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board review > msk > Flashcards

msk Flashcards

1
Q

during a clavicular fracture what muscle protects the subclavian vessels and brachial pleuxs

A

subclavius muscle

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2
Q

the brachial pleuxs lies behind what part of the clavical and anterior to the first rib

A

middle 1/3

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3
Q

which fracture of the femural head causes inc risk of osteonecrosis

?

A

subcapital fracture of the femoral neck

bc cut of blood supply by deep femoral artery

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4
Q

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?

A

osteo arthritis

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5
Q

positive thompson test detect?

A

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

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6
Q

compartment syndrome is caused by?

trick question

A

compression of the small veins of the limb

know this!!!!

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7
Q

on the boards

what disorder has an increase risk of recurrent shoulder dislocation

A

ehlers danlos syndrome

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8
Q

what can cause a posterior shoulder dislocation

A

electrical injury / ightening strike, or severe epileptic seizures

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9
Q

what ligament is most commonly injured in an anterior dislocation of shoulder

A

inferior glenohumeral ligament

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10
Q

radial head subluxation

what ligmament is involved

A

annular ligament.

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11
Q

ewings sarcoma is associated with what chromosomal translocation

A

t(11:22) –> activation of C-myc promotor –> massive production of EWS-FL-1

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12
Q

osteochondroma

what part of bone

A

metaphysis of long bone

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13
Q

osteoma

A

bone metaphysis

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14
Q

osteoid osteoma

A

metaphysis of long bone

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15
Q

osteoblastoma

A

epiphysis of long bones

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16
Q

giant cell tumor

A

epiphysis of long bone

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17
Q

giant cell tumor

A

epiphysis of long bones

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18
Q

osteosarcoma

A

metaphysis of distal femur, proximal tibia

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19
Q

chondrosarcoma

A

pelvis, shoulder, spread from the medulla through the cortex into the soft tissue

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20
Q

ewing sarcoma

MUTATION in?

derived from

A

diaphysis of long bones

t (11;22) –> activation C-MYC promotor –> massive production of EWS-FL-1

derived from neuroectoderm

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21
Q

what causes the pain in osteoma

which allows it to be treated with aspirin

A

excessive prostaglandin E2 production

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22
Q

what bone tumor is proliferation of

malignant OsteoBLAST`

A

osteroSARCOMA

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23
Q

RB mutation put a person at risk for

familial retinoblastoma and ?

ON BOARDS

A

osteoSARCOMA

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24
Q

pt presents with

inc alk phos

bone pain

swelling

xray shows elevation of periosteum

A

osteosarcoma

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25
Q

xray shows lifting of the periosteum ( codmans triangle) and Sunburrst growth pattern (due to?)

A

calcified malignant cells

in osteosarcoma

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26
Q

what bone tumor histo shows

anaplastic small blue cells (arranged in pseudorosette patterns

A

ewing.

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27
Q

what bone tumor

has osteoclastic giant cells

and originates from monocytes in epiphysis

usually seen in women

A

giant cell tumor

benign

28
Q

soap bubbe appearance on xray

A

giant cell tumor.

29
Q

which bone disease has

persistent primary spongiosa (endochondral bone / calcified cartilage) ?

A

osteopetrosis

30
Q

pathogenesis of osteopetrosis

in adults

A

chloride channel mutation —-> prevention of bicarbonate exchange –> block the proton pump formation

31
Q

low serum ca

high Alk phos

normal serum phosphate

A

osteopetrosis

32
Q

cause of anemia in osteopetrosis

and tx

A

deficient marrow

bone marrow transplant

33
Q

xray for pt with osteoporosis will show

A

radiolucency!!!

34
Q

pts with osteoporosis

have

A. thin corticol bone

B. thin trabecular bone

C. both are thin

?

A

both thin cortical and trabecular

35
Q

bone mineral density scan will be abnormal in a pt with

A. bulimia

B. Anorexia

?

A

anorexia

pts can develop osteoporosis

36
Q

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)

A

osteporosis

37
Q

how do you develop osteoporosis after post menopause

A

over expression of RANK receptors in hypoestrogenic, –> inc bone resorption due to inc osteoclastic actibvity.

38
Q

uncomfortable intercouse, irregular menses, irritability

45 yo female amenorrhea

this describes what

A

climacteric period (pre menopause)

39
Q

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)

A

achilles tendon rupture

40
Q

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

A

low ca

low phosphate

mild inc in alk phos

mild inc in secretion of PTH

41
Q

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

?

A

osteomalacia

25 hydroxycholecalciferol

42
Q

if you see increase alk phos

what would you check to see if its from live or bone

A

gamma-glutamy transpeptidase

elevated in liver pathology

43
Q

in pagets disease what are the two complications

that can lead to death

A

1. high output heart failure from ateriovenous shunts in vascular boney lesions

inc risk of osteosarcoma

44
Q

radiographic clue for

osteomalacia

A

looser zones defective calcification –> inc osteoid

45
Q

radiographic clue for

osteoporosis/osteopenia

A

increased radiolucency

46
Q

radiographic clue for

radiographic clue for hyperparathyroidism

A

subperiosteal reabsorption

47
Q

radiographic clue for

mosaic pattern

(puzzle pieces stuck together)

A

pagets

48
Q

activating mutation in the fibroblast growth factor receptor gene 3 (FGFR3) –> negative effect on cartilage growth.

what type of bone formation is this?

A

endochondral bone formation

not intramembranous bone fromation (flat bones of face, skull, calvice, whre mesenchymal membrane is transfored into spongy bone.)

49
Q

bon the boards

look for young pt with bone pain, swelling (usually near the knee), pathological fractures and elevated alkaline phosphatase

A

osteosarcoma

50
Q

what ligament does the radial head slip out of in radial head subluxation

A

annular ligamnet.

51
Q

on boards

a pt who is unable to abduct or extend/flex his arm

A

frozen shoulder

52
Q

if a pt has a

pertrochanteric fracture of the femur. (below the neck)

will there be osteonecrosis

A

no

bc still supplied by retinacular blood vessels.

however a subcapital fracture of the femoral neck will

53
Q

medial longitudinal arch

structures touching ground?

A

calcaneus

talus,

navicular

cuneiforms

metatarsals 1-3

54
Q

Lateral longitudinal arch

structures touching ground

A

calcaneus

cuboid

4th and 5th metatarsals

55
Q

transverse arch

A

cuboid

cuneiforms

metatarsals

56
Q

are you going to give prednisone orally for OA

A

NO

only intraarticular

57
Q

question

pt comes in with spasticity due to spinal cord injury

what will you give

and its moa?

A

baclofen

activates GABA B!!!

know that baclofen withdraw symptoms resemble benzos and alcohol withdraw.

58
Q

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

A

exudate

glucose levels are very LOW (<25) and

high LDH (exudate)

59
Q

RA pt with baker cyst

can mimic DVT

what study should you order

A

US

60
Q

on the boards

if a young woman w/ SLE wants to become pregnant

what should you discontinue and start?

A

discontinue cyclophosphamide

and select

mycophenolate mofetil.

61
Q

Q

pain in the groin

A

avascular necrosis of hip[

62
Q

local tenderness on the outer aspect of the greater trochanter

A

trochanteric bursitis

63
Q

Q

monoarthritis w/ redness, tenderness

and fever

A

aspirate

think septic arthritis

64
Q

Q

groin pain increases w/ abduction

and normal hip joint

A

sartorius muscle injury during sports (soccer game)

65
Q

Q

low back pain with point tenderness in the gluteal region

externally rotated lower limb

A

piriformis spasm

fatty wallet syndrome

board review (20 decks)

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