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KAPLAN FLASH CARDS > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is the sign called for a young boy who helps himself up to stand in Muscular Dystrophy due to proximal muscle weakness?

A

Gowers Sign

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2
Q

Composition of gout crystals versus pseudo gout crystals

A

GOUT: Monosodium urate

PSEUDOGOUT: Calcium pyrophosphate dihydrate (CPPD)

**Know that to a lesser degree, apatite-associated arthropathy can also be calcium phosphate

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3
Q

Mutation & associated gene in osteogenesis imperfecta

A

type 1 collagen
COL1A1 gene mutation

*collagen (bone) doesn’t reform strong after breaks

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4
Q

Disease associated with “beading of the costochondral junctions of the ribs”

A

Rickets

*termed rachitic rosary

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5
Q

What other disease (albeit uncommon) can demonstrate blue sclera besides OI?

A

Ehlers-Danlos disease

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6
Q

Damage to which muscle & its innervation causes “winged scapula”

A

SALT

Serratus anterior; long thoracic nerve

*Serratus anterior inserts on the medial border of scapula

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7
Q

What type of injury (direction of trauma) causes winged scapula?

A

Downward blow to the shoulder joint, stretching the nerve

**also surgery within axillary area such as mastectomy

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8
Q

What does the gene mutation in OI cause molecularly?

A

Impaired post-translational hydroxylation of lysine & proline residues

*Causes destabilization of the collagen helix, causing bone fragility

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9
Q

Cause of osteitis fibrous cystic (also called von Recklinghausen disease of bone)

A

Primary hyperparathyroidism due to parathyroid adenoma

*often not palpable on neck

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10
Q

3 main symptoms of hyperparathyroidism

A
  1. Bone pain
  2. Constipation
  3. Nausea

*Polydipsia & polyuria due to hypercalcemia too

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11
Q

What is a characteristic finding on x-ray of osteitis fibrous cystic

A

Cystic lesions due to excessive osteoclastic resorption of bone

“brown” tumors because lined with osteoclasts & blood pigment

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12
Q

Purpose of muscle spindles

A

Sensory structure in skeletal muscle monitoring length of muscle

*Relaxing the antagonistic muscle

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13
Q

Innervation of muscle spindles

A

Type Ia & II sensory neurons

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14
Q

Purpose of Golgi tendon organs

A

Monitor changes in muscle length & tension, located in muscle tendons

*Reduce tension within muscle & tendon by limiting muscle contraction

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15
Q

Innervation of Golgi tendon organs

A

Type Ib sensory neurons

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16
Q

What mutation makes up roughly 50% of HCM patients?

A

AD mutation in the cardiac myosin binding protein C gene

*Rest is beta-myosin heavy chain mutation

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17
Q

Kocher criteria (4) to differentiate septic arthritis versus “transient” synovitis of the hip in pediatric patients

A
  • Refusal to bear weight
  • Fever
  • ESR > 40
  • WBC > 12,000 cells/uL
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18
Q

Most common cause of septic arthritis

A

Staph aureus

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19
Q

What is an osteophyte?

A

Bone spur

*Typical in older adults due to “wear & tear” of bone and reformation occurring

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20
Q

What type of lesions are associated with metastatic prostate cancer

A

Sclerotic, osteoblastic (bone-reforming) lesions

**on the contrary, osteolytic would be multiple myeloma or lung cancers

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21
Q

Alkaline phosphatase (ALP) is a non-specific marker, but is increased in which of the following situations/diseases?

A
  • Metastatic prostate cancer (osteoblastic activity)
  • Osteoarthritis (reactive bone formation)
  • Biliary obstruction
  • Liver diseases
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22
Q

Falling on an outstretched hand can break what bone in the hand most often?

A

Hook of hamate

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23
Q

Which two muscles originate from the hook of hamate?

A

Flexor digiti minimi
Opponens digiti minimi

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24
Q

Which two muscles surround the median nerve in the carpal tunnel?

A

Flexor digitorum superficialis
Profundus

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25
Q

Which cancer can Pagets disease turn into?

A

Osteosarcoma

*Due to high cell turnover

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26
Q

Characteristics of Pagets disease?

A
  • Increased bone density
  • Cortical thickening
  • Bowing
  • Overgrowth
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27
Q

Signs & symptoms of Pagets disease

A
  • Skull & foot enlargement
  • Long bone fractures
  • Mosaic bone pattern
  • Hearing loss
  • High output cardiac failure
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28
Q

Lab findings of Pagets disease

A

Isolated increase in ALP

Normal: calcium, phosphate, PTH
^Because Pagets is a remodeling disorder, not a hormonal/calcium disorder

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29
Q

ALP is a marker for osteoclasts or osteoblasts?

