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MSK Flashcards

1
Q

osteogenesis imperfecta types

A

collagen disorder. decreased synth (type 1, 3&4. AD) or abnormal collagen (type 2. AR).

  1. acquired mutation, not present at birth (2-6yo). normal lifespan with increased # during infancy. most common. otosclerosis (deaf), blue sclera, teeth abno.
  2. incompatible with life. multiple intrauterine #s. death 2nd Pulm hypoplasia.
  3. same as type 1 but present birth with growth retardation.
  4. same as type 1 but present birth with short stature. less otosclerosis, sclera normal, only mild osteoporosis and #.
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2
Q

osteoporosis
osteomalacia
Vitamin d def

A

osteoporosis. n bone mineralization and matrix, decreased volume
osteomalacia. n bone matrix but doesn’t mineralized. get cartilage overgrowth (flaring metaph and Ricketts rosary ribs).
vit c def. scurvy. decreased matrix with n mineralization. fragile vessels. collagen x link disorder.

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3
Q

osteoporosis types

A
  1. Juvenile
    Post menopausal. f>m 6.1. decreased oestrogen with increased osteoclast and turnover bone. cancellous > cortical
    Senile. older >65. f>m 2.1. increased osteoblast with decreased turnover. cancellous = cortical

2ndry. crf, congenital (osteogenesis imperfecta, sickle cell), etoh, malabsorption or nutrition, steroids, malignancy, endo (hyper or hypoparathyroid), immune (RA, SLE)

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4
Q

rickets

A

osteomalacia
decreased vit d
decreased intake/ sunlight, decreased synthesis kidney (1.25 dihydroxycholcalciferol crf), resistance to vit d.
n matrix with decreased mineralization so cartilage overgrowth with weak bendy bones (looser zones and#, bowed, rickets rosary ribs, metaph flaring and fraying)

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5
Q

scurvy/vit c

A

collagen x link disorder
normal mineralization bone but decreased matrix
lucent bands, subperiosyeal haem, joint haem, pencil thin cortex and metaph cupping/spur

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6
Q

pagets

A

increased bone turnover with disordered remodeling
?cause, ? chronic paramyxoid infection
3 phases:
1. lytic. increased osteoclast, increased vascularity, increased breakdown. cortex and trabecular thin
2. mixed. osteoclast and vascularity decrease with osteoblast increase. irregular disorganized remodeling with thick trabecular and cortex. mosaic
3. burnout. uniform Sclerotic. decreased cellular activity

axial skeleton and long bones.
malig degeneration to fibrosarc, chondrosarcoma, osteosarcoma.

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7
Q

AVN causes

A

epiphyseal. cartilage preserved but wedge shaped epiphyseal infect with subchondral collapse
metadiaphyseal. indolent. cortex preserved
causes: ASEPTIC
Anaemia (sickle cell), Steroids, Etoh, Pancreatitis, trauma, Idiopathic, CVD

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8
Q

osteomyelitis bugs

A

neonates. GBStaph . epiphyseal and metaph
kids. h. influenza. don’t cross growth plate. metaph only
adults. fused growth plate so cross. staph aureus
IVDU. spine, SIJ, sternoclavicular.
bodies abscess. chronic walled off abscess
involcrum (abscess with Sclerotic wall), sequestrum (central bone), cloaca (tract to cortex/joint).

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9
Q

TB osteomyelitis

A 
spares IV discs. 
travels under ALL and multilevel
psoas spread
\+/- ca+
also knees, hips, other big joints. looks like gout on steroids.
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10
Q

RA

A

T CD4 cell autoimmune chronic systemic inflamm
joints. synovitis 》erosion. proximal hands and feet then larger joints (spares hips and Lumbar spine).
pannus. inflammatory ST
Lungs. nodules (can be large and cavitating), sensitive to silicosis = caplan. UIP, effusion
heart. peri or myocarditis
skin. nodules on pressure areas
spleenomegaly (felty) with neutropaenia

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11
Q

seronegative spondyloarthropathy

A

HLA B27, Rh -ve
PAIR. Psoriasis, Ank spon, Inflammatory (IBD), Reactive/Reiter
SIJ, inflamm arthropathy symmetric, enthesopathy and bone proliferation, syndesmophytes

