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Musculoskeletal Flashcards

1
Q

Unhappy triad

A

MCL, ACL, Medial meniscus

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2
Q

The term anterior and posterior in ACL and PCL refer to what?

A

Where they attach to the tibia

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3
Q

If looking down on the tibia where would we see the PCL attaching?

A

Posterior pretty much in the dead center

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4
Q

Between the ACL and PCL, which stays mostly in the midline and which sweeps side to side?

A

PCL is more confined to the midline, ACL goes from lateral (superior) to medial (inferior)

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5
Q

Bones of the hand (include position)

A

(proximal thumb side) Scaphoid, Lunate, Triquetrum, Pisiform (proximal pinkie side). (Distal thumb side) Trapezium, Trapezoid, Capitate, Hammate (distal pinkie side)

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6
Q

What nerve is compressed by incorrect use of crutches?

A

Radial

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7
Q

What does the lower trunk of the brachial plexus innervate and what is the consequence of this?

A

All intrinsic muscles of the hand. Damage leads to hand clumsiness

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8
Q

Damage to which nerve leads to wrist drop?

A

Radial

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9
Q

Damage to what structure leads to waiters tip (Erbs Palsy)?

A

Upper trunk of brachial plexus

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10
Q

What structures will likely be damage by the following injuries: fracture of surgical neck of humerus, dislocation of humeral head, fracture of midshaft humerus

A

Surgical neck - axillary nerve, humeral head - axillary nerve, midshaft - radial nerve

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11
Q

What structures will likely be damaged by the following injuries: fracture of supracondylar humerus, dislocated lunate, fracture of medial epicondyle of humerus, fracture of hook of hamate, and upper trunk compression

A

Supracondylar humerus - median (prox), lunate - median (dist), medial epicondyle of humerus - ulnar (prox), hook of hamate (ulnar - dist), upper trunk - musculocutaneous

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12
Q

If you have a fracture at midshaft of the humerus, what two structures are at risk?

A

Radial nerve and deep brachial artery

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13
Q

Causes of carpal tunnel

A

Repetitive stress (most common), fluid retention (renal failure, hypothyroid, pregnancy), DM, RA, dialysis-associated amyloidosis

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14
Q

Course of the median nerve

A

Between humeral and ulnar heads of pronator teres then between flexor digitorum superficials and flexor digitorum profundus, then enters carpal tunnel

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15
Q

Complications of mastectomy

A

Winged scapula (serratus anterior, LTN), lymphedema, inability to abduct shoulder past 90 degrees (serratus anterior, LTN)

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16
Q

Nerve responsible for thigh adduction

A

Obturator (L2-L4)

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17
Q

Trendelenberg sign

A

Contralateral hip drops when standing on leg ipsilateral to lesion. Problem with superior gluteal nerve (L4-S1)

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18
Q

Where should you give butt injections?

A

Superolaterally. Superomedial quadrant endangers superior gluteal nerve (may get trendelenburg sign)

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19
Q

Sciatica in posterior thigh with diminished ankle reflex

A

Compression of S1

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20
Q

Which is the thin filament and which the thick?

A

Actin is thin filament (lighter), myosin is thick (darker)

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21
Q

What system in skeletal muscle ensures coordinated contraction of myofibrils?

