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USMLE Step 1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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USMLE® Step 1 flashcards
1
Q

Forms of Osteopetrosis

A
  1. Infantile form (CA type II gene mutation)(Autosomal recessive)
  2. Adolescent (Albers-Shonberg Disease)(Autosomal dominant)
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2
Q

Clinical Features of Osteopetrosis (5)

A
  1. Bone prone to fracture.
  2. Pancytopenia (deposition on bone in medullary space)
  3. Hepatosplenomegaly (extra medullary hematopoiesis).
  4. Cranial nerve compression (excess bone in the skull).
  5. Hydrocephalus (narrowing of foramen magnus).
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3
Q

Rickets and Osteomalacia are nutritional bone disorders caused by..

A

Low Ca or Vitamin D intake.

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4
Q

Thickening of the growth plate (epiphyseal widening from osteoid deposition) is seen in…

A

Rickets

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5
Q

Clinical Features of Rickets (3) (black child with cotton candy head)

A
  1. Genu varum.
  2. Rachitic rosary (swelling of costochondral junctions).
  3. Craniotabes (soft skull).
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6
Q

Osteomalacia occurs in areas of bone turnover, making the bones prone to fractures, the most affected bones are…(3)

A

Spine, pelvis and legs

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7
Q

Classic x-ray finding in Osteomalacia

A

Pseudofractures (Looser zones: stress fractures inadequately mineralized)

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8
Q

Mention the causes of Vitamin D deficiency (3)

A
  1. Fat malabsorption (CF, Pancreatitis, IBD, Celiac disease)
  2. Renal and liver failure
  3. Reduced sun exposure
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9
Q

How would you expect to find the values of Ca, PTH, Phosphate and Alkaline phosphatase in a patient with low Vitamin D?

A

Ca and Phosphate: low
PTH: high
Alkaline phosphatase: high (indicates osteoblast activity)

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10
Q

Paget’s disease is a focal bone disorder common in older patients characterized by…

A

Excessive bone remodeling

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11
Q

Histology hallmark of Paget’s disease is…

A

Mosaic pattern of lamellar bone and cement lines.

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12
Q

Chalkstick fractures are characteristic of…

A

Paget’s disease

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13
Q

The classic bone disease in patients with Hyperparathyroidism is…

A

Osteitis fibrosa cystica.

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14
Q

How would you expect to find the levels of Ca, Phosphate and PTH in a patient with Osteitis fibrosa cystica? Explain every answer.

A

Ca: high (PTH promotes expression of RANK-L by osteoblast that promotes osteoclast activity)
PTH: high (classic cause of Osteitis fibrosa cystica is Parathyroid adenoma)
Phosphate: low (PTH promotes phosphate excretion by the kidneys)

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15
Q

The classic X-ray finding of Osteitis fibrosa cystica is…

A

Subperiosteal resorption commonly seen in the bone of fingers.

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16
Q

What is the only scenario when PTH and Phosphate would be both high?

A

Renal Osteodystrophy (bone abnormalities in renal failure)

17
Q

In a patient with bone pain/fractures and high PTH and low calcium what are the possible diagnosis? (2)

A

Calcium deficiency.
Vitamin D deficiency.

18
Q

In a patient with bone pain/fracture with normal calcium and PTH, what are the possible diagnosis? (4)

A
  1. Osteoporosis
  2. Osteopetrosis
  3. Paget’s disease
  4. Bone tumors
19
Q

In a patient with bone pain/fractures and high PTH and high calcium what are the possible diagnosis? (1)

A
  1. Osteitis fibrosa cystica (Parathyroid adenoma)
20
Q

Bone metastasis are way more common than bone tumors, in which part of the bone are commonly seen?

A

Diaphysis.

21
Q

What disease causes the classic metastatic osteoclastic lesion?

A

Multiple myeloma.

22
Q

What disease causes the classic metastatic osteoblastic lesion?

A

Prostate cancer.

23
Q

Primary bone tumors often occur in…(1.age group, gender) especially in…(2.location). Can present as…(3.clinical picture)

A
  1. children/young adults, males.
  2. long bones, at the knee most frequently.
  3. bone pain/ pathological fractures.
24
Q

Characteristics of Osteoid osteomas
0. Cell type
1. Size
2. Location
3. Presentation
4. Responsive to NSAIDs/Apirin
5. X-ray finding

A
  1. Osteoblast
  2. Less than 2 cm
  3. Surface of cortex in Diaphysis
  4. Bone pain at night
  5. Yes
  6. Bump in long bone, radiolucent central osteoid core surrounded by reactive bone
25
Q

Characteristics of Osteoblastoma
1. Size
2. Bones where usually locate
3. Responsive to NSAIDs/Aspirin

A
  1. Bigger than 2 cm
  2. Spine
  3. No
26
Q

Characteristics of Osteosarcoma
1. Cell type
2. Location
3. Presentation
4. X-ray finding

A
  1. Osteoblast
  2. Metaphysis
  3. Enlarging bone mass, pathologic fractures
  4. Codman triangle, sunburst/sunray
27
Q

Patients with Paget’s disease at risk of developing which cancer type?

A

Osteosarcoma

USMLE Step 1 (2 decks)

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