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
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
3
Q
Mutation & associated gene in osteogenesis imperfecta
A
type 1 collagen
COL1A1 gene mutation
*collagen (bone) doesn’t reform strong after breaks
4
Q
Disease associated with “beading of the costochondral junctions of the ribs”
A
Rickets
*termed rachitic rosary
5
Q
What other disease (albeit uncommon) can demonstrate blue sclera besides OI?
A
Ehlers-Danlos disease
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
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
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
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
10
Q
3 main symptoms of hyperparathyroidism
A
- Bone pain
- Constipation
- Nausea
*Polydipsia & polyuria due to hypercalcemia too
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
12
Q
Purpose of muscle spindles
A
Sensory structure in skeletal muscle monitoring length of muscle
*Relaxing the antagonistic muscle
13
Q
Innervation of muscle spindles
A
Type Ia & II sensory neurons
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
15
Q
Innervation of Golgi tendon organs
A
Type Ib sensory neurons
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
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
18
Q
Most common cause of septic arthritis
A
Staph aureus
19
Q
What is an osteophyte?
A
Bone spur
*Typical in older adults due to “wear & tear” of bone and reformation occurring
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
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
22
Q
Falling on an outstretched hand can break what bone in the hand most often?
A
Hook of hamate
23
Q
Which two muscles originate from the hook of hamate?
A
Flexor digiti minimi
Opponens digiti minimi
24
Q
Which two muscles surround the median nerve in the carpal tunnel?
A
Flexor digitorum superficialis
Profundus
25
Which cancer can Pagets disease turn into?
Osteosarcoma
\*Due to high cell turnover
26
Characteristics of Pagets disease?
- Increased bone density
- Cortical thickening
- Bowing
- Overgrowth
27
Signs & symptoms of Pagets disease
- Skull & foot enlargement
- Long bone fractures
- Mosaic bone pattern
- Hearing loss
- High output cardiac failure
28
Lab findings of Pagets disease
Isolated increase in ALP
**Normal: calcium, phosphate, PTH**
^Because Pagets is a remodeling disorder, not a hormonal/calcium disorder
29
ALP is a marker for osteoclasts or osteoblasts?
Osteo**blasts**
\*Thus, bone formation shows increased ALP
30
Podagra
Enlarged painful toe
\*ie: Gout
31
Which disease is associated with osteitis fibrous cystic
Chronic renal failure
32
In down syndrome patients with decreasing coordination, what should we suspect?
Atlantoaxial instability, get cervical x-ray asap
33
Explain Rickets (don't say vitamin D deficiency only)
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**
34
Hallmark signs of rickets
- Bowed legs
- Chest wall deformities
- Bone pain
- Pathologic fractures
- Poor growth
- Widened growth plates
35
Lab findings in Rickets
Increased ALP
Decreased calcium and/or phosphate
36
What happens to the number of osteoblasts in Rickets
**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
37
What happens to the number of osteoclasts in Rickets
Nothing - stays the same
38
Content of rheumatoid nodules consist of what?
Resemble granulomas!!
\*Central areas of fibrinoid necrosis surrounded by palisading rim of epithelioid cells & lymphocytes
39
Content of gout tophi consist of what?
Crystalline masses surrounded by macrophages
\*Considered a foreign body giant cell granuloma
40
Content of ganglion cyst consist of what?
Myxoid degeneration of connective tissue
\*Normal connective tissue replaced by gelatinous or mucoid substance
41
What is the consequence of CN XII damage in the tongue?
"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
42
What muscle of the tongue causes the tongue to protrude, which to retract?
Protrude: Genioglossus
Retract: Hyoglossus
43
What collagen is affected in osteoarthritis?
Type II (cartilage)
44
Midshaft fracture of the humerus causes damage to which nerve and what would be the problem?
Radial nerve damage
"wrist drop" occurs since extensors don't work
45
What joints of the hand does RA versus osteoarthritis affect?
