MSK Test 2 Flashcards
Myositis Ossificans
Hardened nodule of muscle near site of previous trauma
Myofibrillar Myopathy (Duchenne’s MD)
Child under 10 has progressive axial muscle weakness, Gower’s Maneuver to stand up from sitting, bulging muscles (lots of fat in muscle on biopsy)
Polymyositis
50+ in age; progressive symmetrical proximal weakness; maybe Anti-Jo-1 on labs
Dermatomyositis
50+ in age; progressive symmetrical proximal muscle weakness, rash on eyelids; maybe Anti-Jo-1 on labs
Inclusion body myositis
symmetrical muscle weakness in FLEXORS of UPPER LIMBS; maybe Anti-Jo-1 on labs
Myasthenia Gravis
Proximal Upper Extremity Weakness, worsens as day goes on and with repeated activity, better with rest
Lambert Eaton Myasthenic Syndrome
Proximal Lower Extremity Weakness, BETTER with repeated activity, irresponsive to anticholinergics
Guillain-Barre Syndrome
Sudden-onset peripheral weakness, 2-3 wks POST INFECTION
Bursitis
Non-radiating pain & tenderness on movement, no change in tone
Tendonitis
Radiating pain/tenderness on movement, no change in muscle tone/capability
Shoulder Impingement (frozen shoulder)
NO motion possible due to constant pain
Megacolon (Hirschbraun’s Disease)
Constipation and weight gain
Psoriasis
Well-demarcated pink/red plaques with SILVER SCALES on elbow, kness, scalp, butt, intergluteal cleft, glans penis; nail pitting, “oilslick” nail color
Seborrheic Dermatitis
Yellow/white pustules with GREASY SCALES
Herpetiformic Dermatitis
Greasy scales over forearms, scalp, or neck following a dermatomal pattern
Basal Cell Carcinoma
Hx Vacation in tropical area, “Pink Papule” with telangectasia, basaloid cell nests and blue cells with big white spaces on histo
Squamous Cell Carcinoma
Outdoor manual laborer, Keratin Pearls on histo, lip or burn scar site of origin, Hx of immunosuppression, chronic draining ulcers, or arsenic
Pemphigus Vulgaris
Flaccid Bullae & crusts on SKIN AND MUCOSA; “tombstone” S. basale layer on histo; “fishnet” pattern on IF staining
Bullus Pemphigus
Tense bullae on SKIN; eosinophils in dermis & blister on histo; IF stain only shows up on Rete’s Ridges (tips of dermal papillae)
Malignant Melanoma
Asymmetrical, Border irregularity, Color heterogeneity, Diameter >6mm with Evolution (significant)
Muscular Dystrophy
Adult onset, progressive DISTAL muscle and facial muscle weakness, cardiac, endocrine, or eye problems also common
Multiple Sclerosis
20-50F, sudden-onset weakness, autonomic function lost
Osteomyelitis
Brodie’s abscess on imaging, pain (referred or localized)
Ritter’s Disease (Staph Scalded Skin Syndrome)
May look like child abuse, negative S. aureus culture for SKIN, positive S. aureus culture for NOSE
Brucellosis
Latin American immigrant or slaughterhouse worker; Undulant fever, MIGRANT joint or muscle pain, “wet hay-smelling” sweat
Trench Fever
Sudden-onset fever, chills, headache; maculopapular rash on trunk/abdomen; 2-4 wk duration of entire disease
Cat Scratch Disease
3-10 day delay, then regional lymphadenopathy, erythematous papulae at slite (skin/eye rash possible, but rare); Warthin-Starry Ag stain
Bacillary Angiomatosis
Cat-owner or hx of lice; Nodular lesion, looks like kaposi sarcoma,
Oroya Fever
recent travels to Peru/Ecuador; Acute fever, anemia
Verruga Peruana
recent travels to Peru/Ecuador; warts, maybe some green/yellow scales, black boils (rare)
Pasteurella microcida
Recent animal bite;
Erysipelothrix rhusiopathiae
Hx of working with pigs or fish; localized eruption of cellulitis 2-7 days post-infection, MAY cause endocarditis w/ bacteremia; clears on own in 4 wks
Osteoporosis
Elderly or post-menopausal woman; fracture sustained from “average” fall, increased Alk-PO4 and Osteocalcin levels, DEXA > 2.5 standard deviations
Osteopetrosis
fracture sustained from “average” fall, increased Alk-PO4 and Osteocalcin levels
Paget’s Dz
Increased hat size (most common), hearing loss, “jigsaw puzzle” histo
Hyperparathyroidism
Osteoporosis
Renal osteodystrophy
osteoporosis, INC PO4-, DEC Ca2+ in serum
Osteomalacia
Pain on weight bearing, bowed limbs (children); rosary chest (children)
