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MSK Flashcards

1
Q

unhappy triad

A

contact sports d/t lat force applied to planted leg
ACL, MCL, medical meniscus (attached to MCL)
lat meniscus actually more common

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2
Q

prepatellar brusitis

A

aka housemaids knee

d/t repeated kneeling

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3
Q

rotator cuff mm innervation

A

C5-6

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4
Q

medial epicondylitis

A

aka golfers elbow
repetitive flexion or idiopathic
pain near medial epicondyle

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5
Q

lateral epicondylitis

A

aka tennis elbow
repetitive extension or idiopathic
pain near lat epicondyle

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6
Q

carpal tunnel associations

A

prego
RA
hypothyroidism

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7
Q

guyon canal

A

compression of ulnar n at wrist or hand

seen in cyclists

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8
Q

axilarry

A

C5-6
deltoid
loss of arm abductions >15 degress
loss of sensation over delt and lat arm

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9
Q

musculocutaneous

A

C5-7
loss of forearm flexion and supination
loss of sensation over lat forearm

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10
Q

radial

A 
C5-T1
wrist drop
loss of extension
decreased grip strength
loss of sensation over post arm/forearm and dorsal hand
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11
Q

median

A 
C5-T1
'Ape hand' 
'popes blessing'
loss of flexion of wrist and lat fingers, thumb opposition, lumbricals on 2nd and 3rd digit
loss of sensation over thenar eminence
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12
Q

ulnar

A 
C8-T1
ulnar claw 
proximal- radial deviation of wrist upon flexion 
loss of wrist flexion 
medial 2 lumbricals
loss of senation over medial 1.5 fingers
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13
Q

recurrent brr of median n

A

C5-T1
‘ape hand’
loss of thenar group
no loss of sensation

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14
Q

obturator

A

L2-4

decreased thigh sensation (medial) and decreased adduction

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15
Q

femoral

A

L2-4

decreased thigh flexion and leg extension

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16
Q

common peroneal

A

L4-S2
foot drop- inverted and plantar flexed at rest
steppage gait
loss of sensation on dorsum of foot
PED: Peroneal Everts and Dorsiflexes, if injured goot dropPED

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17
Q

tibial

A

L4-S3
inability to curl toes and loss of sensation on sole of foot
proximal lesions- foot everted at rest
can be d/t bakers cyst
TIP: Tibial Inverts and Plantar flexes, if injured cannot stand of TIP toes

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18
Q

superior gluteal

A

L4-S1
trendelenburg gait
loss of glut medium and minimus

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19
Q

inferior gluteal

A

L5-S2
difficulty climbing Strauss, rising from seated position
loss of hip extension

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20
Q

herniated L3-L4

A

weakness of knee extension

decreased patellar reflex

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21
Q

herniated L4-5

A

weakness in dorsiflexion

difficulty in heel walking

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22
Q

herniated L5-S1

A

weakness of plantarflexion
difficulty in toe walking
decreased achilles reflex

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23
Q

achondroplasia

A

failure of longitudinal bone growth ->
membraneous ossfication not affected -> big head
constitutive activation of FGFR3 inhibits chondrocyte proliferation
85%+ sporadic
AD w/full penetrance (homo lethal)
MCC of dwarfism

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24
Q

osteopetrosis

A

failure of normal bone resorption
thickened dense bones that fracture
pancytopenia, extramedullary hematopoiesis
mutations in carbonie anhydrase II cannot create acidic environment
x-ray bone-in-bone appearance
can cause CN palsies
bone marrow transplant

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25
Q

paget disease

A

disordered bone remodeling
increase in both osteoblastic and osteroclastic activity
mosaic pattern
long bone chalk-stick fractures
increased blood flow from AV shunts may cuase high-output heart failure
increased risk of osteogenic sarcoma
hat sized increased
hearing loss d/t narrowed auditory foramen

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26
Q

stages of pagets

A

lytic-osteoclasts
mixed-osteoclasts and blasts
sclerotic- osteroblasts
quiescent- minimal activity

