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MSK, Skin, and Connective Tissue First Aid USMLE Step 1 > MSK Path > Flashcards

MSK Path Flashcards

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USMLE® Step 1 flashcards
1
Q
  • Symptoms: Football injury from lateral tackle Lab Values: Positive anterior drawer sign. Pathophysiology: Damages MCL, ACL, and lateral meniscus Treatment: *
A

Unhappy triad/knee injury

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2
Q
  • Symptoms: Short limbs, normal axial skeletal Lab Values: ** Pathophysiology: Constitutive activation of fibroblast growth factor receptor (FGFR3) actually inhibits chondrocyte proliferation. > 85% of mutations occur sporadically and are associated with advanced paternal age, but the condition also demonstrates autosomal-dominant inheritance. Common cause of dwarfism. Treatment: *
A

Achondroplasia

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3
Q
  • Symptoms: Postmenopausal woman. Vertebral crush fractures, femoral neck fracture, distal radius (Colles’) fractures. Lab Values: Decreased bone mass. Normal serum calcium, phosphate, alkaline phosphatase, PTH. Pathophysiology: Reduction of primarily trabecular (spongy) bone mass in spite of normal bone mineralization. Treatment: *Estrogen and/or calcitonin; bisphosphonates or pulsatile PTH for severe cases. Glucocorticoids are contraindicated.
A

Osteoporosis

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4
Q
  • Symptoms: Failure of normal bone resorption leads to dense bones that are prone to fracture. Decrease in marrow space leads to anemia, thrombocytopenia, infection. Can result in cranial nerve impingement and palsies due to narrowed foramina. Frontal bossing of the skull. Unusual dentition, including malformed and unerrupted teeth . Lab Values: Normal serum calcium, phosphate, PTH and alkaline phosphatase. Erlenmeyer flask widening on X-ray. Pathophysiology: Genetic deficiency of carbonic anhydrase II leading to decreased osteoclast function. Treatment: *
A

Osteopetrosis (marble bone disease)

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5
Q
  • Symptoms: *Soft bones, bowed legs, rachitic rosary (knobs at costochondral joints), Harrison’s sulci, craniotabes (thinning of the skul), and growth retardation. * Lab Values: Low serum calcium, high serum PTH, low serum phosphate. Normal alkaline phosphatase.Osteoid matrix accumulation. Pathophysiology: Defective mineralization/calcification of osteoid due to vitamin D deficiency. Increased unmineralized osteoid. Treatment: *Vitamin D
A

Osteomalacia/rickets

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6
Q
  • Symptoms: Pain, “brown tumors” (cystic spaces lined by osteoclasts filled with fibrous stroma and blood) Lab Values: High serum calcium, low serum phosphate, high alkaline phosphatase. Pathophysiology: Caused by hyperparathyroidism Treatment: *
A

Osteitis fibrosa cystica

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7
Q
  • Symptoms: *Pathologic fracture, high output cardiac failure (AV shunts), risk of osteosarcoma, cranial nerve impingement (hearing loss), enlarged skull/feet. * Lab Values: Mosaic pattern on X-ray. Normal serum calcium, phosphorous, and PTH. Increased alkaline phosphatase. Pathophysiology: Caused by paramyxovirus. Leads to increased osteoblastic and osteoclastic activity. Treatment: *
A

Paget’s disease (osteitis deformans)

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8
Q
  • Symptoms: ** Lab Values: Shepherd’s crook deformity. Ground-glass bone appearance. Pathophysiology: Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae. Affects many bones. Treatment: *
A

Polyostotic fibrous dysplasia

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9
Q
  • Symptoms: Polyostotic fibrous dysplasia, café-au-lait spots, precocious puberty, short stature in young female. Lab Values: ** Pathophysiology: Mosaic G-protein signaling mutation. Treatment: *
A

McCune-Albright syndrome

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10
Q
  • Symptoms: Blue sclerae, multiple fractures, hearing loss, dental imperfections. Confused with child abuse. Lab Values: ** Pathophysiology: Genetic defect in type I collagen; autosomal dominant. Results in defective bone matrix formation. Treatment: *
A

Osteogenesis imperfecta

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11
Q
  • Symptoms: New piece of bone grows on another piece of bone, often in the skull. Lab Values: ** Pathophysiology: Associated with Gardner’s syndrome (FAP). Treatment: *
A

Osteoma

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12
Q
  • Symptoms: Pain worse at night, relieved by NSAIDs. Found in diaphysis of proximal tibia and femur. Lab Values: ** Pathophysiology: ** Treatment: *
A

