my eyes”. Dry eyes + conjunctivitis.
- Xerostomia (↓saliva production): Dry mouth.
- Bilateral Parotid enlargement
- Arthritis

LABS: Antinuclear Antibodies
- SS-A and/or SS-B

COMP:

  • Dental caries
  • MALT Lymphoma
31
Q

SLE

Pres (9: Epi, 3, 2, 5), Antibodies (5), Blood Findings (4)
Comp / Causes of Death (3)?

A

PRES: Young female, MC African

  • Arthritis
  • Fever, Fatigue + Weight Loss
  • Photosensitivity
  • “Butterfly” facial rash
  • Oral / Nasopharyngeal ulcers
  • Neuro disorders (eg seizures)
  • Libman-Sacks Endocarditis
  • Renal Disease (Lupus Nephropathy + DP Glomerulonephritis)
  • Raynaud Phenomenon
  • Autoimmune (IgG) = Warm Agglutinin Hemolytic Anemia

ANTIBODIES:

  • ANA (sensitive, not specific)
  • Anti-Smith (specific)
  • Anti-Cardiolipin (-> False + on Syphilis test)
  • Anti-Histone
  • Anti-dsDNA (specific & poor prognosis)

BLOOD:

  • ↓C3 + C4 (due to IC formation)
  • Schistocytes
  • Neutropenia
  • Lymphopenia

COMP:

  • Constrictive Pericarditis / Libman-Sacks Endocarditis (due to serositis -> effusions in lupus)
  • Renal Disease / Failure
  • Infections
32
Q

Polymyalgia Rheumatica

Assoc, Pres (Epi +2), Blood Findings (2), RX?

A

ASSOC:
- Temporal Giant Cell Arteritis

PRES: > 50 y.o, MC Females

  • Pain / stiffness in Shoulders + Hips
  • Fever, Fatigue + Weight Loss

BLOOD:

  • ↑C-reactive protein
  • ↑ESR

RX = Prednisone

33
Q

Fibromyalgia

Pres (Epi + 2)?

A

PRES: 20-50 y.o, MC Females

  • Widespread MSK stiffness, pain + paresthesia
  • Poor sleep + fatigue
34
Q

Dermatomyositis

Def’n, Pres (3, incl 3 rashes), Comp?

A

Infl disorder of skin + skeletal muscle. PERImysial infl w CD4+ T cells.

PRES: Polymyositis + …

  • Rashes
    - Malar rash (similar to SLE)
    - Heliotrope rash
    - “Shawl + Face rash”
  • Gottron Papules: red papules on elbows, knees + knuckles
  • “Mechanic’s hands”

COMP:
-↑risk of occult malignancy

35
Q

Pseudogout

Def’n, Assoc (2), Micro Finding?

A

Precipitation of calcium pyrophosphate dihydrate crystals in joints.

ASSOC:

  • Hemochromatosis
  • Hyper- + Hypoparathyroidism

FINDING:
- POSITIVELY birefringent RHOMBOID crystals
(blue when parallel to light; yellow when perpendicular to light)
* Contrast with Gout *

36
Q

Gout

Def’n, MC Locations (5), Cause, Mech (2),
Seen In, Pres (6), Micro Finding?

A

Acute inflammatory MONOarthritis caused by precipitation of monosodium urate crystals in joints.

External Ear, Elbows (olecranon bursa), Fingers, Achilles tendon, Big Toe.

CAUSE = Hyperuricemia.

MECH of Hyperuricemia:
* 1. (90%) UNDEREXCRETION of uric acid. Mostly idiopathic, however
can be exacerbated by certain meds (ie thiazide diuretics).
2. (10%) OVERPRODUCTION of uric acid.

SEEN IN:
- Lesch-Nyhan Sx

PRES: MC in Males. “Sudden swollen + painful big toe.”

  • Asymmetric joint distribution
  • Red, swollen + painful joints
  • Podagra
  • Tophi (Chronic Gout ONLY)
  • Acute attacks after large meal or alcohol consumption

FINDING:
- NEEDLE-shaped + NEGATIVELY birefringent crystals
(yellow under parallel light; blue under perpendicular light)
* Contrast with Pseudogout *

37
Q

Polymyositis

Def’n, Location, Pres?

A

Infl disorder of skeletal muscle. Char by ENDOmysial infl
with CD8+ T cells.

MC in Shoulders.

PRES: Symmetrical
- Progressive PROXIMAL muscle weakness

38
Q

Psoriatic Arthritis
(although seen in fewer than 1/3 of patients with Psoriasis)

Pres (2), XR Finding?

A

PRES: Asymmetric + Patchy involvement

  • Joint stiffness + pain
  • Dactylitis (“sausage fingers”)

XR FINDING:
- “Pencil in cup” deformity

39
Q

Ankylosing Spondylitis

Def’n + Location, HLA, Pres (3), Labs, XR Finding?

A

Chronic inflammatory arthritis of Spine + SI joint.
Ankylosed joint = fixed.

HLA-B27.

PRES:
- Stiff / ankylosed spine -> Hunched over back.
“Pain in lower back / SI joint. Pain improves as day progresses”.
- Aortitis + Aortic Regurg
- Uveitis -> risk of Blindness

LABS:
- Bl Gas abnormalities (hunched back affects chest cavity and ability to breathe)

XR:
- “Bamboo spine” on XR (due to vertebral fusion).

39
Q

Seronegative Spondyloarthropathies

4 Types (“PAIR”), Def’n, Assoc, Pres (Epi)?

A
  • Psoriatic Arthritis
  • Ankylosing Spondylitis
  • IBD
  • Reactive Arthritis / Reiter’s Sx

Arthrites without Rheumatoid factor.

Strong assoc with HLA-B27.

PRES: MC in Males

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