A

T-tubules

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22
Q

Type 1 and Type 2 muscle

A

1 - slow twitch, red. 2 - Fast twitch, white

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23
Q

Short limbs with a normal spine

A

FGFR-3 mutation

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24
Q

Short limbs with a short spine

A

GH or IGF-1 mutation

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25
Histology of osteoporosis
Trabecular thinning with fewer interconnections
26
Histology of osteopetrosis
Spongiosa filling medullary canals with no mature trabeculae
27
Which type of osteoporosis is post menopausal?
Type 1
28
Histology of osteomalacia/rickets
Osteoid matrix accumulation around trabeculae
29
Bony prominance at costochondral junctions with bowed legs
Rickets (prominences are called rosary chest)
30
Histology of Pagets disease of bone
Lamellar bone structure resembling a mosaic
31
Complications of Pagets disease of bone
Hearing loss (auditory foramen narrowing), increased hat size
32
Genetic deficiency and labs in osteopetrosis
Deficiency of carbonic anhydrase 2. Calcium, phosphate, and alk phos are normal. Anemia, thrombocytopenia, infection, extramedullary hematopoiesis
33
Lab values in Pagets disease of bone
Normal except Alk Phos, which is high
34
Appearance of osteitis fibrosa cystica
Brown tumors
35
Marker for Pagets disease of bone
High Alk Phos with (sometimes) TRAP positivity
36
McCune-Albright
Polyostotic fibrous dysplasia. Multiple unilateral bone lesions with endocrine abnormalities (precocious puberty) and cafe-au-lait spots. Bone replaced by fibroblasts, collagen, and irregular bony trabeculae
37
Age, location, and predisposing factors in osteosarcoma
Males ages 10-20. Metaphysis of long bones (femur, proximal tibia). Associated with Pagets, bone infarcts, radiation, and familial Rb
38
What causes Codmans triangle (sunburst pattern) in osteosarcoma?
Elevation of periosteum
39
Translocation in Ewings sarcoma
11,22
40
Onion skin appearance in bone
Ewings sarcoma
41
Bone tumors by location and malignant status
Epiphysis - Giant cell tumor (benign). Metaphysis - Osteochondroma (benign) and Osteosarcoma (malignant). Diaphysis - Chondrosarcoma (malignant), and Ewings sarcoma (malignant)
42
Where are Heberdens nodes and Bouchards nodes and what disease are they associated with?
OA. Heberden - DIP, Bouchard (PIP)
43
RA treatment
NSAIDs, COX-2 inhibitors, glucocorticoids (short term), DMARDS (MTX, Sulfasalazine, hydroxychloroquine, TNF-a inhibitors)
44
Autoantibodies in Sjogrens
SS-A and SS-B
45
Birefringence of gout and pseudogout
Gout - negative, Pseudogout - weakly positive
46
Precipitants of gout
Lesch-Nyhan, PRPP excess, decreased excretion (eg thiazides), increased cell turnover, von-Gierkes disease
47
Give the color of crystals in gout and pseudogout
Gout - yellow when parallel, blue when perpendicular. Pseudogout - yellow when perpendicular, blue when parallel
48
Crystals in pseudogout
Calcium pyrophosphate
49
Causes of infectious arthritis
Septic - s aureus, streptococcus, n gonorrhoeae. Chronic - TB, lyme
50
Causes of osteonecrosis (avascular necrosis)
Trauma, high dose corticosteroids, alcoholism, sickle cell
51
Seronegative spondyloarthropathies
Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease associated spondylitis, Reactive (Reiters) arthritis
52
Where is inflammation common in akylosing spondylitis and what is the consequence of this?
Sites of tendon insertion. May lead to reduce chest expansion and hyperventilation
53
Presentation of Reiters syndrome
Conjunctivitis with anterior uveitis, urethritis, arthritis and sacroilitis. Cant see cant pee cant climb a tree
54
SLE is associated with antiphospholipid antibodies. What is the clinical consequence of these?
Venous and arterial thromboemboli. Also recurrent miscarriages (which is how SLE may present)
55
Common antibodies in SLE
Anti-dsDNA, anti-smith, antiphospholipid
56
What is the accuracy of ANA in SLE?
Sensitive but not specific
57
Which antibody in SLE is most prognostic?
Anti-double stranded DNA. Indicates poor prognosis (anti-smith is specific but not prognostic)
58
Antibodies associated with drug induced lupus
Antihistone antibodies
59
Restrictive lung disease, hilar lymphadenopathy, erythema nodosum, Bells palsy, uveoparotitis, hypercalcemia, elevated ACE levels
Sarcoidosis
60
Treatment for sarcoid
Steroids
61
Lab findings and treatment for polymyalgia rheumatica
Elevated ESR with normal CK. Treat with prednisone
62
What disorder besides SLE includes a malar rash
Dermatomyositis
63
Findings in dermato and polymyositis
High CK, high Aldolase, positive ANA and positive anti-jo-1
64
Finger ulceration and telangiectasias in a woman
CREST syndrome
65
What causes the esophageal dysmotility of CREST syndrome?
Fibrous replacement of the muscularis
66
Antibodies in diffuse scleroderma and CREST syndrome respectively
Diffuse scleroderma - SCL-70 antibody (which is anti-DNA topoisomerase 1). CREST - anti-centromere antibody
67
CREST syndrome
Calcinosis (and anti-centromere), Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia
68
Which has a worse prognosis, diffuse scleroderma or CREST?
Diffuse scleroderma
69
Histologic appearance of warts
Epidermal hyperplasia, hyperkeratosis, koilocytosis
70
Nevocellular nevus
Common mole. Benign
71