Osteoid osteoma

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13
Q
  • Symptoms: Pain worse at night, relieved by NSAIDs. Found in vertebrae. Lab Values: ** Pathophysiology: ** Treatment: *
A

Osteoblastoma

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14
Q
  • Symptoms: Age 20-40. Tumor in epiphyseal end of long bone. Lab Values: “Soap bubble” or “double bubble” appearance on X-ray. Pathophysiology: ** Treatment: *
A

Giant cell tumor (osteoclastoma)

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15
Q
  • Symptoms: Male <25. Mature bone with cartilaginous cap on metaphysis of long bones. Lab Values: ** Pathophysiology: ** Treatment: *
A

Osteochondroma

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16
Q
  • Symptoms: Intramedullary neoplasm of DISTAL extremities. Lab Values: ** Pathophysiology: ** Treatment: *
A

Enchondroma

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17
Q
  • Symptoms: Tumor in metaphysis of long bones (distal femur, proximal tibia). History of Paget’s disease, retinoblastoma, radiation, bone infarcts. Lab Values: sis proto-oncogene mutation. Sunburst pattern (Codman’s triangle) on X-ray. “ Pathophysiology: ** Treatment: *
A

Osteosarcoma

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18
Q
  • Symptoms: Male appearance in bone. Pathophysiology: ** Treatment: *Dactinomycin
A

Ewing’s sarcoma

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19
Q
  • Symptoms: Male 30-60. Intramedullary tumor of pelvis, spine, scapula, humerus, tibia, or femur. History of osteochondroma. Lab Values: ** Pathophysiology: ** Treatment: *
A

Chondrosarcoma

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20
Q
  • Symptoms: Pain in weight-bearing joints after use (e.g., at the end of the day), improving with rest. In knees, cartilage loss begins on medial aspect (“bowlegged”). Noninflammatory. No systemic symptoms. Involves DIPs. Lab Values: Subchondral cysts, sclerosis, osteophytes (bone spurs), eburnation (polished, ivory-like appearance of bone), Heberden’s nodes (DIP), and Bouchard’s nodes (PIP). Pathophysiology: Mechanical wear and tear of j oints leads to destruction of articular cartilage Treatment: *
A

Osteoarthritis

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21
Q
  • Symptoms: Female with morning stiffness lasting > 30 minutes and improving with use, symmetric joint involvement, systemic symptoms (fever, fatigue, pleuritis, pericarditis). NO DIP INVOLVEMENT. Lab Values: HLA-DR4. Rheumatoid factor (Anti-IgG IgM), anti-CCP antibody, HLA-DR4, pannus formation (MCP,PIP, fibrinoid necrosis with palisading histiocytes (rheumatoid nodules), ulnar deviation, subluxation, Baker’s cyst (behind the knee). Swan-neck, Boutonniere deformity. Pathophysiology: Autoimmune inflammatory disorder affecting synovial joints. Treatment: *Anakinra, entanercept, infliximab, adalimumab, hydroxychloroquine, sulfasalazine, methotrexate
A

Rheumatoid arthritis

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22
Q
  • Symptoms: Female 40-60. Xerophtalmia, xerostomia, arthritis, enlarged parotid, dental caries. Increased B-cell lymphoma risk. Lab Values: SS-A (Ro) and SS-B (La) ribonucleoprotein antibodies. ANA+. Pathophysiology: ** Treatment: *
A

Sjogren’s syndrome

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23
Q
  • Symptoms: Male with painful MTP of the big toe (podagra). Asymmetric joint distribution. Attack precipitated by chemotherapy, alcohol, large meal, von-Gierke’s disease, Lesch-Nyhan syndrome, thiazide diuretics. Lab Values: Negatively birefringent spindle shaped crystals (monosodium urate). Tophus formation (often on external ear, olecranon bursa, or Achilles tendon). Pathophysiology: ** Treatment: *Indomethacin, colchicine, allopurinol, probenecid
A

Gout

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24
Q
  • Symptoms: Clasically in the knee. Male or female. Lab Values: Weakly positively birefringent rhomboid shaped crystals (calcium pyrophosphate). Pathophysiology: ** Treatment: *
A

Pseudogout

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25
Q
  • Symptoms: Monoarticular, migratory arthritis with asymmetrical pattern. N. gonorrhoeae, B. burgdorferi. Lab Values: ** Pathophysiology: ** Treatment: *
A

