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MSK Flashcards

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USMLE® Step 1 flashcards
1
Q

Valgus/varus stress test

A

Valgus tests MCL (push laterally)

Varus tests LFL (push medially)

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2
Q

McMurray test

A

Popping on external rotation: medial meniscus tear

Popping on internal rotation: lateral meniscus tear

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3
Q

Unhappy triad

A

Occurs due to lateral force applied to planted leg. Classicaly damages ACL, MCL, and medial meniscus

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4
Q

Prepatellar bursitis

A

Repeted trauma or pressure from extensive kneeling

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5
Q

Baker cyst

A

Popliteal fluid related to chronic joint disease

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6
Q

Muscles of the rotator cuff

A

Supraspinatus: abducts arm initially, assessed by empty can test; suprascapular nerve

Infraspinatus: laterall forates the arm; suprascapular nerve

Teres minor: adducts and laterally rotates arm; axillary nerve

Subscapularis: medially roates and adducts; upper and low subscapular nerve

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7
Q

Golfer’s elbow

A

Medial epicondylitis. Repetitive flexion

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8
Q

Tennis elbo

A

Lateral epicondylitis. Repetic extension

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9
Q

Bones of wrist

A

Scared lovers try positions that they can’t handle

Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
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10
Q

Fractures of wrist

A

Scaphoid most commonly fractured. Palpated in anatomic snuff box. Prone to avascular necrosis.

Hook of hamate fractured on fall on an outstretched hand. Can cause ulnar nerve injury

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11
Q

Axillary nerve damage

A

Occurs due to fractured surgical neck of humerus. Presents with loss of arm abductaion and loss of sensation over deltoid and lateral arm

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12
Q

Musculocutaneous nerve damage

A

Occurs due to upper trunk compreesion. Presents with loss of forearm flexion and supination, loss of sensation over lateral forearm

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13
Q

Radial nerve damage

A

Occurs due to midshaft fracture of humerus or compression of axilla. Presents with wrist drop, decreased grip strength, loss of sensation over posterior arm/forearm and dorsal hand

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14
Q

Median nerve damage

A

Occurs due to supracondylar fracture of humerus, carpal tunnel syndrome, wrist laceration. Presents with loss of wrist and lateral finger flexion, loss of opposition of thumb, inability to pronate. Loss of sensation over thenar eminence, lateral 3.5 fingers

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15
Q

Ulnar nerve damage

A

Occurs due to fracture of the medial epicondyle, fractured hook of hamate. Presents with ulnar claw, radial deviation of wrist, loss of wrist flexion and flexion of medial fingers, loss of ab and adduction of fingers, loss of sensation over medial fingers and hypothenar eminence

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16
Q

Recurrent branch of median nerve damage

A

Occurs due to superficial laceration of palm. Loss of thenar muscles - opposition, abduction, flexion of thumb. No loss of sensation.

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17
Q

Upper trunk of brachial plexus

A

Derived from C5, C6. Damaged in Erb palsy (waiter’s tip). Seen in infants due to lateral traction on neck during delivery. Deficits in axillary nerve (deltoid), suprascapular nerve (supraspinatus and infraspinatus) and musculocutanous nerve (biceps)

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18
Q

Lower trunk of brachial plexus

A

Derived from C8, T1. Damaged in Klumpke palsy. Seen in infants due to upward force on arm during delivery. Deficits in median and ulnar nerves resulting in total claw hand

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19
Q

Long thoracic nerve

A

Derived from C5 through C7. Presents with winged scapula due to loss of function in serratus anterior. Damaged with axillary node dissection after mastectomy and stab wounds.

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20
Q

Thoracic outlet syndrome

A

Seen in pancoast tumor. Causes compression of lower trunk and subclavian vessels. Presents with atrophy of intrinsic hand muscles and total claw hand plus with ischemia, pain, edema

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21
Q

Presentation of proximal and distal medial and ulnar nerve damage

A

Distal ulnar: can’t extend third and fourth fingers; remain clawed at rest or when extending fingers
Proximal ulnar nerve: ok gesture when trying to make a fist - can’t flex fourth and fifith fingers

Distal median nerve: cant extend first and second fingers at rest
Proximal median nerve: can’t flex first and second fingers when making a fist

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22
Q

Functions of dorsal and palmar interossei

A

DAB and PAD: dorsals abduct, palmars adduct

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23
Q

Obturator nerve

A

L2-L4. Damaged in pelvic surgery. Presents with decreased medial thigh sensation and decreased adduction

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24
Q

Femoral nerve

A

L2-L4. Damaged in pelvic fracture. Presents with decreased thigh flexion and leg extension.