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12
Q

Ank spon

A 
bamboo spine
dagger spine
shiny corners
Sq.  VB
enthesophytes
SIJ
anterolateral hatchet prox humerus
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13
Q

Reactive arthritis

A

feet>hands
triad. can’t see (conjunctivitis), can’t wee (uveitis ), can’t climb a tree
2-3 weeks post infection. salmonella

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14
Q

psoriatic arthritis

A 
hands > feet
pencil in cup
new bone proliferation
sausage digit
ivory phalanx
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15
Q

SLE

A

multisystemic autoimmune vasculitis

non erosive joints, ligament laxity and subluxation,AVN
anti dsDNA and smith antibodies
Pulm haem, bone infarct, pericardial or pleural effusion , enteritis, discoid or malar rash, oral ulcers

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16
Q

gout

A

accumulation of monosodium irate crystals in joints and kidneys
crystals not water soluble. yellow, sharp, bifringent -ve
kidneys. medulla. CRF and calculator
joint. recurrent inflamm with synovial thickening, periarticular eroisions and pannus
cause.1. 95%primary. genetic predisposition
2ndry. increased prod (mm, tumour, infection), decreased excretion (crf)

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17
Q

CPPD

A

Calcium Pyrophosphate depo in joints..chalky white
unknown aetiology
chondrocalcinosis, hook osteophytes 2/3rd MCP

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18
Q

PVNS cf synovial chondromatosis

A

pigmented villonodular synovitis
PVNS. 10-30yo.don’t ca+. diffuse (big joints, knee) or focal (hands, wrists tendon sheath) haemosiderin depo, villonodular finger like projections synovial membrane.
synovial.chondromatosis. older 30-50yo. ca+ intra articular foreign bodies.

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19
Q

multiple enchondromas

A 
olliers.
diaphyseal medullary expansion. 
short tubular bones of fingers and feet
bilateral and asymmetric
associated.  panc and granulosa cell ovarian tumor
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20
Q

acromegally

A 
2nd pit adenoma. growth overstimulation
thick skull with big sinuses
big jaw
hypertrophy spinal ligs
VB #s
distal phalanx spade
heal pad thick
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21
Q

hyperparathyroid

A
  1. adenoma or hyperplasia of parathyroid
  2. Renal cause (renal osteodystrophy)
  3. parathyroid adenoma due to chronic hyperparathyroid. doesn’t return to n once stimulus fixed

subperiosteal bone resorption. radial side 2&3 digit, med tibia, humerus and femur
subchondral resorption. distal clavicles, pub symph and SIJ erosion
subligamentous resorption. Inferior calcaneous, is children tuberosity
acroosteolysis, ST ca+, superscan, superior and inferior rib notch
** 2ndry (renal osteodystrophy) also get rugger jersey spine

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22
Q

DISH cf Ank spon

A

DISH.>4 flowing osteophytes VB R>L.
OPLL ca+
enthesopathy
NO SIJ (Ank spon does)

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23
Q

insufficiency fracture

A 
vertebral crush or wedge
sacral H
NOF
proximal 1/3 femur bisphosphinate
public rami
calcaneous under
sternum 
*xray often n. do bonescan for  increased activity
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24
Q

chondrocalcinosis

A

CPPD most common
crystals, cation, cartilage destruction
crystals. CPPD, gout, HADD
cations. wilsons, hyperparathyroid, iron (haemachromatosis)
Cartilage destruction. OA, acromegaly, trauma

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25
Q

sacral mass

A

chordoma
chondrosarcoma
GCT
plasmacytoma

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26
Q

modic changes

A
  1. oedema. dark bright
  2. fat. bright bright
  3. sclerosis. dark dark
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27
Q

tarlov cyst

A

s2 and s3
causes erosion
25% symptomatic, rest not.