Infectious arthritis

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26
Q
  • Symptoms: Chronic inflammatory disease of spine and sacroiliac joints leading to ankylosis (stiff spine due to fusion of joints), uveitis, and aortic regurgitation. Lab Values: *HLA-B27. Bamboo spine. * Pathophysiology: ** Treatment: *
A

Ankylosing spondylitis

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27
Q
  • Symptoms: Conjunctivitis, anteiror uveitis, urethritis, arthritis. Lab Values: Follows a GI or chlamydia infection. Pathophysiology: ** Treatment: *
A

Reiter’s syndrome (reactive arthritis)

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28
Q
  • Symptoms: Joint pain and stiffness associated with psoriasis. Asymmetric and patchy involvement. Lab Values: Dactylitis (“sausage fingers”), “pencil-in-cup” deformity on x-ray. Pathophysiology: ** Treatment: *
A

Psoriatic arthritis

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29
Q
  • Symptoms: Black female 14-45. Malar/discoid rash, photosensitivity, fever, fatigue, weight loss, nonbacterial endocarditis, noninfectious pericarditis (serous), hilar adenopathy, and Raynaud’s phenomenon. Libman-Sacks endocarditis. Pericarditis. Nephritic and nephrotic syndormes. Lab Values: HLA-DR2. Wire-loop lesions in kiney. False positive VDRL test due to antiphospholipid antibodies. Anti-dsDNA, anti-Smith, and anti-nuclear antibodies. Low C3 and C4. Pathophysiology: Type III hypersensitivtiy Treatment: *
A

Systemic lupus erythematosus

30
Q
  • Symptoms: ** Lab Values: Anti-histone antibodies Pathophysiology: ** Treatment: *
A

Drug-induced lupus

31
Q
  • Symptoms: Black female. Bilateral hilar lymphadenopathy (Angel wing on CXR), erythema nodosum, Bell’s palsy, uveoparotitis (eye irritation/pain), restrictive lung disease, restrictive cardiomyopathy. Lab Values: Noncaseating granulomas, elevated serum ACE, hypercalcemia. Schaumann bodies (laminated dystrophic calcification) and asteroid bodies (stellate giant-cell cytoplasmic inclusions). Elevated CD4:CD8 ratio. Pathophysiology: Hypercalcemia due to elevated conversion of vitamin D to its active form in epithelioid macrophages. Treatment: *Steroids, captopril.
A

Sarcoidosis

32
Q
  • Symptoms: Female >50. Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss. Does not cause muscular weakness. Associated with temporal (giant cell) arteritis. Lab Values: Elevated ESR, normal CK Pathophysiology: ** Treatment: *Prednisone
A

Polymyalgia rheumatica

33
Q
  • Symptoms: Symmetric axial/proximal muscle weakness. Lab Values: Anti-Jo-1 antibodies, ANA+, elevated CK and aldolase Pathophysiology: CD8+ T-cell induced injury to myofibers. Treatment: *Steroids
A

Polymyositis

34
Q
  • Symptoms: Axial/proximal muscle weakness, malar rash, heliotrope (shawl and face), Gottron’s papules “mechanic’s hands”. Increased risk of malignancy. Lab Values: Anti-Jo-1 antibodies, ANA+, elevated CK and aldolase Pathophysiology: CD8+ T-cell induced injury to myofibers. Treatment: *Steroids
A

Dermatomyositis

35
Q
  • Symptoms: Ptosis, diplopia (cranial near weakness), thymoma. Symptoms worsen with activity. Lab Values: Dx with edrophonium. Anti-NAchR antibodies. Pathophysiology: ** Treatment: *Neostigmine, pyridostigmine, physostigmine
A

Myasthenia gravis

36
Q
  • Symptoms: Proximal muscle weakness. Symptoms improve with activity. No exatraocular weakness. Associated with paraneoplastic diseases (small cell lung cancer). Lab Values: Anti-presynaptic calcium channel antibodies. Pathophysiology: ** Treatment: *
A

Lambert-Eaton syndrome

37
Q
  • Symptoms: Raynaud’s phenomenon, fatigue, arthralgias, myalgias, and esophageal hypomotility. Lab Values: anti-U1RNP antibody, ANA+. Pathophysiology: ** Treatment: *Steroids
A

Mixed connective tissue disease

38
Q
  • Symptoms: Widespread skin involvement, rapid progression, early visceral involvement. Raynaud’s phenomenon, esophageal dysmotility. Puffy and taut skin with absence of wrinkles. Pulmonary hypertension and cor pulmonale in late stage. Lab Values: Anti-Scl70 antibodies (topoisomerase), ANA+. Intimal thickening of pulmonary arterioles leading to pulmonary hypertension; accentuated S2. Pathophysiology: Excessive fibrosis and collagen deposition throughout the body. NOT AUTOIMMUNE. Death due to pulmonary hypertension and cor pulmonale. Treatment: *
A