RA: Proximal interphalangeal joints
OA: Distal interphalangeal joints
46
Cause of osteoarthritis
Mechanical wear and tear
47
What's the pathogenesis of Pagets disease
Paramyxovirus infection of osteoclasts & genetic susceptibility
48
3 stages of Pagets disease
1. Osteolytic stage (osteoclast activity dominates)
2. Mixed osteolytic-osteoblastic
3. Osterosclerotic stage (osteoblastic activity predominates in this "burnout stage")
49
Microscopically, what would Pagets look like?
"Mosaic Pattern"
\*Irregular thick & thin lamellar bone with abnormal cement lines
50
What are the two types of bone formation in development and give examples of each
INTRAMEMBRANEOUS OSSIFICATION:
-Flat bones (skull, maxilla, mandible, pelvis, clavicles)
ENDOCHONDRAL OSSIFICATION:
- Long bones
- Bones forming from cartilage (limbs, hands, feet)
51
Causes of carpal tunnel besides overuse
- RA (tendon inflammation)
- Hypothyroidism (because of myxedema)
- Acromegaly (synovial tendon hyperplasia)
- Obesity
- Pregnancy (edema)
52
Anterior & posterior borders of carpal tunnel
\*stupid fucking question
Anterior: Flexor retinaculum
Posterior: Carpal bones
53
Fracture of the supracondylar region of the distal humerus will damage which nerve?
Median
54
Which two muscles border the Bakers Cyst?
Medial gastrocnemius & semimembranosus muscles
55
What is damaged (nerve wise) by the grabbing of a tree branch falling?
Lower trunk of the brachial plexus
56
Order or arrangment of structures in the cubital fossa
TAN
- Tendon of biceps
- Brachial Artery
- Median Nerve
57
Which artery accompanies the radial nerve
Profundii brachii artery
58
What does the musculocutaneous nerve turn into & wear in the arm?
Lateral cutaneous nerve for the forearm
Lateral to the biceps tendon
59
Which two muscles does the radial nerve travel between and where does it go at the cubital fossa?
Brachialis & brachioradialis
Lateral to biceps tendon
60
What is the cubital tunnel?
Area in the elbow where the ulnar nerve passes
61
What cords are in the brachial plexus and what nerves do they give off?
Lateral Cord:
- Musculocutaneous
- Median
Posterior Cord:
- Radial
- Axillary
Medial Cord:
- Median
- Ulnar
62
What trunks are supplied by the cervical roots?
C5 + C6 = Superior
C7 = Middle
C8 + T1 = Inferior
63
3 most common sites of fracture in osteoporotic women
1) Vertebra (compression)
2) Hip (neck of femur)
3) Wrist (Colles)
64
What nerve innervates ALL interosseous muscles of the hand?
Ulnar nerve
65
Innervation of the **adductor** pollices brevis
Ulnar nerve
66
Innervation of the **abductor** pollices brevis
Median nerve
67
Innervation of the opponens pollices brevis
Median nerve
68
Arterial supply of the femoral head
Medial femoral circumflex artery
\*Branch of the deep femoral artery (a continuation of the external iliac after the inguinal ligament)
69
What are the two most common associations with avascular necrosis of the femoral head?
1) Chronic steroid use
2) Alcohol abuse
\*possibly due to hyper coagulability
70
Explain the course of the external iliac
-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
What lies on top of the anterior scalene muscle?
Phrenic nerve & subclavian vein
72
What lies between the anterior & middle scalene muscles?
Brachial plexus & subclavian artery
73
What is thoracic outlet syndrome? Treatment?
Compression of the subclavian artery & lower trunk of brachial plexus
Tx: Incision of anterior scalene
74
What rami does the phrenic nerve arise from?
C3, C4, C5
75
The supra scapular nerve is a branch of which brachial trunk?
Upper
76
What is Alkaptonuria?
AR causing deficiency in homogentisic acid oxidase (enzyme for metabolism of tyrosine)
77
Signs of Alkaptonuria
1) Blue-black hue (ochronosis) to skin due to accumulation of homogentisic acid in cartilage
2) Urine turns black when left standing
78
Patient presents with arm hanging by side, palm facing posteriorly. What is the name of this injury and what nerve is damaged?
"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
Appearance of synovial biopsy in a patient with RA
- Proliferative synovial fluid
- Intense inflammatory infiltrates (plasma cells, lymphocytes, macrophages)
80
Where do the greater and lesser saphenous veins drain to?