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28
Q

femeroacetabular impingement

A

cam. overgrowth acetabulum

pincer. NOF bulge

29
Q

Morton neuroma

A

3rd and 4th metatarsal head (3rd interspace)
2nd metatarsal interspace less common (2nd and 3rd MT heads)
chronic entrapment plantar digital nn by intermetatarsal lig.
fibrous, low T1 and T2 ,hypoechoic but enhances

30
Q

hypothyroid

A

delayed skeletal maturation. assessment age with Greulich and Pyle
cortical thickening
stipple epiphysis (lots of ossifucation centres)
small or absent epiphyseal growth centre

31
Q

Achilles tendon tear

A

2-6cm from insertion

can’t get tenosinovitis as no synovial sheath, but get fluid around

32
Q

Fibrous dysplasia.

4 patterns

A

monostotic
polyostotic
craniofacial
cherubism - mandible and maxillary only

33
Q

McCune albright

A

polyostotic fibrous dysplasia (unilateral usually)
cafe au lait spots
precocious puberty, hypercortisol/cushing

34
Q

meniscus cyst

A

adj to anterior horn lateral meniscus. associated with complex tear
adjacent to posterior horn medial meniscus. associated with horizontal tear

35
Q

posterolateral corner

A

4 main structures: Lat colat, pop mm, popliteofib lig, biceps femoris.
ACL > PCL

36
Q

O’Donoghue unhappy triad

A

ACL
mcl
med meniscal tear

pivot shift injury. basketball.

37
Q

Blount disease

A

osteoneceosis of medial tibial condyle
<>
big (obese), black, boys.

38
Q

erlenmeyer flask

A

TOP DOG
Thalassemia,osteopetrosis, Pyle disease ( metaphyseal bone dysplasia), Diaphyseal eclasia (multiple hereditary exostoses), olliers, gauchers
lead poisoning, fibrous dysplasia, rickets, Achondroplasia

39
Q

rotator cuff us

A

supra spin do in int. rotation. xray do extra rotation.
ant tear 》posterior. 1cm medial to insertion.
associated. type 3 acrimion

40
Q

rib notching

A

superior: CTDs, Maran, NF, OI, hyperparathyroid

inferior: enlarged collateral vessels (aortic coarct or thrombus, Blalock taussig, Pulm aa stenosis, svc obst, avm )
neurogenic tumor (NF, neuroma)
osseous (hyperparathyroid, Thalassemia)

41
Q

Kummel disease

A

AVN of VB post wedge # non union
2 weeks post major trauma
lower t and upper l spine
IV vacume cleft and fluid level

42
Q

Ewing cw osteosarcoma

A

Ewing is younger age group and diaphyseal. ST>bone
OS is older and metaphyseal.
do an MRI to assess for local extent, skip lesions, which mm compartment in
CT chest for mets. dense and Ca+ in osteosarcoma

43
Q

osteosarcoma subtypes

A

conventional

telangectatic. worst prog. lytic, fluid/necrotic filled
peristaltic. around bone. diaphyseal
paraosteal. best prog. outer periosteum with cleft between. older 20- 50yo

primary associated with retinoblastoma and le fraumeni
2ndry from fiborous dysplasia, pagets, rxt, OM

44
Q

adimantinoma

A

anterior tibia cystic multilocular lesion in teen boy

locally aggressive

45
Q

elastofibroma

A

Fibrous mass between scapula and chest wall 2ndry to friction.
old lady
benign

46
Q

ST mass

A

rhabdomyosarcoma - most common in kids (most common bladder, but can occur anywhere)
synovial cell sarcoma - near joint but not within. +/- ca+.
liposarcoma - 40-60yo. extremities and retroperitoneal. well cx looks like lipoma
Malignant fiborous histiocytoma - most common ST sarcoma in adult. Extremities and retroperitoneal. 2nd to pagets or rxt. aggressive.
Fibromatoses - nodular. Palmar (dupuytren) plantar penis (peyronie ) mm shoulder, chest wall, back, thigh, h&n messenteric

47
Q

spondylolisthesis grades

A
  1. 0-25%
  2. 25-50%
  3. 50-75%
  4. 75-100%
48
Q

mm lesion with high T2 and rim c+ ddx

A

abscess
haematoma
sarcoma
*no hx trauma or infection… sarcoma needs to be excluded.