Systemic sclerosis (diffuse scleroderma)

39
Q
  • Symptoms: Calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. Limited skin involvement, often confined to fingers and face. More benign clinical course. Lab Values: Anti-centromere antibodies, ANA+ Pathophysiology: Excessive fibrosis and collagen deposition throughout the body. NOT AUTOIMMUNE. Treatment: *
A

Limited scleroderma (CREST syndrome)

40
Q
  • Symptoms: Benign, superficial, well-encapsulated fat tumor. Lab Values: ** Pathophysiology: ** Treatment: *
A

Lipoma

41
Q
  • Symptoms: Malignant fat tumor that can be quite large. Will recur unless adequately excised. Typically thigh or retroperitoneum. Lab Values: Microscopically has lipoblasts. Scalloping of lipid globules around the nucleus. Pathophysiology: ** Treatment: *
A

Liposarcoma

42
Q
  • Symptoms: Benign tumor derived from striated muscle (skeletal or cardiac). Rhabdomyoma of the heart occurs in tuberous sclerosis. Lab Values: ** Pathophysiology: ** Treatment: *
A

Rhabdomyoma

43
Q
  • Symptoms: Most common soft tissue tumor of childhood. Malignant. Arises from skeletal muscle, most often in head/neck of males. In females found in vagina or bladder (sarcoma botryiodies). Lab Values: ** Pathophysiology: ** Treatment: *
A

Rhabdomyosarcoma

44
Q
  • Symptoms: Dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis. No arthritis. Lab Values: ** Pathophysiology: ** Treatment: *
A

Sica syndrome

45
Q
  • Symptoms: Tissue has waxy appearance. Lab Values: Apple-green birefringence of Congo red stain. Pathophysiology: Primary: amyloid light chain (multiple myeloma). Secondary: amyloid acute-phase (chronic infection), beta2 microglobulin (dialysis), amyloid beta (Alzheimers), transthyretin (senile cardiac), amylin (diabetes mellitus type 2), A-CAL (thyroid medullary carcinoma). Treatment: *
A

Amyloidosis

46
Q
  • Symptoms: Female 30-50. Diffuse musculoskeletal pain, stiffness, paresthesias, insomnia, emotional disturbances. Pain exacerbated by exercise. Lab Values: ** Pathophysiology: ** Treatment: *TCAs.
A

Fibromyalgia

47
Q
  • Symptoms: Fever, bone pain. Infection of the metaphysis. Lab Values: ** Pathophysiology: Most common cause: S. aureus. Second most common cause: S. pyogenes. Diabetics/IV drug users: Pseudomonas. Sickle cell anemia: Salmonella. Treatment: *
A

Osteomyelitis

48
Q
  • Symptoms: Adult >50. Asymmetrical distal muscle weakness. Lab Values: Cytoplasmic vacuoles with basophilic granules and amyloid. Pathophysiology: ** Treatment: *
A

Inclusion body myositis

49
Q
  • Symptoms: Benign dermal spindle cell proliferation most often seen on the extremeties. Forms a small red nodule that idents when squeezed. Lab Values: ** Pathophysiology: ** Treatment: *
A

Dermatofibroma (fibrous histocytoma)

50
Q
  • Symptoms: Non-neoplastic prolifertive disorder that histologicallyr esembles a sarcoma. Fibrous tissue infiltrates muscle or other tissue and may cause a mass lesion. Lab Values: ** Pathophysiology: ** Treatment: *
A

Fibramatosis

51
Q
  • Symptoms: Malignant fibrous tumor. Usually deep in thigh or upper limb. May present with hypoglycemia (paraneoplastic syndrome). Lab Values: Herring bone pattern seen . Pathophysiology: ** Treatment: *
A

Fibrosarcoma

52
Q
  • Symptoms: Retroperitoneum and thigh. Strikingly pleomorphic cells. Caused by past radiation therapy. Lab Values: Cells are very pleomorphic. Pathophysiology: ** Treatment: *
A

Malignant fibrous histiocytoma (pleomorphic sarcoma)

53
Q
  • Symptoms: Benign smooth muscle tumor in uterus or stomach. Associated with iron deficiency anemia if it bleeds. Lab Values: ** Pathophysiology: ** Treatment: *
A

