msk Flashcards
during a clavicular fracture what muscle protects the subclavian vessels and brachial pleuxs
subclavius muscle
the brachial pleuxs lies behind what part of the clavical and anterior to the first rib
middle 1/3
which fracture of the femural head causes inc risk of osteonecrosis
?
subcapital fracture of the femoral neck
bc cut of blood supply by deep femoral artery
legg-calve perthes disease
idiopathic avascular osteonecrosis of the capital epiphysis of femoral head
classic: boy 4-20 yo, unilateral painless limping
pt is at risk of devloping?
osteo arthritis
positive thompson test detect?
achilles tendone rupture
no planter flexion of the foot with squeezing the calf muscle
know: that planter flexion of foot depends on an intact soleus muscle attached to an intach achilles tendon
compartment syndrome is caused by?
trick question
compression of the small veins of the limb
know this!!!!
on the boards
what disorder has an increase risk of recurrent shoulder dislocation
ehlers danlos syndrome
what can cause a posterior shoulder dislocation
electrical injury / ightening strike, or severe epileptic seizures
what ligament is most commonly injured in an anterior dislocation of shoulder
inferior glenohumeral ligament
radial head subluxation
what ligmament is involved
annular ligament.
ewings sarcoma is associated with what chromosomal translocation
t(11:22) –> activation of C-myc promotor –> massive production of EWS-FL-1
osteochondroma
what part of bone
metaphysis of long bone
osteoma
bone metaphysis
osteoid osteoma
metaphysis of long bone
osteoblastoma
epiphysis of long bones
giant cell tumor
epiphysis of long bone
giant cell tumor
epiphysis of long bones
osteosarcoma
metaphysis of distal femur, proximal tibia
chondrosarcoma
pelvis, shoulder, spread from the medulla through the cortex into the soft tissue
ewing sarcoma
MUTATION in?
derived from
diaphysis of long bones
t (11;22) –> activation C-MYC promotor –> massive production of EWS-FL-1
derived from neuroectoderm
what causes the pain in osteoma
which allows it to be treated with aspirin
excessive prostaglandin E2 production
what bone tumor is proliferation of
malignant OsteoBLAST`
osteroSARCOMA
RB mutation put a person at risk for
familial retinoblastoma and ?
ON BOARDS
osteoSARCOMA
pt presents with
inc alk phos
bone pain
swelling
xray shows elevation of periosteum
osteosarcoma
xray shows lifting of the periosteum ( codmans triangle) and Sunburrst growth pattern (due to?)
calcified malignant cells
in osteosarcoma
what bone tumor histo shows
anaplastic small blue cells (arranged in pseudorosette patterns
ewing.
what bone tumor
has osteoclastic giant cells
and originates from monocytes in epiphysis
usually seen in women
giant cell tumor
benign
soap bubbe appearance on xray
giant cell tumor.
which bone disease has
persistent primary spongiosa (endochondral bone / calcified cartilage) ?
osteopetrosis
pathogenesis of osteopetrosis
in adults
chloride channel mutation —-> prevention of bicarbonate exchange –> block the proton pump formation
low serum ca
high Alk phos
normal serum phosphate
osteopetrosis
cause of anemia in osteopetrosis
and tx
deficient marrow
bone marrow transplant
xray for pt with osteoporosis will show
radiolucency!!!
pts with osteoporosis
have
A. thin corticol bone
B. thin trabecular bone
C. both are thin
?
both thin cortical and trabecular
bone mineral density scan will be abnormal in a pt with
A. bulimia
B. Anorexia
?
anorexia
pts can develop osteoporosis
all the following can cause
hypogonal states
renal insufficiency –> osteodystrophy )( no a-1 hydroxy)
endocrine disorders (hyper PTH) thyrotoxicosis)
GI disorders (celiac and crohns disease both cause def in vit D)
drugs: steroids, antiepileptics (barbs, phenytoin –> inc metabolism fo vit D )
anticoagulants (heparin –> inc osteoclast activity)
PPIs (dec ca reabsorption)
rosiglitazone, plogitazone )dec osteobastic bone formation)
osteporosis
how do you develop osteoporosis after post menopause
over expression of RANK receptors in hypoestrogenic, –> inc bone resorption due to inc osteoclastic actibvity.