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27
Q

causes of osteronecrosis

A 
ASEPTIC
alcoholism
sickle cell
storage 
exogenous/endogenous steroics
pancreatitis
trauma
idiopathc
caisson (the bends)
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28
Q

lab values osteoporosis

A

serum Ca, phos, ALP, PTH normal

decreased bone mass/DEXA

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29
Q

lab values osteomalacia

A

decreased Ca, phos
increased ALP, PTH
soft bones

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30
Q

lab values osteopetrosis

A

Ca normal or low
Phos, ALP, PTH normal
dense brittle bone

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31
Q

lab values pagets

A

normal Ca, phos PTH
elevated ALP
mosaic bone

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32
Q

lab hypervitaminosis D

A

Ca and phos high
normal ALP
high PTH
granulomatous diseases (sarcoid)

33
Q

osteitis fibrosa cystica d/t primary hyperparathyroidism

A

increased Ca, ALP, and PTH
decreased Phos
brown tumors d/t fibrous replacement of bone

34
Q

osteitis fibrosa cystica d/t secondary hyperparathyroidism

A

decreased Ca
increased Phos, ALP, PTH
compensation for ESRD

35
Q

benign bone tumors

A

giant cell

osteochrondroma (MC)

36
Q

Giant cell

A 
20-40yr
epiphyseal end of long bones
benign, but locally aggressive
often knee
'soap bubble' on xray
multinucleated giant cells
Neoplastic cells are osteoblasts  (express RANKL)
markers- alkaline phosphatase and ostocalsin
37
Q

osteochondroma

A

MC benign bone tumor

males

38
Q

malignant bone tumors

A

osteosarcoma/osteogenic sarcoma

Ewing sarcoma

39
Q

osteosarcoma

A

2nd MC primary malignant bone tumor (after MM)
Bimodal 10-20 and >65
metaphysis of long bones, usually at knee
codmans triangle or sunburst on x-ray
aggressive Tx w/surgical resection and chemo

40
Q

predisposing factors for osteosarcoma

A 
pagets
bone infarcts
radiation
familial retinoblastoma
Li-fraumeni
41
Q

Ewing sarcoma

A

boys

42
Q

11,22

A

EWS-FLI1

43
Q

joint findings in osteoarthritis

A 
subchondral cysts
sclerosis
osterophyts
ebunation
synovitis
heverden nodes (DIP)
Bouchard nodes (PIP)
no MCP involvement
44
Q

RA etiology

A

autoimmune
mediated by cytodines
type III and IV hypersensitivity rxn

45
Q

RA joints

A

pannus (MCP, PIP)
sub-q rheumatoid nodules (fibrinoid necrosis)
ulnar deviation of fingers
subluxation
rare swan neck and boutonniere deformities
rare DIP involvement

46
Q

predisposing factors to RA

A

females
RF (anti-IgG)
anti-CCP more specific
HLA-DR4

47
Q

sjogren syndrome

A

autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates
females 40-60

48
Q

findings of sjogren

A

inflammatory joint pain (can be associated w/RA)
xerophthalmia
xerostomia
antinuclear Abs: SS-A/anti-Ro, SS-B (anti-La)
b/l parotid enlargement

49
Q

complications of sjogrens

A

dental carries

MALT lymphomas

50
Q

what meds can decrease uric acid excretions

A

thiazide diuretics

51
Q

what is associated w/overproduciton of uric acid

A

lesch-nyhans
PRPP excess
increased cell turn over (tumor lysis syndrome)
von Gierke disease

52
Q

gout crystals

A

needle shaped, neg bifringement

yellow under parallel light, blue under perpendicular

53
Q

pseudogout

A 
Ca pyrophophate crystals 
basophilc rhomboid cyrstals
large joints (knee)
>50, both sexes
blue when parallel to light, yellow when perpendicular
54
Q

pseudogout associations

A

homochromatosis
hyperparathyroidism
osteoarthritis

55
Q

infectious arthritis

A

S. aureus
Steptococcus
Neisseria gonorrhea

56
Q

seronegative spondyloarthropathies

A 
HLA-B27, NO RF
PAIR
Psoriatic arthritis 
Ankylosing spondylitis 
Inflammatory bowel disease
Reactive arthritis
57
Q

psoriatic arthritis

A

joint pain and stiffness associated w/psoriasis
asymmetric and patchy involement
dactylitis (sausage fingers)
pencil-in-cup