Leiomyoma

54
Q
  • Symptoms: Malignant smooth muscle tumor of the uterus and GI tract. Lab Values: ** Pathophysiology: ** Treatment: *
A

Leiomyosarcoma

55
Q
  • Symptoms: Associated with neurofibromatosis. Involves major nerve trunks. Lab Values: Stains with S-100. Pathophysiology: ** Treatment: *
A

Neurofibrosarcoma

56
Q
  • Symptoms: Appears in mesenchymal cells around the joints of distal extremities. Lab Values: Glands plus spindle cells, biphasic appearance. Pathophysiology: ** Treatment: *
A

Synovial sarcoma

57
Q
  • Symptoms: Recurrent spiking fevers with polyarticular joint point, salmon-pink rash anywhere on body. Decreased growth rates, chronic anterior uveitis. Lab Values: Rheumatoid factor negative. Hemophagocytic syndrome (macorphages laden with RBCs). Pathophysiology: ** Treatment: *Etanercept.
A

Juvenile idiopathic arthritis

58
Q
  • Symptoms: IN ADULTS. Recurrent spiking fevers with polyarticular joint point, salmon-pink rash anywhere on body. Decreased growth rates, chronic anterior uveitis. Lab Values: Rheumatoid factor negative. Hemophagocytic syndrome (macorphages laden with RBCs). Pathophysiology: ** Treatment: *Etanercept.
A

Still’s disease

59
Q
  • Symptoms: Hypercoagulable state associated with SLE. Lab Values: Elevated PTT that isn’t corrected with 1:1 mixing with fresh frozen plasma. False positive VLDR (anticardiolipin). Pathophysiology: ** Treatment: *
A

Antiphospholipid syndrome

60
Q
  • Symptoms: ** Lab Values: ** Pathophysiology: Infarction of bone and marrow. Pain associated with activity. Caused by trauma, high-dose coritocosteroids, alcoholism, and sickle cell disease. Tends to be femoral head. Treatment: *
A

Osteonecrosis (avascular necrosis)

61
Q
  • Symptoms: Overuse of the extensor muscles of forearm and wrist, including extensor carpi radialis. Lab Values: ** Pathophysiology: “Tennis elbow” Treatment: *
A

Lateral epicondylitis

62
Q
  • Symptoms: Overuse of the felxor muscles of forearm and wrist. Lab Values: ** Pathophysiology: “Golfer’s elbow” Treatment: *
A

Medial epicondylitis

63
Q
  • Symptoms: Elevated temperature following use of succinylcholine, halothane/-fluranes. Rhabdomyolysis progressing to renal failure. Can also present with hypotension, arrhytmias, and DIC. Lab Values: Elevated creatine, BUN during renal failure. Pathophysiology: Defect in ryanodine receptor. Treatment: *Dantrolene.
A

Malignant hyperthermia

64
Q
  • Symptoms: Order of damage is anterior talofibular > calcaneofibular > posterior talofibular ligments. Lab Values: ** Pathophysiology: ** Treatment: *
A

Ankle sprain (by invesion)

65
Q
  • Symptoms: Deltoid ligament. Lab Values: ** Pathophysiology: ** Treatment: *
A

Ankle sprain (by eversion)

66
Q
  • Symptoms: ** Lab Values: ** Pathophysiology: ** Treatment: *
A

Pycnodysostosis

67
Q

Kids present with pigeon chest, frontal bossing, rachitic rosary, and leg bowing.

A

Vit D Deficiency –> Rickets

68
Q

Stages: 1. Osteoclasts go crazy

  1. OC and OB work to lay down new bone/resorb bone
  2. Osteoblasts work to make up for the damage.
    - -> Bone pain, Lion-like facies (due to thickened bones of face)
    - Treat with calcitonin and bisphosphonates
A

Paget’s Disease (Osteitis Deformans)

69
Q

Loss of Function Mutations in Ext1 or Ext2 = Heparan Sulfate Proteoglycans.
- Lateral projection of growth plate.

A

Osteochondroma (exostosis)

70
Q
  • Malignant Proliferation of Osteoblasts

- Neoplastic Bone has a coarse lace-like pattern.

A

Osteosarcoma.

71
Q

SLE’s I’M DAMN SHARP

A 
Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid
Malar rash
Discoid Rash
Antinuclear antibody
Mucositis (oropharyngeal ulcers)
Neurologic Disorders
Serositis (pleuritis, pericarditis)
Hematologic Disorders
Arthritis
Renal Disorders
Photosensitivity

MSK, Skin, and Connective Tissue First Aid USMLE Step 1 (4 decks)

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