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UWorld Journal > MSK > Flashcards

MSK Flashcards

1
Q

what is osgood-schlatter disease

A

overuse injury of the secondary ossification center (apophysis) of the tibial tubercle

very common cause of knee pain in young adolescent athletes after a recent growth spurt

pain and swelling at the tibial tubercle, the insertion point of the patellar ligament

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2
Q

insertion site of the quadriceps muscles group

A

tibial tuberosity

by the patellar ligament

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3
Q

what is the psoas sign

A

inflammation of the psoas muscle causes pain when the hip is extended

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4
Q

how to tell that the alkaline phosphatase is from the bone and not placenta, liver, or intestine

A

two predominant contributors of alkaline phosphatase: bone and liver

can be differentiated by electrophoresis and specific monoclonal antiboies

heat denature bone-specific alkaline phosphatase

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5
Q

what is bone-specific alkaline phosphatase used for

A

reflects osteoblastic activity

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6
Q

mechanism of action of colchicine and side effects

A

second-line agent for acute gouty arthritis

inhibits tubulin polymerization and microtubule formation in leukocytes, reducing neutrophil chemotaxis an emigration to sites inflamed by tissue deposition of monosodium urate crystals

also impaired GI mucusal function by microtubule disruption–> diarrhea, nausea, vomiting, and abdominal pain

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7
Q

type 1 muscle fiber

A

slow twitch; red fibers resulting from increased mitochondria and myoglobin concentratioin (increased oxidative phosphorylation)–> sustained contraction

increased with endurance training

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8
Q

type 2 muscle fiber

A

fast twitch; white fibers from decreased mitochondria and myoglobin concentration (increased anaerobic glycolysis)

proportion increased after weight/resistance training, sprinting

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9
Q

CREST syndrome

A
  • Calcinosis (subcutaneous Ca2+ deposits which may be asumptomatic or painful)
  • Raynaud’s phenomenon
  • Esophageal dysmotility
  • Sclerodactyly (thickening of the skin of the hands and feet)
  • Telangiectasias (dilated blood vessels)

associated with anti-centromere antibodies

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10
Q

what is ankylosing spondylitis?

A

inflammatory condition associated with HLA-B27 serotype

stiffness and fusion (ankylosis) of axial joints

most commonly affected joints: sacroiliac and apophyseal joints of the spine

peripheral arthritis and enthesitis (pain and swelling at the sites of tendon insertion in to bone)

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11
Q

complications of ankylosing spondylitis

A
  • respiratory: limit chest wall expansion–> hypoventilation
  • cardio: ascending aortitis–> dilation of aortic ring and aortic insufficiency
  • eye: anterior uveitis –> pain, blurred vision, photophobia, and conjunctival erythema
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12
Q

characteristics of anaplastic tumors

A

neoplastic cells that have complete lack of differentiation–>high-grade

1) loss of cell polarity with complete disruption of normal tissue architecture; cels coalesce into islands in a disorganized, infiltrative fashion
2) significant variation in shape and size of cells and nuceli
3) large nuclei that are deep-staining with abundant, coarsely-clumped chromatin and large nucleoi
4) numerous mitotic figures
5) giant, multinucleated tumor cells

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13
Q

dermatomyositis

A

autoimmune inflammatory disease that affects muscles and skin

malar rash, Gottron papules, heliotrope rash, “shawl and face” rash, “mechanic’s hands”

increased risk of malignancy, especially lung, colorectal, and ovarian

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14
Q

characteristic of follicular lymphoma

A

most common indolent non-Hodgkin lymphoma in adults, second most common NHL overall

derives from follicular B cells

waxing and waning clinical course

middle-aged patients with painless lymph node enlargmet or ab discomfort from abdominal mass

histology: cleaved and noncleaved folllicle center cells in a nodular pattern

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15
Q

mutation associated with follicular lymphoma

A

t(14;18) translocation–> overexpression of bcl-2 oncogene that blocks programmed cell death

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16
Q

DIC in pregnancy is mediated by

A

tissue factor (thromboplastin) found in high concentration in placental trophoblast

initiate coagulatioin cascade, depleting clotting factors and platelets–> lots of bleeding

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17
Q

signs of thrombotic thrombocytopenic purpura

A

new-onset neurologic symptoms, anemia with schistocytes, thrombocytopenia, and acute kidney injury

due to deficiency of ADAMTS13, a von Willebrand factor cleaving protease

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18
Q

how come there is hypercalcemia in sarcoidosis

A

caused by PTH-independent formation of 1,25-dihydroxyvitamin D by activated macrophages

leads to increased intestinal absorption of calcium

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19
Q

what is rheumatoid factor

A

IgM antibody specific for Fc component of IgG

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20
Q

what does dystrophin do?