Eczema location, triggers, and histology
Skin flexures. May be triggered by foods or other environmental factors. Will see spongiosis on microscopy
72
Psoriasis location, and histology
Knees and elbows. Acanthosis with parakeratotic scaling (nuclei in cornuem). Increased spinosum, decreased granulosum, occasional neutrophils
73
Vitiligo
Irregular areas of complete depigmentation. Caused by a decrease in melanocytes
74
Infectious organisms of impetigo and potential results of the infection
S aureus or strep pyogenous. May result in rheumatic fever or post-strep GN
75
What does PABA sunscreen block?
UVB (but not UVA)
76
Pemphigus vulgaris
IgG against desmosomes (3 and 1). Positive Nikolskys sign
77
Bullous pemphigoid
IgG against hemidesmosomes (epidermal basement membrane). Negative Nikolskys sign. Does not affect oral mucosa (unlike pemphigus vulgaris)
78
Histology of actinic keratoses
Hyperkeratosis, parakeratosis, basal cell layer atypia. Risk of carcinoma is proportional level of dysplasia
79
Mutation in melanoma
BRAF mutation in 40 to 60 percent
80
What do prostaglandins and prostacyclins respectively do to uterine tone?
Prostaglandins increase uterine tone, prostacyclin decreases uterine tone
81
What is the only LOX related drug approved for asthma in young kids?
Montelukast
82
How big is COX-2 and when is it detectable?
72 KD. Only expressed during inflammation (COX-1 is constitutively expressed)
83
List the NSAIDs (4)
Ibuprofen, naproxen, indomethacin, ketorolac
84
Toxicities of NSAIDs
Renal damage, fluid retention, aplastic anemia, GI distress, ulcers
85
What effect does celecoxib have on platelet aggregation?
None. It is anti-inflammatory without impairing platelet function
86
What drug is used to prevent recurrence of colonic adenocarcinoma?
COX-2 inhibitors (may decrease adenomtaous polyp formation)
87
Acetominophen
Reversibly inhibits COX (mostly in CNS). Not anti-inflammatory. Use to avoid Reyes syndrome. N-acetylcysteine is antidote
88
List the bisphosphonates (5)
Etidronate, pamidronate, alendronate, risedronate, zoledronate (IV)
89
Mechanism of bisphosphonates
Inhibit osteoclastic activity
90
Uses and toxicities of bisphosphonates
Malignancy-associated hypercalcemia, Pagets disease, postmenopausal osteoporosis. Corrosive esophagitis, nausea, diarrhea, osteonecrosis of jaw
91
Mechanism of Probenacid, Allopurinol, Febuxostat
Probenecid - inhibits reabsorption of uric acid in PCT. Allopurinol and febuxostat inhibit xanthine oxidase
92
What should you not give with allopurinol?
Salicylates (all but highest doses depress uric acid clearance)
93
Mechanism of colchicine
Stabilizes tubulin, impairing leukocyte chemotaxis and degranulation
94
Etanercept
TNF-a inhibitor. Use in RA, psoriasis, AS
95
Infliximab
Anti-TNF antibody. Use in Crohns, RA, AS
96
Adalimumab
Anti-TNF antibody. Use in RA, psoriasis, AS
97
Complication of TNF-a inhibitor therapy
Infection, especially reactivation of TB
98
What structure may be damaged in a femoral neck injury
Medial circumflex artery
99
What type of antibody is Rh factor?
IgM against IgG
100
In which condition do you get fixing of the joint, RA or OA?
RA
101
Why does alcohol make gout worse?
Metabolic acidosis. Uric acid has to compete with lactic acid and keto-acids created by alcohol for excretion
102
Why are patients with AS often hunched over?
Because they have restrictive lung disease due to limitation of movement
103
Dowagers hump
Osteoporosis
104
Difference between osteomalacia and osteporosis (besides just degree)
Osteoporosis affects both mineral and organic component, osteomalacia is decreased mineral with normal organic component
105
Most common benign bone tumor
Osteochondroma (exostosis)
106
Most common cause of HCC in children
Alpha-1-antitrypsin deficiency
107
What is going on in the thymus in MG
Germinal follicles (which is abnormal since B cells shouldnt be in thymus). Removing thymus helps MG. 10-15 percent will develop a thymoma, but B-cell hyperplasia is best answer for this
108
If you have CREST plus kidney involvement, what is the diagnosis?
Progressive systemic sclerosis. CREST cannot involve the kidneys
109
Racoon eyes, elevated serum CK, rash over PIP
Dermatomyositis. High association with cancer
110
Type of hypersensitivity in atopic dermatitis
Type 1
111
Cause of seborrheic dermatitis (dandruff)
Malassezia furfur
112
Most common cause of tinea capitis
Trichopyton tonsurans
113
All superficial dermatophyte infections besides tinea capitis are due to what?
Trychophyton rubra
114
Rash on butt, oblong with red outside and pale in middle. Negative KOH prep
Pityriasis rosea. Non infectious. 3 days later it will return with rash in christmas tree distribion
115
Which type of malignant melanoma can african american patients get?
Acrolentiginous (most aggressive, not related to radiation)
116
Malignant melanoma on the face of an older patient
Lentigo maligna melanoma
117
Most important prognostic factor in melanoma
Depth of invasion (will not metastasize if less than .76 mm)
118
Contractures developing over a period of hours
Black widow bite (look for history of being in a basement or area which might have spiders)
119
What type of toxins do the black widow and brown reculse respectively have
Black widow - neurotoxin, brown reculse - necrotoxin

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