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25
Q

Common peroneal nerve

A

L4-S2. Damaged with trauma to lateral leg, fibular neck fracture. Presents with foot drop - inverted and plantarflexed foot at rest. Loss of sensation on dorsum of foot

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26
Q

Tibial nerve

A

L4-S3. Damaged in knee trauma, Baker cyst, tarsal tunnel syndrome. Presents with inability to curl toes, everted foot, loss of sensation on sole of foot

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27
Q

Superior gluteal nerve

A

L4-S1. Damaged during IM infection to upper medial gluteus. Innervates gluteus minimus and medius. Presents with trendelenburg sign 0 pelvis tilts to side contralaterla to lesion

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28
Q

Inferior gluteal nerve

A

L5-S2. Damaged due to posterior hip dislocation. Innervates gluteus maximus. Presents with trouble clmbing stairs and standing up. Loss of hip extension.

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29
Q

Peroneal vs tibial nverve

A

Peroneal everts and dorsiflex

Tibial inverts and plantarflexes

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30
Q

Sciatic nerve

A

L4-S3. Innervates posterior thigh

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31
Q

Pudendal nerve

A

S2-S4. Innervates perineum

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32
Q

Dihydropyridine receptor

A

VG Ca++ channel in muscle cells

33
Q

Sarcomere bands

A 
A band: length of myosin, never changes
H band: overlap of two myosin strands
M line: where myosins meet
I band: actin segment
Z line: where actins meet
34
Q

Endochondral vs membranous ossification

A

Endochondral: axial and appendicular skeleton and base of skull. Cartilaginous model made first my chondrocytes; osteoclasts and ocsteoblasts replace with woven bone and then with lamellar bone

Membranous ossification: bonds of calvarium and facial bones. Woven bone formed directly without cartilage; later remodeled to lamellar bone

35
Q

Osteoblasts vs osteoclasts

A

Osteoblasts: secrete collagen and catalyze bone mineralization; differentiate from mesenchymal cells in periostium

Osteoclasts: Dissolve bone by secreting acid and collagenases. Differentiate from monocytes/macrophages

36
Q

Achondroplasia

A

AD fully penetrant activating mutation in FGFR3
over 85% of mutations sporadic
Failed endochondral ossification with unaffected membranous ossification results in large head relative to limbs

37
Q

Osteoporosis

A

Loss of trabecular bone mass with normal bone mineralization and normal lab values. Can cause vertebral compression fractures

38
Q

Osteopetrosis

A

Defective osteoclasts lead to failure of normal bone resorption. Thickened dense bone that are prone to fracture and bone filling marrow space resulting in pancytopenia and extramedullary hematopoiesis.

X-ray: bone in bone appearance

Presentation: can cause cranial nerve impingement and palsies

Treatment: Bone marrow transplant - osteoclasts derived from monocytes

39
Q

Osteomalacia

A

Vitamin D deficiency. Defective mineralization.

Labs: low vit D, low serum Ca++, increased PTH, low serum phosphate

Hyperactive osteoblasts results in elevated alk phos

40
Q

Paget disease of bone

A

Localized bone disorder. Both increased osteoblastic and clastic activity.

Labs: Normal Ca++, phos, PTH, elevated alk phos

Path: Moszic pattern of woven and lammelar bone

41
Q

Giant cell tumor

A

Benign tumor of bone. Seen in 20-40 year olds at epiphyseal end of long bones. Often around the keee. Locally aggressive.

42
Q

Osteocondroma

A

Most common benign bone tumor, Seen in young males less than 25. Mature bone with cartilaginous cap. Rarely transforms

43
Q

Osteosarcoma

A

Distribution bimodal: primary occurs in 10-20 yo, secondary in those over 65

Predisposing factors: PAget disease of bone, bone infarcts, radiation, familial retinoblastoma, Li Fraumeni

Coldman triangle on xray

Aggressive

44
Q

Ewing sarcoma

A

Seen in boys less than 15
Seen in diaphysis of long bones
Anaplastic small blue cell tumor. Extremely aggressive. Onionstkin reaction

Associated with t(11;22)

45
Q

HLA type associated with RA

A

HLA-4

46
Q

Drugs used to treat RA

A

Anti-inflammatory: NSAIDs, glucocorticoids
Disease-modifying agents: methotrexate, sulfasalazine
Biologics: TNF-alpha inhibitors

47
Q

Clinical findings of Sjogrens syndrome

A 
Inflammatory joint pain
Xerophthamia
Xerostomia
Anti-SS-A (anti-Ro), Anti-SS-B (Ant-La)
Bilateral parotid gland enlargement

MALT lymphoma is complication

48
Q

Treatment of pseudogout

A

Acute attacks: NSAIDs

Prophylaxis: colchicine

49
Q

Systemic juvenile idiopathic arthritis

A

-recurrent and relapsing spiking fevers
-polyarticular join pain
-salmon pink macular rash
rheumatoid factor negative
-chronic uveitis and decreased growth

50
Q

Presentation of psoriatic arthritis

A

Seen in less than 1/3 of psoriasis patients
Asymmetric, patchy involvement
Dactylitis

51
Q

Clinical features of ankylosing spondylitis

A

Ankylosis: stiffness due to joint fusion in spine
Uveitis
Aortic regurgitation

52
Q

Reactive arthritis

A

Triad of conjunctivitis, urethritis, and arthritis post-GI infection or GU infection