A

stabilize interaction between sarcolemma and the intracellular contraction apparatus

disruption to this protein–> membrane damage and myonecrosis

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21
Q

ankylosing spondylitis

A

chronic inflammatory disorder of the sacroiliac joints and axial skeleton

–> spine x-rays reveal sclerosis, ligamentous calcification, and vertebral fusion (“bamboo spine”)

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22
Q

seronegative spondyloarthropathies diseases

A

ankylosing spondylitis, reactive arthritis, arthritis associated with inflammatory bowel disease, and psoriatic arthritis

all don’t have serum rheumatoid factor

patients with these disease have higher incidence of the HLA-B27 allele

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23
Q

what is serum sickness

A

type III hypersensitivity reaction to nonhuman proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes

fever, pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels

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24
Q

osteoarthritis vs rheumatoid arthritis

focused on osteoarthritis

A

osteoarthritis:
- increases with age, >40
- involves knees, hips, DIP and 1st CMC joint
- non or brief (<30 min) morning stiffness
- no systemic symptoms
- hard, bony enlargement of joints

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25
Q

osteoarthritis vs rheumatoid arthritis

focused on RA

A
  • 40-40, often younger
  • MCP, PIP and wrist joints
  • prolonged morning stiffness
  • fever, fatigue, and weight loss
  • soft/spongy, warm joints
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26
Q

what is heteroplasmy in inheritance pattern?

A

presence of both normal and abnormal mitochondrial DNA –> variable expression of an mitochrondrially inherited disease

27
Q

anti-Jo-1

A

anti-histidyl-tRNA synthetase

found in dermatomyositis and polymyositis

28
Q

production of which cytokines plays a huge role in the severity and progression of giant cell arteritis

A

IL-6

29
Q

breast cancer med that also decrease risk of both bone fractures and breast cancer

A

selective estrogen receptor modulators exhibit estrogen antagonist and agonist properties in a tissue-specific manner

Raloxifene- estrogen agonist activity on bone and estrogen antagonist effect on breast tissue and uterus so doesn’t increase risk of endometrial cancer

30
Q

tamoxifen

A

selective estrogen receptor modulator that has strong estrogen antagonist activity in the breast and in used in the treatment of estrogen receptor-positive breast cancer

agonist activity on the uterus increaes risk of endometrial hyperplasia/cancer

31
Q

relationship between TNF-alpha and latent tuberculosis

A

TNS-alpha is necessary for effective sequestration of mycobacteria within granulomas

so TNF-alpha inhibitors promote reactivation of latent tuberculosis–> increased risk of disseminated disease

32
Q

signs and symptoms of femoral neuropathy

A

weakness involving the quadriceps muscle group and weakening of iliopsoas with more proximal nerve injuries

difficulty with stairs and frequent falling secondary to “knee buckling”

diminished patellar reflex

sensory loss over anterior and medial thigh and medial leg

33
Q

characteristic of SLE

A

loss of immune self-tolerance with production of autoantibodies against nuclear antigens–> deposition of immune complexes in tissues and consumption of complement

34
Q

drug-induced lupus erythematosus (DILE)

A

abrupt onset of lupus symptoms (eg, fever, arthralgias, pleuritis) with positive anti-histone antibodies

associated wtih drugs that are metabolized by N-acetylation in the liver (eg, procainamide, hydralazine, isoniazid)

people who are slow acetylators are at greater risk for developing DILE

35
Q

what do you find in synovial fluid of pseudogout

A

rhomboid-shaped calcium pyrophosphate crystals

positive birefringent

36
Q

marfan syndrome

A

defect in fibrillin-1= extracellular glycoprotein that acts as a scaffold for elastin

fibrillin are abundant in zonular fibers of lens, periosteum, and aortic media

–> aortic root dilation with dissection and rupture=common cause of death

37
Q

first-line treatment for acute gouty arthrtis

A

NSAIDs

38
Q

rotator cuff muscles and their function

A
  • supraspinatus: abduction
  • infraspinatus: external rotation
  • teres minor: adduction and external rotation
  • subscapularis: adduction and internal rotation
39
Q

presenting features of osteonecrosis

A

most common site: femoral head: chronic, progressive groin and hip pain that is exacerbated by weight bearing

restricted movement in the affectd join, with no swelling, erythma, or warmth in the surrounding area

microscopic analysis: wedge-shaped zone of affected bone–> dead bony trabeculae (empty lacunae) and fat necrosis

40
Q

common causes of osteonecrosis

A

sickle cell disease–> thrombotic occlusion of arteries

-glucocorticoid therapy, vasculitis, and alcoholism

41
Q

what is defective in osteogenesis imperfecta

A

defective synthesis of type 1 collagen in osteoid by osteoblasts

42
Q

muscles used when siting up from supine position:

A

external abdominal obliques, rectus abdominis, and hip flexors (psoas major, psoas minor, and iliacus)

