MSK Flashcards
unhappy triad
contact sports d/t lat force applied to planted leg
ACL, MCL, medical meniscus (attached to MCL)
lat meniscus actually more common
prepatellar brusitis
aka housemaids knee
d/t repeated kneeling
rotator cuff mm innervation
C5-6
medial epicondylitis
aka golfers elbow
repetitive flexion or idiopathic
pain near medial epicondyle
lateral epicondylitis
aka tennis elbow
repetitive extension or idiopathic
pain near lat epicondyle
carpal tunnel associations
prego
RA
hypothyroidism
guyon canal
compression of ulnar n at wrist or hand
seen in cyclists
axilarry
C5-6
deltoid
loss of arm abductions >15 degress
loss of sensation over delt and lat arm
musculocutaneous
C5-7
loss of forearm flexion and supination
loss of sensation over lat forearm
radial
C5-T1 wrist drop loss of extension decreased grip strength loss of sensation over post arm/forearm and dorsal hand
median
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
ulnar
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
recurrent brr of median n
C5-T1
‘ape hand’
loss of thenar group
no loss of sensation
obturator
L2-4
decreased thigh sensation (medial) and decreased adduction
femoral
L2-4
decreased thigh flexion and leg extension
common peroneal
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
tibial
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
superior gluteal
L4-S1
trendelenburg gait
loss of glut medium and minimus
inferior gluteal
L5-S2
difficulty climbing Strauss, rising from seated position
loss of hip extension
herniated L3-L4
weakness of knee extension
decreased patellar reflex
herniated L4-5
weakness in dorsiflexion
difficulty in heel walking
herniated L5-S1
weakness of plantarflexion
difficulty in toe walking
decreased achilles reflex
achondroplasia
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
osteopetrosis
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
paget disease
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
stages of pagets
lytic-osteoclasts
mixed-osteoclasts and blasts
sclerotic- osteroblasts
quiescent- minimal activity
causes of osteronecrosis
ASEPTIC alcoholism sickle cell storage exogenous/endogenous steroics pancreatitis trauma idiopathc caisson (the bends)
lab values osteoporosis
serum Ca, phos, ALP, PTH normal
decreased bone mass/DEXA
lab values osteomalacia
decreased Ca, phos
increased ALP, PTH
soft bones
lab values osteopetrosis
Ca normal or low
Phos, ALP, PTH normal
dense brittle bone
lab values pagets
normal Ca, phos PTH
elevated ALP
mosaic bone
lab hypervitaminosis D
Ca and phos high
normal ALP
high PTH
granulomatous diseases (sarcoid)
osteitis fibrosa cystica d/t primary hyperparathyroidism
increased Ca, ALP, and PTH
decreased Phos
brown tumors d/t fibrous replacement of bone
osteitis fibrosa cystica d/t secondary hyperparathyroidism
decreased Ca
increased Phos, ALP, PTH
compensation for ESRD
benign bone tumors
giant cell
osteochrondroma (MC)
Giant cell
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
osteochondroma
MC benign bone tumor
males
malignant bone tumors
osteosarcoma/osteogenic sarcoma
Ewing sarcoma
osteosarcoma
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
predisposing factors for osteosarcoma
pagets bone infarcts radiation familial retinoblastoma Li-fraumeni
Ewing sarcoma
boys
11,22
EWS-FLI1
joint findings in osteoarthritis
subchondral cysts sclerosis osterophyts ebunation synovitis heverden nodes (DIP) Bouchard nodes (PIP) no MCP involvement
RA etiology
autoimmune
mediated by cytodines
type III and IV hypersensitivity rxn
RA joints
pannus (MCP, PIP)
sub-q rheumatoid nodules (fibrinoid necrosis)
ulnar deviation of fingers
subluxation
rare swan neck and boutonniere deformities
rare DIP involvement
predisposing factors to RA
females