53
Q

Renal syndromes associated with lupus

A

Nephritic: diffuse proliferative GN
Nephrotic: membranous GN

54
Q

Cuases of drug induced lupus

A

Hydralazine, procainamide

55
Q

Polymyalgia rheumatica

A

Seen in women over 50, often associated with temporal arteritis

Pain and stiffness in shoulders and hips, fever, malaise, weight loss

56
Q

Polymyositis vs dermatomyositis

A

Polymyositis: proximal muscle weakness, CD8+ inflammation, often involves shoulders

Dermatomyositis: Malar rash, Gottram papules, heliotrope rash, shawl and face rash, mechanics hands, CD4+ inflammation, risk of occult malignancy

57
Q

Myositis ossificans

A

Metaplasia of skeletal muscle into bone due to muscle trauma

58
Q

Embryologic origin of parathyroid glands

A

Inferior from third pharyngeal pouch (along with thymus); superior from fourth pharyngeal pouch (along with ultimobranchial body)

59
Q

Colchicine

A

MOA: binds intracellular tubulin, inhibiting polymerization into microtubules, disrupting cytosekletal-dependent functions like chemotaxis and phagocytosis

Use: gout flares, prophylaxis while initating allopuirnol

Adverse effects: nausea, abdominal pain, diarrhea

60
Q

Heteroplasmy

A

Having different organellar genomes within a single cell. Can be used to describe differences among patients with a mitochondrial gene mutation: more severe disease associatd with having higher proportion of defective mitochondrial genomes wtihin cells

61
Q

Mitochondrial encephalomyopathy

A

Neuromuscular lesions, ragged red skeletal fibers, lactic acidosis.

62
Q

snRNPs

A

Involved in RNA splicing

63
Q

Sporotrichosis

A

Subcutaneous mycosis caused by Sporothrix schenckii. Dimorphic fungi found on plants. Enters through breaks in skin often thorn pricks) and spreads along lymphatics

64
Q

Succinylcholine

A

MOA: depolarizing NMJ blocker that causes continuous stimulation to the ACh receptor, preventing ACh from binding; results in flaccid paralysis

Adverse effects: nicotinic ACh receptor is a nonselective cation channel so it allows for K+ release as well as Na+ influx and can lead to hyperkalemia and arrhythmia in patients with crush or burn injuries, denervating injuries, and myopathies

65
Q

Atracurium

A

MOA: nondepolarizing NMJ blocker.

Adverse effects: Causes histamine release which can result in hypotension, flushing, bronchoconstriction. Metabolized to laudanosine which can cause seizures

66
Q

Baclofen

A

MOA: muscle relaxant that affects GABAb receptors in spinal cord

67
Q

Dantrolene

A

MOA: Prevents release of Ca++ into cytoplasm by blocking RyR receptors

Use: Malignant hyperthermia

68
Q

anti-Jo-1

A

Antibody seen in polymyositis and dermatomyositis. Also called anti-histidyl-tRNA synthetase

69
Q

Acetaminophen OD

A

Metabolite depletes glutathione and forms toxic tissue byproducts in liver leading to hepatic necrosis. N-acetylcysteine is antidote - acts by regenerating glutathione

70
Q

Bisphosphonates

A

Name: Alendronate

MOA: inhibits osteoclast activity by binding hydroxyapatite in bone

Use: osteoporosis, hypercalcemia, Paget disease of bone, multiple myeloma to prevent new bone lesions

Toxicity: corrosive esophagitis, osteonecrosis of jaw

71
Q

Teriparatide

A

MOA: recombinant PTH, increases osteoblast activity

Use: osteoporosis

72
Q

Allopurinol

A

MOA: inhibits xanthine oxidase, decreasing uric acid production

Use: gout, lymphoma and leukemia to prevent urate nephropathy

73
Q

Febuxostat

A

MOA: inhibits xanthine oxidase

74
Q

Pegloticase

A

MOA: Recombinant uricase; catalyzes metabolism of uric acid

75
Q

Probenecid

A

MOA: Inhibits reabsorption of uric acid in proximal convoluted tubule

ADR: can precipitate uric acid calculi

76
Q

Colchicine

A

MOA: binds and stabilizes tubulin, preventing MT polymerization

77
Q

Etanercept

A

MOA: TNF-alpha decoy receptor

Use: RA, psoriasis, ankylosing spondylitis

ADR: infection, reactivation of latent TV due to disruption of granuloma formation and stabilization

78
Q

Infliximab and adalimumab

A

MOA: anti-TNF-alpha monoclonals

Use: IBD, RA, ankylosing spondylitis, psoriasis

79
Q

CREST syndrome

A

More benign version of systemic sclerosis with only localized skin involvement

  • calcinonsis
  • raynaud’s
  • esophageal dysmotility
  • sclerodactyly
  • telangiectasias

Anti-centromere antibodies highly specific.

USMLE (17 decks)

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