uncomfortable intercouse, irregular menses, irritability
45 yo female amenorrhea
this describes what
climacteric period (pre menopause)
on the boards
pt treated with fluoroquinolones for few weeks
hes an athelete and heard a popping after jumping
+ thompson test (no planter flexion of the foot w/ squeezing the calf)
achilles tendon rupture
child with
thinning of occiptial and parietal bones –> craniotabes (thinning and softening of skull)
delayed closure of fontanelle and bow legs.
protrusion of sternum
short stature
what labs do you expect
low ca
low phosphate
mild inc in alk phos
mild inc in secretion of PTH
on the boards
elderly pt
w/ malnutrition and living at home w/ no UVR exposure
what would be the best marker of what this pt is deficient in
?
osteomalacia
25 hydroxycholecalciferol
if you see increase alk phos
what would you check to see if its from live or bone
gamma-glutamy transpeptidase
elevated in liver pathology
in pagets disease what are the two complications
that can lead to death
1. high output heart failure from ateriovenous shunts in vascular boney lesions
inc risk of osteosarcoma
radiographic clue for
osteomalacia
looser zones defective calcification –> inc osteoid
radiographic clue for
osteoporosis/osteopenia
increased radiolucency
radiographic clue for
radiographic clue for hyperparathyroidism
subperiosteal reabsorption
radiographic clue for
mosaic pattern
(puzzle pieces stuck together)
pagets
activating mutation in the fibroblast growth factor receptor gene 3 (FGFR3) –> negative effect on cartilage growth.
what type of bone formation is this?
endochondral bone formation
not intramembranous bone fromation (flat bones of face, skull, calvice, whre mesenchymal membrane is transfored into spongy bone.)
bon the boards
look for young pt with bone pain, swelling (usually near the knee), pathological fractures and elevated alkaline phosphatase
osteosarcoma
what ligament does the radial head slip out of in radial head subluxation
annular ligamnet.
on boards
a pt who is unable to abduct or extend/flex his arm
frozen shoulder
if a pt has a
pertrochanteric fracture of the femur. (below the neck)
will there be osteonecrosis
no
bc still supplied by retinacular blood vessels.
however a subcapital fracture of the femoral neck will
medial longitudinal arch
structures touching ground?
calcaneus
talus,
navicular
cuneiforms
metatarsals 1-3
Lateral longitudinal arch
structures touching ground
calcaneus
cuboid
4th and 5th metatarsals
transverse arch
cuboid
cuneiforms
metatarsals
are you going to give prednisone orally for OA
NO
only intraarticular
question
pt comes in with spasticity due to spinal cord injury
what will you give
and its moa?
baclofen
activates GABA B!!!
know that baclofen withdraw symptoms resemble benzos and alcohol withdraw.
Q on boards
pt develos interstitial lung disease with pleural effusion
you figure out this is caused by RA
what type of effusion
and you expect Glucose and LDH levels to be
exudate
glucose levels are very LOW (<25) and
high LDH (exudate)
RA pt with baker cyst
can mimic DVT
what study should you order
US
on the boards
if a young woman w/ SLE wants to become pregnant
what should you discontinue and start?
discontinue cyclophosphamide
and select
mycophenolate mofetil.
Q
pain in the groin
avascular necrosis of hip[
local tenderness on the outer aspect of the greater trochanter
trochanteric bursitis
Q
monoarthritis w/ redness, tenderness
and fever
aspirate
think septic arthritis
Q
groin pain increases w/ abduction
and normal hip joint
sartorius muscle injury during sports (soccer game)
Q
low back pain with point tenderness in the gluteal region
externally rotated lower limb
piriformis spasm
fatty wallet syndrome