Osteogenesis Imperfecta
Blue Sclera, hearing loss, fractures very easily
Compartment Syndrome
Pain, Paresthesia, Palpable firmness/pressure, Pallor, Paralysis, Pulselessness
Ewing Sarcoma
White adolescent boys, Diaphyseal growth, fever, chills, weight loss, +PAS staining,
Osteosarcoma
10-20 or 65+, metaphyseal growth, Codman’s Triangle on imaging, nuclear hyperchromasia & pleomorphism on histo; can be firm & fibrous, fleshy, glistening, or telangiectatic
Vitligo
Irregular, asymmetrical, spreading non-pigmented spots on body
Urticaria
pruritic, transient wheals on trunks and extremities
Atopic dermatits (eczema)
Red, scaly, oozing, crusted lesions on cheeks/extensors (babies), flexors (children), or flexors/hands (adults)
Allergic contact dermatitis
localized, non-spreading, erythematous lesions; changes color of skin
Erythema multiforme
Targetoid lesions (may look like bullae), Hx - Sulfa drug use or HSV infection
Steven Johnsons Syndrome
Toxic Epidermal Necrosis
> 30% body involvement, entire layers of skin come off, erosion and crusting of mucosa, swelling of lips, erythema throughout body, positive Nikolsky sign (rubbing produces blisters)
LIchen Planus
Pruritic, Purple, Polygonal, Planar, Papules & Plaques on skin, gingiva, buccal mucosa, or vulva
SLE
Malar erythematous rash, scaly plaques that WORSEN with sun exposure; discoid patches on skin; NON-EROSIVE to joints
Epidermolysis bullosa aquista
adult-onset acral blisters on trauma-prone places (knuckles, soles, etc.); “salt split skin” on IF staining
Osteoarthritis
elderly; asymmetrical pain in joints, morning stiffness 5000
Rheumatoid Arthritis
20-40+ onset, symmetrical, systemic pain in joints, morning stiffness >1 hr, BETTER with use, DIP IS SPARED; Swan Neck/Boutonniere’s Deformity; juxta-articular osteopenia, Pannus seen on imaging; transparent joint fluid, WBC 1000-7000
Ankylosing spondylosis
18-25M, bamboo back on imaging, positive Schober Test, bilateral sacroiliitis, back pain ALLEVIATES when walking up stairs/hill
Psoriatic Arthritis
asymmetrical arthritis, nail pitting, bilateral sacroilitiis, conjunctivitis, “sausage fingers”
Reactive Arthritis (Reiter’s)
Can’t see, Can’t Pee, Can’t Climb a Tree (conjunctivitis, urethritis, arthritis); had “diarrhea/UTI” that resolved 2-3 wks ago; yellow joint fluid, 1000-75000 WBC
Gout
Exquisite pain, warmth, swelling on BIG TOE (1st MTP), needle-shaped crystals (neg biferengence)
Pseudogout
pain, swelling on KNEE (asymmetrical), rhomboid-shaped crystals (pos biferengence)
Septic arthritis
Rapid-onset swelling, redness; asymmetrical; OPAQUE joint fluid (usually deep yellow)
Fibromyalgia
20-60F, Diffuse aching, stiffness, fatigue, headache, neck/upper limb stiffness & parasthesia; Hx of IBS, mood d/o, insomnia, RA, Lyme’s Dz, HypoT
Cutaneous B. anthrax
Papule –> ulcer –> eschar, lymphadenopathy, low-grade fever; 1-12 days post-infection
Gastrointestinal B. anthrax
fever, ulcer, then either regional lymphadenopathy & edema OR bloody diarrhea, malaise, nausea/vomitting
Pulmonary B. anthrax (Woolsorter’s Disease)
flu-like symptoms WITHOUT runny nose; fatigue, medastinal lymph node enlargement, pleural effusion, all within 3 days
Bubonic Y. pestis
regional lymph swelling, necrosis, DIC, septic shock
Pneumonic Y. pestis
sudden-onset chills, fever, weakness, hemoptysis, hemorrhage, shock
Francisella tularensis (Tularemia/Rabbit Fever)
fever, regional lymphadenopathy, ulcers on skin and mucosa
M. leprae (Hansen’s Disease)
numerous skin lesions, Anergic T-cells, physical deformities
M. tuberculosis (Tuberculosis)
Night sweats, NERVE damage, isolated skin lesions, +lepromon,
M. avium-intracellulaire or M. Kansaii
Hx AIDS diagnosis
Seborrheic Keratosis
round, flat, velvety, “stuck on” plaques (flesh-colored to black colored), Horn Pseudocysts & hyperkeratosis on histo
Actinic Keratosis
Ill-defined, scaly plaques on sun-exposed areas, cutaneous horn, solar elastosis & parakeratosis on histo, hx cumulative sun exposure (outdoor laborer)
Dermatofibroma