58
Q

ankylosing spondylitis

A

chronic inflammatory disease of spine and SI joint
uveitis
aortic regurg
bamboo spine (vertebral fusion)

59
Q

Reactive arthritis

A

Conjuctivits, urethritis, arthritis
can’t see, can’t pee, can’t climb a tree
Post GI (shigella, salmonella, yersinia, campylobacter) or chlamydia infections

60
Q

systemic lupus erythmatosus

A 
women, repro age, black 
RASH OR PAIN
rash (malar or discoid)
arthritis 
soft tisseus/serositis
hematologic disorders 
oral/nasopharyngeal ulcers
renal disease/raynauds
photosensitivity/postive VDRL/RPR
anti-nuclear Abs
immunsuppressants
nerological disorders
61
Q

CCD in SLE

A

cardiovascular disease
infections
renal disease

62
Q

SLE nephritis

A

type III sensitivity rxn
nephritic- diffuse proliferative glomerulonephritis
nephrotic- membranous glomerulonephritis

63
Q

libman-sacks endocarditis

A

SLE

nonbacterial wart-like vegetations on both sides of valve

64
Q

SLE findings

A

antinuclear abs (ANA), not specific
anti-dsDNA abs (specific, poor prognosis -> renal disease)
anti-smith/anti-snRNP abs (specific, not prognostic)
anti-histone- drug SLE
decreased C3, C4, CH50 d/t IC formation

65
Q

antiphospholipid syndrome

A

primary or secondary autoimmune
MC d/t SLE
history of thrombosis and/or spontaneous abortions
lupus anticoagulant, anticardiolipin anti beta2 glycoprotein Abs
false + VRDL d/t anditcoagulant and anticardiolipin
Tx systemic anticoagulation

66
Q

sarcoidosis

A

immune mediated widespread, noncaseating granulomas
elevated ACE, CD4/CD8 ratio
black females
often asymptomatic, except for enlarged lymph nodes

67
Q

sarcoidosis CXR

A

b/l adenopathy and coarse reticular opacities

CT better shows extensive hilar and mediastinal adenopathy

68
Q

sarcoidosis is associated w/what?

A 
restrictive lung disease (interstitial fibrosis)
erythema nodosum 
lupus pernio 
bells palsy
epithelioid granulomas 
uveitis 
hypercalcemia
69
Q

epithelioid granulomas of sarcoidosis

A

schaumann and asteroid bodies

70
Q

hypercalcemia of sarcoidosis

A

d/t increased 1 alpha hydroxylase mediated vit D activation in macros

71
Q

polymyalgia rheumatica

A

pain and stiffness in shoulder and hips w/fever malaise, weight loss
does not cause mm weakness
women >50
associated w/temporal arteritis

72
Q

labs in polymyalgia rheumatica

A

increased ESR, CRP

normal CK

73
Q

Tx of polymyalgia rheumatica

A

rapid response to low dose corticosteroids

74
Q

polymyositis and dermatomyositis

A 
increased CK
ANA+
anti-Jo1
anti-SRP
anti-Mi2 
Tx steroids followed by long term immunosuprresion (MTX)
75
Q

polymyositis

A

progressive symmetric proximal mm weakness
endomysial inflammation w/CD8 cells
most often involves shoulders

76
Q

dermatomyositis

A 
similar to polymyositis but has malar rash
gottrons papules
heliotrope rash
shawl and face rash 
mechanics hands
increased risk of occult malignancy 
perimysial inflammation 
atrophy w/CD4 cells
77
Q

sclerederma/systemic sclerosis

A

triad of autoimmunity, noninflammatory vasculopathy, collagen deposition w/fibrosis
puffy, taught skin w/p wrinkles
fingertip pitting
sclerosis of renal, pulmonary (MCCOD), GI
females

78
Q

diffuse scleroderma

A

widespread skin involvement
rapid progression
early visceral involvement
anti Scl-70/anti topoisomerase I

79
Q

limited scleroderma

A 
limited skin involvement, more benign
anti-centromere
CREST
calcinosis
raynauds
esophageal dysmotility
sclerodactyly 
telangiectasia

step i (22 decks)

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