Great saphenous --\> common femoral
Lesser saphenous --\> popliteal --\> femoral --\> common femoral
81
Bells Palsy is due to what? And what nerve does it affect?
Lyme's disease (borrelia burgdorferi)
Facial nerve
82
Because of the nerve bells palsy is effected by, what other symptoms would we see? List their associated muscle
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
Innervation of masseter & temporalis
Mandibular division of trigeminal nerve
84
Classic symptom of Ewing sarcoma & histological and radiological finding
Pain worse at night
Histology: small blue cells
Radiography: periosteal reaction
85
Where would pain of a scaphoid bone fracture be localized?
Anatomical snuff box
\*Floor of it is the scaphoid is reasoning why
86
A fall on outstretched hands will likely break which bone of the hand?
Scaphoid
87
Muscles affected in Trendelenburg sign? What is their innervation?
Abductors of the hip
Gluteus minimus
Gluteus medius
\*Innervated by superior gluteal nerve
88
Causes of Trendelenburg sign
- Polio
- Disc herniation at lower lumbar
- Intragluteal injections injuring superior gluteal nerve
89
Innervation of adductors of the hip [adductor Magnus]
Obturator
90
Innervation of gluteus maximus
Inferior gluteal nerve
91
Dislocation of the humerus anteriorly/inferiorly is likely to injure which nerve? What movement is impaired by this?
Axillary nerve
\*Impaired shoulder ABDuction, loss of sensation over the lateral upper arm
92
Borders & content of the quadrangular space
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
Borders & content of triangular space
Teres minor
Teres major
Long head of triceps
CONTENT: circumflex scapular artery
94
Borders & content of triangular interval
Teres major
Long head of triceps
Shaft of humerus & lateral head of triceps
CONTENT: radial nerve & profunda brachii artery
95
What is Klumpke paralysis
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
What syndrome would Klumpke paralysis cause and why?
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
Which nerve root(s) supplies the long thoracic nerve?
C5, C6, C7
98
Does prostate cancer have osteolytic or osteoblastic lesions on imaging?
Osteoblastic
\*Will see elevated ALP in labs
99
Characteristic symptom fo osteoarthritis
Pain with movement, alleviation of pain at rest
100
What is the cause of osteopetrosis?
Defective/decreased osteoCLAST function
\*Causes decreased bone resorption and thick, sclerotic bone
101
What would an x-ray of the long bones show in osteopetrosis?
Broad metaphyses & diaphyses
\*Bones look thick, but are actually brittle
102
Complications of osteopetrosis
Narrowing of cranial foramina with cranial nerve compression
\*Vision & hearing loss
\*\*Facial nerve palsy
\*\*\*Hydrocephalus
103
What disease presents with pancytopenia & dacrocytes (tear drop red cells)
Osteopetrosis
104
What are the classic radiographic findings of osteoarthritis?
- Subchondral sclerosis
- Cysts
105
In osteoarthritis, where does cartilage degeneration typically begin?
Medial aspect of the knees, leading to varus deformity
106
What type of arthritis is associated with bone & cartilage erosion?
RA
107
Chondrocalcinosis is associated with what?
Pseudogout
\*CPPD- calcium pyrophosphate deposition
108
Loss of bony trabecular is associated with what?
Osteoporosis
109
Presentation of femoral nerve injury
- Weak hip flexion
- Weak knee extension
- Absent knee-jerk reflex
110
What muscles are innervated by the femoral nerve?
Anterior compartment muscles of the thigh
111
Presentation of genitofemoral nerve injury
Parasthesia over the mons pubis, femoral triangle, labia majora
112
Presentation of iliohypogastric nerve injury
Burning pain & paresthesia in the area between an incision and thigh, labia, and mons pubis
113
Presentation of obturator nerve injury
Numbness in the upper medial thigh and weakness in hip adduction
114
Presentation of pudendal nerve injury
Vulvar, gluteal, perineal pain
115
Does nerve injury typically occur at the surgical neck or the anatomical neck of humerus?
Surgical neck
\*Anatomical neck is the attachment of the capsular ligament of the shoulder, no nerves traverse in this area