little tan-brown papules that dimple upon pinching and are firm to palpation on LEGS of 40+ yo; spindle cell infiltration & collagen entrapment by cells on Histo
Dermatofibrosarcoma protuberans
large, firm, lumpy nodule on trunk, scalp, or extremities; confused for cysts or lipomas first;
Langerhans Cell histiocytosis
pink/flesh-colored papules, pustules, or vesicles in CHILDREN; flexural areas, neck, axilla, or perineum; S100+ and CD1a+ on staining
Mastocytosis
More mast cells seen on skin and organs in histo (or solitary cutaneous aggregation of mast cells on skin); non-scaling papules/plaques look large & red on kids, small & dark red on adults
Merkel Cell carcinoma
Erythemous, violacious lesions; Round blue cell tumors (little cytoplasm) on histo; in elderly with Hx of UV exposure or MC Polyoma Virus
Measles
Koplik’s Spots, Maculopapular rash starts at post-auricular area, goes to TRUNK
Mumps
Parotitis (swollen cheeks/parotids), Orchitis
Rubella
transient blush rash (or asymptomatic), lymphadenopathy (mild and self-limiting), transient thrombocytopenia
Hand, Foot & Mouth Disease
small, red sores on mouth and spreads to palms/soles
Fifth’s Disease
slapped cheeks rash that may spread to limbs, anemic crisis (rare), polyarthritis (adult)
Smallpox
Sudden onset vesicle/bullae erythematous rash (“boiled skin”)
Molluscum Contagiosum
small, wartlike lesions that disappear in 1-2 months
Pseudocowpox
Milker’s Nodule big, red, & stationary lesion near joints of fingers
Rickettsiae rickettsii (RMSF)
2-14 day incubation, Malar rash starts on extremities and spreads to limbs as petechial rash; Ticks
Rickettsiae prowazekii (Endemic Typhus)
8 day incubation, rash starts on TRUNK and spreads to EXTREMITIES; Lice
Ehrlichiosis
1-2 wk incubation, in coastal, midwest, and south U.S.; rash is RARE, Lone Star tick
Anaplasmosis
NO rash, intracytoplasmic inclusions (morulae) on granulocytes (“mulberry” appearance), Black Legged Tick
Borrelia recurrentis
Relapsing weeklong fevers (1-2 relapses), in LICE
Borrelia hermsii/turicatae
Relapsing weeklong fevers (3-4 relapses), in soft ticks
Lyme’s Disease
initially erythema at bite site with partial clearing –> asymmetrical, erythematous, annular rash with nerve palsy (rare) or cardiomyopathy (rarer), Black Legged Tick
STARI (Masters Disease)
Lone Star tick, targetoid-like lesion at bite site, general symptoms and myalgia
Dysplastic Nevi Syndrome (MAPP)
> 50 melanocytic nevi seen in one clinic visit, bridging of adjacnet nests and increased melanocyte count on Histo, CDKN2A mutant
Basal Cell Nevus Syndrome (Gorlin Syndrome)
Multiple Basal Cell Carcinomas before age 20, medulloblastoma, ovarian fibroma, rib anomalies, keratocysts; PTCH mutation
Neurofibromatosis Type I
Cafe Au Lait spots, Lisch Nodules, axillary freckles, “bag of worms” appearance of nerves
Neurofibromatosis Type II
Bilateral schwannomas, multiple meningiomas, cafe au lait spots
Muir-Torre Syndrome
Sebaceous tumors (yellow/white pitted nodules on head and neck), underlying gastric or GU carcinoma; multivacuolated cytoplasm of sebaceous gland on histo
Cowden’s Syndrome
hamartomas, benign follicular neoplasms; underlying breast or thyroid malignancy; PTEN mutation
Tuberus Sclerosis
Renal or CNS tumors, facila angiofibroma, “ash leaf” macules (hypopigmented), Shagreen patches, Periungal/subungal fibromas, cafe au lait spots
Epiderolysis bullosa
easy blistering (variable amounts of force needed to blister, but easier than average)
Sjorgen Syndrome
Anti-SS-A, Anti-SS-B, or Anti-Jo-1 on serum, Dry eyes and mouth
Scleroderma
Thickening & hardening of skin, Raynaud’s Phenomenon, Anti-Scl70 (DNA topoisomerase) on labs
Osteochondroma
solitary broccoli or mushroom-shaped growth, thickened cartilage growth plate on histo
Enchondroma
Sudden-onset pain, with “stippling” (cartilage mineralization) on imaging, “normal” histology
Giant Cell tumor
25-40 yo; “soap bubbles” at epiphysis/metaphysis of long bones; Large, uniformly distributed cells on histo
Chondrosarcoma
> 50 yo, stippling (cartilage mineralization) and bony trabecular invasion/extraosseous extension seen; increased cell numbers and chondrocyte atypia on histo