49
Q

Jones fracture

A

at least 2cm distal to joint 5th MC base

don’t involve the joint

50
Q

Sacroiliitis

A

PAIR
psoriasis, Ank spon (starts inferior), IBD, Reactive
gout - Sclerotic erosions - good differentiator
brucellosis, JCA, whipples

51
Q

sudecks atrophy

complex regional pain sx

A

type 1. no nn lesion
type 2. nn lesion

trauma, cns disorder, immobilization, MI
patchy periarticular osteopaenia, ST swelling 》atrophy, joint space preserved, subcortical erosions/resorption

52
Q

hypertrophic OA

A

periosteal reaction of distal long bones with no lesion
smooth periosteal thickening that becomes multilayered and extends from diaph 》metaph 》epiph.
lung. plural (mesothelioma, pleural fibroma), Congenital cyanotic heart disease, lung abscess or mets, bronchogenic ca, IBD, lymphoma (GI and pulm), whipples, PBC.

53
Q

skeletal Tb

Tb dactylitis

A

expansive diaphyseal lesion (balloon like with int. septa)
Associated ST swelling.
no periosteal reaction
bones distal to wrist and Tarsus involved
cold abscess in adj ST with chronic sinus
kids

54
Q

premature suture closure

A 
rickets
over shunting
hypophosphataemia
sickle cell and thalassemia
dysplasias
hyperthyroid
Mucopolysaccharidosis (h and m)
55
Q

rickets mimics

A

biliary atresia
hypophosphataemia
chondrodysplasia
metabolic bone disease

56
Q

cortical desmoid

A

posterior medial femoral epicondyle
don’t touch lesion
pain
hot on bone scan until involute

57
Q

Coraco-aceomial

acromio-clavicular

A

cc- <13mm

AC - <6mm or <4m asymmetry

58
Q

Tarsal coalition

A

talocalcaneal most common - C sign
calcaneonavicular - ant eater. best seen oblique xray or MRI FS T2
can be cartilage, see bony oedema on MRI

59
Q

Gorlin disease

A

multiple odontogenic keratocysts, BCCs, bifide ribs and ST ca+

60
Q

pagets cw FD skull

A 
both:
sclerotic/lytic mixed
diploic widening
thick cortex - pagets involves both inner and outer but FD spares inner
FD usually unilateral, pagets whole
61
Q

pagets CN palsy

A

8, 7, 2, 3 or peripheral nns
also chordoma and FD
cavernous sinus thrombus CN palsy in 3, 4, 6

62
Q

rib notching in coarctation

A

3 to 8

costcervical trunk is 1 and 2

63
Q

floating teeth

A

hyperparathyroid
cushing
scleroderma

64
Q

tumoral calcinosis

A

hereditary periarticular ca+
hip, shoulder, elbow, foot, wrist
amorphous, cloud like
no erosion or ST mass associated

65
Q

Achondroplasia

A

skeletal dysplasia. rhizomelic
short femur
splayed 2,3 and 4 digit. trident
frontal bossing skull
big cranial vault with small foramen magnum
posterior VB scallop in and progressive narrowing interped distance
short pedicles and widened IV discs
anteriorly flared ribs
horizontal acetabulum with tombstone stumpy iliac wings and champaign glass small pelvis
metaph flaring long bones
rhizomelic
metacarpals and metatarsals short and all same length

66
Q

Parsonage turner

quadrilateral space syndrome

A

brachial plexus neuritis
increased T2 and dennervation rotator cuff mms
ddx. disuse, suprascap notch mass (ganglion)

axillary nn entrapment. teres minor or deltoid mm atrophy/fat infiltration/T2 high
space-triceps long head, teres minor, major and humerus.

67
Q

thick skull

A 
phenytoin
shunted hydrocephalus
acromegaly. enl frontal sinus and big jaw
extramedullary haematopoiesis
Pagets. inner and outer table 
Fiborous dysplasia.  inner table spared

focal. osteoma, meningioma, mets

68
Q

Hair on end

A

Hemolytic Anaemia. Thalassemia (inner and put table gone), Sickle cell (assoc infection 2nd no spleen), hereditary spherocytosis
Neoplasia. Haemangioma, meningioma, mets haemangiopericytoma
Other. Cyanotic heart disease, severe iron deficiency kids
pagets. cotton wool
hyperparathyroid. salt and pepper
kids. LCH (EG), Neoplasia, infection.

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