A

Osteoblasts

*Thus, bone formation shows increased ALP

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30
Q

Podagra

A

Enlarged painful toe

*ie: Gout

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31
Q

Which disease is associated with osteitis fibrous cystic

A

Chronic renal failure

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32
Q

In down syndrome patients with decreasing coordination, what should we suspect?

A

Atlantoaxial instability, get cervical x-ray asap

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33
Q

Explain Rickets (don’t say vitamin D deficiency only)

A

Decreased mineralization of bone osteoid

*Rickets refers to mineralization deficiencies at the growth plate and can only occur while growth plates are open (growing children)

**In adults, its only osteomalacia

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34
Q

Hallmark signs of rickets

A
  • Bowed legs
  • Chest wall deformities
  • Bone pain
  • Pathologic fractures
  • Poor growth
  • Widened growth plates
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35
Q

Lab findings in Rickets

A

Increased ALP
Decreased calcium and/or phosphate

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36
Q

What happens to the number of osteoblasts in Rickets

A

Increased because trying to lay down osteoid in an effort to strengthen the bone

*Osteoblasts produce collagen with calcium and phosphorous, but the increased osteoid isn’t mineralized and bone remains soft & weak

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37
Q

What happens to the number of osteoclasts in Rickets

A

Nothing - stays the same

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38
Q

Content of rheumatoid nodules consist of what?

A

Resemble granulomas!!

*Central areas of fibrinoid necrosis surrounded by palisading rim of epithelioid cells & lymphocytes

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39
Q

Content of gout tophi consist of what?

A

Crystalline masses surrounded by macrophages

*Considered a foreign body giant cell granuloma

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40
Q

Content of ganglion cyst consist of what?

A

Myxoid degeneration of connective tissue

*Normal connective tissue replaced by gelatinous or mucoid substance

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41
Q

What is the consequence of CN XII damage in the tongue?

A

“Tongue licks the lesion”

Right nerve damage will mean that the muscles of the left side of the tongue will be unopposed and the tongue will move to the right

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42
Q

What muscle of the tongue causes the tongue to protrude, which to retract?

A

Protrude: Genioglossus
Retract: Hyoglossus

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43
Q

What collagen is affected in osteoarthritis?

A

Type II (cartilage)

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44
Q

Midshaft fracture of the humerus causes damage to which nerve and what would be the problem?

A

Radial nerve damage

“wrist drop” occurs since extensors don’t work

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45
Q

What joints of the hand does RA versus osteoarthritis affect?

A

RA: Proximal interphalangeal joints

OA: Distal interphalangeal joints

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46
Q

Cause of osteoarthritis

A

Mechanical wear and tear

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47
Q

What’s the pathogenesis of Pagets disease

A

Paramyxovirus infection of osteoclasts & genetic susceptibility

48
Q

3 stages of Pagets disease

A
  1. Osteolytic stage (osteoclast activity dominates)
  2. Mixed osteolytic-osteoblastic
  3. Osterosclerotic stage (osteoblastic activity predominates in this “burnout stage”)
49
Q

Microscopically, what would Pagets look like?

A

“Mosaic Pattern”

*Irregular thick & thin lamellar bone with abnormal cement lines

50
Q

What are the two types of bone formation in development and give examples of each

A

INTRAMEMBRANEOUS OSSIFICATION:
-Flat bones (skull, maxilla, mandible, pelvis, clavicles)

ENDOCHONDRAL OSSIFICATION:

  • Long bones
  • Bones forming from cartilage (limbs, hands, feet)
51
Q

Causes of carpal tunnel besides overuse

A
  • RA (tendon inflammation)
  • Hypothyroidism (because of myxedema)
  • Acromegaly (synovial tendon hyperplasia)
  • Obesity
  • Pregnancy (edema)
52
Q

Anterior & posterior borders of carpal tunnel

*stupid fucking question

A

Anterior: Flexor retinaculum

Posterior: Carpal bones

53
Q

Fracture of the supracondylar region of the distal humerus will damage which nerve?

A

Median

54
Q

Which two muscles border the Bakers Cyst?

A

Medial gastrocnemius & semimembranosus muscles

55
Q

What is damaged (nerve wise) by the grabbing of a tree branch falling?

