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MSK Flashcards

1
Q

A lateral blow to the knee causes the “unhappy triad” injury. What makes up the triad?

A

LAMe
LAME

Lateral meniscus
MCL
ACL

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2
Q

Dislocation of which wrist bone can cause median nerve compression?

A

Lunate

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3
Q

Which 2 nerves come off the posterior cord of the brachial plexus?

A

Axillary and radial (i.e. extensors)

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4
Q

Trauma to which wrist bone can damage the ulnar nerve?

A

Hamate (specifically the hook)

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5
Q

“Pope’s blessing” claw = _____ nerve damage.

A

Ulnar

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6
Q

What nerve innervates the thenar muscles?

A

Median

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7
Q

Which muscles are responsible for the clawing defects seen in ulnar and median nerve lesions?

A

Lumbricals

Flex at MCP, extend at PIP and DIP

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8
Q

What is the MOA of etanercept, a drug used to treat moderate-to-severe RA in patients who have failed methotrexate alone?

A

A decoy TNF-alpha that binds to the Fc component of IgG to reduce the biological activity of TNF-alpha

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9
Q

What is McCune-Albright syndrome and how does it present?

A

Mutation in GNAS gene -> constant G protein activation -> hormone overproduction

Peripheral precocious puberty
Irregular cafe-au-lait macules
Polyostotic fibrous dyslplasia

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10
Q

What is Legg-Calve-Perthes disease?

A

A disease of young children that results in isolated idiopathic osteonecrosis of the hip.

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11
Q

Which band does not get smaller in muscle contraction?

A

A band

“HIZ shrinkage”

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12
Q

Which autoimmune marker is seen in primary biliary cirrhosis?

A

Anti-mitochondrial antibodies

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13
Q

Which artery is at risk from a femoral neck fracture?

A

Medial circumflex

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14
Q

Anti-Jo antibodies are Abs against what exactly?

A

(seein in polymyositis!)

Against histidyl-trna-synthetase

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15
Q

What are the treatments for ACUTE gouty arthritis and what is the MOA?

A

NSAIDs are fine in most patients but if not (i.e. renal failure, PUD)…Colchicine:

Anti-inflammatory that binds intracellular tubulin preventing tubulin polymerization into microtubules -> impaired leukocyte migration and phagoyctosis -> reduced inflammation

Can cause n/v/d

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16
Q

What drug is contraindicated/needs to be monitored with allopurinol (xanthine oxidase inhibitor) use?

A

Azathioprine

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17
Q

Longterm treatment for gout?

A

Allopurinol (xanthine oxidase inhibitor) to decrease uric acid production

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18
Q

In addition to spinal problems, what other symptoms can ankylosing spondylitis patients present with?

A

Chronic hypoventilation
Ascending aortitis -> aortic insufficiency
Anterior uveitis

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19
Q

Back pain relieved by walking up hill or leaning on a stroller/shopping cart = ?

A

Spinal stenosis, usually caused by degenerative arthritis of the spine

This leads to hypertrophy of the ligamentum flavum along the posterior aspect of the spinal canal

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20
Q

What crystal accumulates in pseudogout? How will patients present?

A

Calcium pyrophosphate

Present with acute mono or oligo arthritis (often knee) characterized by pain, swelling, erythema, and warmth.

Synovial fluid will show blue pos birefringent crystals, rhomboid shaped + neutrophils

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21
Q

Achondroplasia is one of the few diseases whose incidence increases with ________.

A

Increasing paternal age

22
Q

Osteopetrosis is due to a gene defect in which enzyme?

A

Carbonic anhydrase II which impairs the ability of osteoclasts to generate an acidic enough environment for bone resorption.

23
Q

What is osteopetrosis?

A

Failure of normal bone resorption due to defective osteoclasts -> thickened, dense bones prone to fracture. Specifically you’ll get overgrowth of cortical bone and filling of marrow space.

24
Q

Mosaic bone, long bone “chalk stick fracture”, elevated Alk phos = ?

A

Paget’s disease of the bone

25
Q

What are the causes of death in Paget’s disease of the bone?

A

AV shunt formation through bone

Osteogenic sarcoma

26
Q

Which primary bone tumor is unique in that it tends to occur in slightly older populations (20-40 years)

A

Giant cell tumor

Multinculeated giant cells
Spindle shapes

Also more common in women

27
Q

What are osteochondromas?

A

Most common benign bone tumor - occurs in the metaphysis of bones
Most common in men <25 years

28
Q

Where are osteosarcomas found? What is the age distribution?

A

Metaphysis of long bones
Codman’s triangle/sunburst appearance due to lifting off of the periosteum

Bimodal age distribution:

peaks at 10-20 years and 65+

29
Q

What are predisposing factors to osteosarcoma?

A

Paget’s disease
Bone infarct
Radiation
Retinoblastoma

30
Q

Osteophytes (bone spurs) occur in ___arthritis.

A

Osteoarthritis

31
Q

DIP pain = ____arthritis.

A

osteoarthritis

32
Q

Pannus formation = ____arthritis

A

Rheumatoid

33
Q

What crystals are formed in gout?

A

Monosodium urate - negatively birefringent - yellow - needle shaped

34
Q

Which arthritis is associated with hemochromatosis?

A

Pseudogout

35
Q

Although you need to check crystals to be definitive, what is one indication that you might be seeing pseudogout instead of gout?

A

Larger joints (e.g. knee) more associated with pseudogout

36
Q

Polymyalgia rheumatica (joint pain without weakness) is often associated with what disease?

A

Temporal giant cell arteritis

37
Q

Polymyositis = proximal muscle ______ but NOT _____.

A

Weakness but not pain

38
Q

CD_+ T cells = polymyositis

CD_+ T cells = dermatomyositis

A 
4+ = polymyositis
8+ = dermatomyositis
39
Q

What is Paget’s disease of the bone?

A

Localized disorder of bone remodeling caused by increased osteoclastic activity followed by increased osteoblastic activity that forms poor-quality bone -> mosaic pattern of woven lamellar bone.

40
Q

Which spinal consequence can be seen in RA?

A

Cervical subluxation

41
Q

What lab findings will you see in RA?

A

Positive rheumatoid factor

Anti-citrullinated (CCP) antibodies

42
Q

What part of the bone does hematogenous osteomyelitis affect?

A

Metaphysis of long bones

43
Q

In acanthosis, which layer is thickened?

A

Spinosum

44
Q

Which arthritis looks like a “pencil in cup deformity” on xr?

A

Psoriatic arthritis

45
Q

Lichen in planus is associated with hepatitis ___.

A

C

46
Q

In which skin lesion do you see parakeratosis?

A

Psoriasis

47
Q

Which skin cancer is associated with BRAF V600 mutation?

A

Melanoma

48
Q

Which skin abnormality can be seen with PBC?

A

Xanthelasma (excess cholesterol!)

49
Q

Round papules that evolve into target lesions with a dusky central area = ?

A

Erythema multiforme

50
Q

Junctional nevus vs compound nevus.

A

Junctional nevus is aj nest at the dermoepidermal unction only. Compound nevi have discrete epidermal AND dermal involvement

51
Q

A curious treatment for psoriasis is with Vitamin ___ analogs such as:

A

D analogs

calcipotriene (calcipotriol)

May work by inhibiting T cell proliferation and other inflammatory mediators

52
Q

What are the most serious side effects of bisphosphanates?

A

corrosive esophagitis and osteonecrosis of the jaw

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