RF (anti-IgG)
anti-CCP more specific
HLA-DR4
sjogren syndrome
autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates
females 40-60
findings of sjogren
inflammatory joint pain (can be associated w/RA)
xerophthalmia
xerostomia
antinuclear Abs: SS-A/anti-Ro, SS-B (anti-La)
b/l parotid enlargement
complications of sjogrens
dental carries
MALT lymphomas
what meds can decrease uric acid excretions
thiazide diuretics
what is associated w/overproduciton of uric acid
lesch-nyhans
PRPP excess
increased cell turn over (tumor lysis syndrome)
von Gierke disease
gout crystals
needle shaped, neg bifringement
yellow under parallel light, blue under perpendicular
pseudogout
Ca pyrophophate crystals basophilc rhomboid cyrstals large joints (knee) >50, both sexes blue when parallel to light, yellow when perpendicular
pseudogout associations
homochromatosis
hyperparathyroidism
osteoarthritis
infectious arthritis
S. aureus
Steptococcus
Neisseria gonorrhea
seronegative spondyloarthropathies
HLA-B27, NO RF PAIR Psoriatic arthritis Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis
psoriatic arthritis
joint pain and stiffness associated w/psoriasis
asymmetric and patchy involement
dactylitis (sausage fingers)
pencil-in-cup
ankylosing spondylitis
chronic inflammatory disease of spine and SI joint
uveitis
aortic regurg
bamboo spine (vertebral fusion)
Reactive arthritis
Conjuctivits, urethritis, arthritis
can’t see, can’t pee, can’t climb a tree
Post GI (shigella, salmonella, yersinia, campylobacter) or chlamydia infections
systemic lupus erythmatosus
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
CCD in SLE
cardiovascular disease
infections
renal disease
SLE nephritis
type III sensitivity rxn
nephritic- diffuse proliferative glomerulonephritis
nephrotic- membranous glomerulonephritis
libman-sacks endocarditis
SLE
nonbacterial wart-like vegetations on both sides of valve
SLE findings
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
antiphospholipid syndrome
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
sarcoidosis
immune mediated widespread, noncaseating granulomas
elevated ACE, CD4/CD8 ratio
black females
often asymptomatic, except for enlarged lymph nodes
sarcoidosis CXR
b/l adenopathy and coarse reticular opacities
CT better shows extensive hilar and mediastinal adenopathy
sarcoidosis is associated w/what?
restrictive lung disease (interstitial fibrosis) erythema nodosum lupus pernio bells palsy epithelioid granulomas uveitis hypercalcemia
epithelioid granulomas of sarcoidosis
schaumann and asteroid bodies
hypercalcemia of sarcoidosis
d/t increased 1 alpha hydroxylase mediated vit D activation in macros
polymyalgia rheumatica
pain and stiffness in shoulder and hips w/fever malaise, weight loss
does not cause mm weakness
women >50
associated w/temporal arteritis
labs in polymyalgia rheumatica
increased ESR, CRP
normal CK
Tx of polymyalgia rheumatica
rapid response to low dose corticosteroids
polymyositis and dermatomyositis
increased CK ANA+ anti-Jo1 anti-SRP anti-Mi2 Tx steroids followed by long term immunosuprresion (MTX)
polymyositis
progressive symmetric proximal mm weakness
endomysial inflammation w/CD8 cells
most often involves shoulders
dermatomyositis
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
sclerederma/systemic sclerosis
triad of autoimmunity, noninflammatory vasculopathy, collagen deposition w/fibrosis
puffy, taught skin w/p wrinkles
fingertip pitting
sclerosis of renal, pulmonary (MCCOD), GI
females
diffuse scleroderma
widespread skin involvement
rapid progression
early visceral involvement
anti Scl-70/anti topoisomerase I
limited scleroderma
limited skin involvement, more benign anti-centromere CREST calcinosis raynauds esophageal dysmotility sclerodactyly telangiectasia