A

Lower trunk of the brachial plexus

56
Q

Order or arrangment of structures in the cubital fossa

A

TAN

  • Tendon of biceps
  • Brachial Artery
  • Median Nerve
57
Q

Which artery accompanies the radial nerve

A

Profundii brachii artery

58
Q

What does the musculocutaneous nerve turn into & wear in the arm?

A

Lateral cutaneous nerve for the forearm

Lateral to the biceps tendon

59
Q

Which two muscles does the radial nerve travel between and where does it go at the cubital fossa?

A

Brachialis & brachioradialis

Lateral to biceps tendon

60
Q

What is the cubital tunnel?

A

Area in the elbow where the ulnar nerve passes

61
Q

What cords are in the brachial plexus and what nerves do they give off?

A

Lateral Cord:

  • Musculocutaneous
  • Median

Posterior Cord:

  • Radial
  • Axillary

Medial Cord:

  • Median
  • Ulnar
62
Q

What trunks are supplied by the cervical roots?

A

C5 + C6 = Superior

C7 = Middle

C8 + T1 = Inferior

63
Q

3 most common sites of fracture in osteoporotic women

A

1) Vertebra (compression)
2) Hip (neck of femur)
3) Wrist (Colles)

64
Q

What nerve innervates ALL interosseous muscles of the hand?

A

Ulnar nerve

65
Q

Innervation of the adductor pollices brevis

A

Ulnar nerve

66
Q

Innervation of the abductor pollices brevis

A

Median nerve

67
Q

Innervation of the opponens pollices brevis

A

Median nerve

68
Q

Arterial supply of the femoral head

A

Medial femoral circumflex artery

*Branch of the deep femoral artery (a continuation of the external iliac after the inguinal ligament)

69
Q

What are the two most common associations with avascular necrosis of the femoral head?

A

1) Chronic steroid use
2) Alcohol abuse

*possibly due to hyper coagulability

70
Q

Explain the course of the external iliac

A

-Common iliac turns into external iliac at the pelvic brim

  • External iliac becomes the femoral artery after the inguinal ligament
  • ->Gives off inferior epigastric
  • Femoral turns into popliteal artery after the adductor hiatus at the popliteal fossa
  • Popliteal gives off the anterior & posterior tibial arteries
71
Q

What lies on top of the anterior scalene muscle?

A

Phrenic nerve & subclavian vein

72
Q

What lies between the anterior & middle scalene muscles?

A

Brachial plexus & subclavian artery

73
Q

What is thoracic outlet syndrome? Treatment?

A

Compression of the subclavian artery & lower trunk of brachial plexus

Tx: Incision of anterior scalene

74
Q

What rami does the phrenic nerve arise from?

A

C3, C4, C5

75
Q

The supra scapular nerve is a branch of which brachial trunk?

A

Upper

76
Q

What is Alkaptonuria?

A

AR causing deficiency in homogentisic acid oxidase (enzyme for metabolism of tyrosine)

77
Q

Signs of Alkaptonuria

A

1) Blue-black hue (ochronosis) to skin due to accumulation of homogentisic acid in cartilage
2) Urine turns black when left standing

78
Q

Patient presents with arm hanging by side, palm facing posteriorly. What is the name of this injury and what nerve is damaged?

A

“Erbs Palsy” or “Waiters tip”

Injured upper trunk of brachial plexus (supraspinatus & axillary n.) due to violent movement of head & neck from ipsilateral shoulder

79
Q

Appearance of synovial biopsy in a patient with RA

A
  • Proliferative synovial fluid
  • Intense inflammatory infiltrates (plasma cells, lymphocytes, macrophages)
80
Q

Where do the greater and lesser saphenous veins drain to?

A

Great saphenous –> common femoral

Lesser saphenous –> popliteal –> femoral –> common femoral

81
Q

Bells Palsy is due to what? And what nerve does it affect?

A

Lyme’s disease (borrelia burgdorferi)

Facial nerve

82
Q

Because of the nerve bells palsy is effected by, what other symptoms would we see? List their associated muscle

A

Buccinator: can’t hold food against the teeth while chewing

Orbicularis oris: drooling

*inability to wrinkle forehead, shut eyes, drooping corner of mouth, decreased tearing, taste disturbance

83
Q

Innervation of masseter & temporalis

A

Mandibular division of trigeminal nerve

84
Q

Classic symptom of Ewing sarcoma & histological and radiological finding

A

Pain worse at night

Histology: small blue cells

Radiography: periosteal reaction

85
Q

Where would pain of a scaphoid bone fracture be localized?