43
Q

side effects of methotrexate

A

stomatitis, bone marrow suppression, and liver function abnormalities

44
Q

dystonia

A

syndrome of prolonged, repetitive muscle contraction

may result from impaired function of basal ganglia

common types of focal dystonia: cervical dystonia (spasmodic torticollis), blepharospasm (involuntary closure of eyelids), and writer’s cramp

45
Q

myoclonus

A

sudden, brief, sometimes severe (shock-like) muscle contraction

ex) hiccups and hypnic jerks (occur when falling asleep)
pathologic: epilepsy and Creutzfeldt-Jakob disease

46
Q

what ligament is torn and displaced in radial head subluxation (nursemaid’s elbow)

A

annular ligament

47
Q

bone mineral density with thiazide diuretics

A

thiazide diuretics increase calcium absorption in the distal convoluted tubules within the nephron

associated with increased bone mineral density and are recommended for treatment of hypertension in patients at risk for osteoporosis

loop diuretics increase urinary calcium loss

48
Q

what happens to serum calcium, phosphorus, and PTH levels in primary osteoporosis (osteoporosis that is not due to an underlying medical disorder)

A

they are all normal

49
Q

parvovirus B19 causes 2 primary syndrome in immunocompetent patients

A

erythema infectiosum: primarily in children, bright red rash on cheecks with circumoral pallor and fever

acute arthropathy: in adults, symmetric polyarthritis involves the proximal interphalangeal, metacarpal, knee, and ankle joints, arthritis is self-limited and nondestructive

50
Q

contracture

A

condition of shortening and hardening of muscles, tendons, or other tissues–> rigidity and deformity of joints

due to excessive matrix metalloproteinase activity and myofibroblast accumulation in the wound margins

can produce deformities of the wound and surrounding tissues, most often on palms, soles, and anterior thorax, or at serious burn sites

51
Q

leukocyte adhesion deficiency (LAD)

A

autosomal recessive disorder characterized by absence of CD18 antigens, which are necessary for the formation of integrins (essential for leukocyte adhesion to endothelial surfaces and migration to peripheral tissues in response to infection or inflammation)–> recurrent skin and mucosal infections without purulence, delayed separation of the umbilical cord, and persistent leukocytosis (elevated levels of WBC)

52
Q

what does FGFR3 do?

A

normally responsible for limiting chondrocyte proliferation during endochondral ossification

in achondroplasia, FGFR3 is mutated and is activated, causing exaggerated inhibition of chondrocyte proliferation that results in bone shortening and craniofacial abnormalities

53
Q

what artery provides the majority of the blood supply to the femoral head and neck

A

medial femoral circumflex artery and its branches

54
Q

what ligament is injured in a lateral ankle sprain due to inversion of the food

A

anterior talofibular ligament

55
Q

which artery is most likely to be injured with midshaft fractures of the humerus

A

deep brachial (profunda brachii) artery

it runs with radial nerve along the posterior aspect of the humerus

56
Q

which part of the spine is also involved in rheumatoid arthritis

A

cervical spine–> can lead to spinal instability with potential radiculopathy/cord compression

57
Q

how does the body prevent damage to the musculoskeletal system when a muscle exerts too much force

A

golgi tendon organs inhibit contraction of the muscle, causing sudden muscle relaxation

58
Q

what is the golgi tendon organs sensitive to and insensitive to

A

sensitive to increases in muscle tension

insensitive to passive stretch

59
Q

medications associated with osteoporotic fractures

A
  • anticonvulsants that induce cytochrome P450 (increase vitamin D catabolism)
  • aromatase inhibitors (decrease estrogen)
  • medroxyprogesterone (decrease estrogen)
  • GnRH agonists (decrease testosterone and estrogen)
  • proton pump inhibitors (decrease calcium absorption)
  • glucocorticoids (decrease bone formation)
60
Q

triad clinical features of McCune-Albright syndrome

A
  • peripheral precocious puberty
  • irregular cafe-au-lait macules
  • polyostotic fibrous dysplasia (multiple osteolytic-appearing lesions of the hip and pelvis)

due to activating mutation in the G protein/CAMP/adenylate cyclase signaling pathway

61
Q

ATP’s role in muscle contraction

A

need ATP to detach myosin crossbridge from actin

when you take off the ATP and it is just the ADP-phosphate complex, then there is a cross-bridge between myosin and actin

62
Q

acute rheumatic fever

A

migratory arthritis, new-onset murmur, fever, and a positive anti-streptolysin O titer

acute morbidity is most likely due to pancarditis (inflammation of the endocardium, myocardium, and epicardium)

63
Q

where is the superior gluteal nerve located

A

superomedial quadrant of the buttock

64
Q

treatment of rheumatoid arthritis

A

because disease-modifying antirheumatic drugs (hydroxychloroquin, methotrexate, minocycline, and sulfasalazine) takes several weeks to take effect, NSAIDs and glucocorticoid can provide rapid symptom relief in the interim

UWorld Journal (18 decks)

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