A

Anatomical snuff box

*Floor of it is the scaphoid is reasoning why

86
Q

A fall on outstretched hands will likely break which bone of the hand?

A

Scaphoid

87
Q

Muscles affected in Trendelenburg sign? What is their innervation?

A

Abductors of the hip
Gluteus minimus
Gluteus medius

*Innervated by superior gluteal nerve

88
Q

Causes of Trendelenburg sign

A
  • Polio
  • Disc herniation at lower lumbar
  • Intragluteal injections injuring superior gluteal nerve
89
Q

Innervation of adductors of the hip [adductor Magnus]

A

Obturator

90
Q

Innervation of gluteus maximus

A

Inferior gluteal nerve

91
Q

Dislocation of the humerus anteriorly/inferiorly is likely to injure which nerve? What movement is impaired by this?

A

Axillary nerve

*Impaired shoulder ABDuction, loss of sensation over the lateral upper arm

92
Q

Borders & content of the quadrangular space

A

Teres minor
Teres major
Long head of triceps
Surgical neck of humerus

CONTENT: Axillary nerve & posterior circumflex artery

*Anterior/inferior dislocation of humerus injures this space (axillary nerve)

93
Q

Borders & content of triangular space

A

Teres minor
Teres major
Long head of triceps

CONTENT: circumflex scapular artery

94
Q

Borders & content of triangular interval

A

Teres major
Long head of triceps
Shaft of humerus & lateral head of triceps

CONTENT: radial nerve & profunda brachii artery

95
Q

What is Klumpke paralysis

A

Brachial plexus injury occurring during breech delivery with arms delivered in an extended position after the head

*Causes stretching of the LOWER brachial plexus

96
Q

What syndrome would Klumpke paralysis cause and why?

A

Ipsilateral Horner syndrome (mitosis, partial ptosis, anhydrosus)

*Because the lower brachial plexus is also made of T1, which is the sympathetic innervation of the face!!

97
Q

Which nerve root(s) supplies the long thoracic nerve?

A

C5, C6, C7

98
Q

Does prostate cancer have osteolytic or osteoblastic lesions on imaging?

A

Osteoblastic

*Will see elevated ALP in labs

99
Q

Characteristic symptom fo osteoarthritis

A

Pain with movement, alleviation of pain at rest

100
Q

What is the cause of osteopetrosis?

A

Defective/decreased osteoCLAST function

*Causes decreased bone resorption and thick, sclerotic bone

101
Q

What would an x-ray of the long bones show in osteopetrosis?

A

Broad metaphyses & diaphyses

*Bones look thick, but are actually brittle

102
Q

Complications of osteopetrosis

A

Narrowing of cranial foramina with cranial nerve compression

*Vision & hearing loss
**Facial nerve palsy
***Hydrocephalus

103
Q

What disease presents with pancytopenia & dacrocytes (tear drop red cells)

A

Osteopetrosis

104
Q

What are the classic radiographic findings of osteoarthritis?

A
  • Subchondral sclerosis
  • Cysts
105
Q

In osteoarthritis, where does cartilage degeneration typically begin?

A

Medial aspect of the knees, leading to varus deformity

106
Q

What type of arthritis is associated with bone & cartilage erosion?

A

RA

107
Q

Chondrocalcinosis is associated with what?

A

Pseudogout

*CPPD- calcium pyrophosphate deposition

108
Q

Loss of bony trabecular is associated with what?

A

Osteoporosis

109
Q

Presentation of femoral nerve injury

A
  • Weak hip flexion
  • Weak knee extension
  • Absent knee-jerk reflex
110
Q

What muscles are innervated by the femoral nerve?

A

Anterior compartment muscles of the thigh

111
Q

Presentation of genitofemoral nerve injury

A

Parasthesia over the mons pubis, femoral triangle, labia majora

112
Q

Presentation of iliohypogastric nerve injury

A

Burning pain & paresthesia in the area between an incision and thigh, labia, and mons pubis

113
Q

Presentation of obturator nerve injury

A

Numbness in the upper medial thigh and weakness in hip adduction

114
Q

Presentation of pudendal nerve injury

A

Vulvar, gluteal, perineal pain

115
Q

Does nerve injury typically occur at the surgical neck or the anatomical neck of humerus?

A

Surgical neck

*Anatomical neck is the attachment of the capsular ligament of the shoulder, no nerves traverse in this area

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