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Step 1 > Musculoskeletal > Flashcards

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
Q

Histology of osteoporosis

A

Trabecular thinning with fewer interconnections

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26
Q

Histology of osteopetrosis

A

Spongiosa filling medullary canals with no mature trabeculae

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27
Q

Which type of osteoporosis is post menopausal?

A

Type 1

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28
Q

Histology of osteomalacia/rickets

A

Osteoid matrix accumulation around trabeculae

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29
Q

Bony prominance at costochondral junctions with bowed legs

A

Rickets (prominences are called rosary chest)

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30
Q

Histology of Pagets disease of bone

A

Lamellar bone structure resembling a mosaic

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31
Q

Complications of Pagets disease of bone

A

Hearing loss (auditory foramen narrowing), increased hat size

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32
Q

Genetic deficiency and labs in osteopetrosis

A

Deficiency of carbonic anhydrase 2. Calcium, phosphate, and alk phos are normal. Anemia, thrombocytopenia, infection, extramedullary hematopoiesis

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33
Q

Lab values in Pagets disease of bone

A

Normal except Alk Phos, which is high

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34
Q

Appearance of osteitis fibrosa cystica

A

Brown tumors

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35
Q

Marker for Pagets disease of bone

A

High Alk Phos with (sometimes) TRAP positivity

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36
Q

McCune-Albright

A

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

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37
Q

Age, location, and predisposing factors in osteosarcoma

A

Males ages 10-20. Metaphysis of long bones (femur, proximal tibia). Associated with Pagets, bone infarcts, radiation, and familial Rb

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38
Q

What causes Codmans triangle (sunburst pattern) in osteosarcoma?

A

Elevation of periosteum

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39
Q

Translocation in Ewings sarcoma

A

11,22

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40
Q

Onion skin appearance in bone

A

Ewings sarcoma

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41
Q

Bone tumors by location and malignant status

A

Epiphysis - Giant cell tumor (benign). Metaphysis - Osteochondroma (benign) and Osteosarcoma (malignant). Diaphysis - Chondrosarcoma (malignant), and Ewings sarcoma (malignant)

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42
Q

Where are Heberdens nodes and Bouchards nodes and what disease are they associated with?

A

OA. Heberden - DIP, Bouchard (PIP)

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43
Q

RA treatment

A

NSAIDs, COX-2 inhibitors, glucocorticoids (short term), DMARDS (MTX, Sulfasalazine, hydroxychloroquine, TNF-a inhibitors)

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44
Q

Autoantibodies in Sjogrens

A

SS-A and SS-B

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45
Q

Birefringence of gout and pseudogout

A

Gout - negative, Pseudogout - weakly positive

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46
Q

Precipitants of gout

A

Lesch-Nyhan, PRPP excess, decreased excretion (eg thiazides), increased cell turnover, von-Gierkes disease

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47
Q

Give the color of crystals in gout and pseudogout

A

Gout - yellow when parallel, blue when perpendicular. Pseudogout - yellow when perpendicular, blue when parallel

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48
Q

Crystals in pseudogout

A

Calcium pyrophosphate

49
Q

Causes of infectious arthritis

A

Septic - s aureus, streptococcus, n gonorrhoeae. Chronic - TB, lyme

50
Q

Causes of osteonecrosis (avascular necrosis)

A

Trauma, high dose corticosteroids, alcoholism, sickle cell

51
Q

Seronegative spondyloarthropathies

A

Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease associated spondylitis, Reactive (Reiters) arthritis

52
Q

Where is inflammation common in akylosing spondylitis and what is the consequence of this?

A

Sites of tendon insertion. May lead to reduce chest expansion and hyperventilation

53
Q

Presentation of Reiters syndrome

A

Conjunctivitis with anterior uveitis, urethritis, arthritis and sacroilitis. Cant see cant pee cant climb a tree

54
Q

SLE is associated with antiphospholipid antibodies. What is the clinical consequence of these?

A

Venous and arterial thromboemboli. Also recurrent miscarriages (which is how SLE may present)

55
Q

Common antibodies in SLE

A

Anti-dsDNA, anti-smith, antiphospholipid

56
Q

What is the accuracy of ANA in SLE?

A

Sensitive but not specific

57
Q

Which antibody in SLE is most prognostic?

A

Anti-double stranded DNA. Indicates poor prognosis (anti-smith is specific but not prognostic)

58
Q

Antibodies associated with drug induced lupus

A

Antihistone antibodies

59
Q

Restrictive lung disease, hilar lymphadenopathy, erythema nodosum, Bells palsy, uveoparotitis, hypercalcemia, elevated ACE levels

A

Sarcoidosis

60
Q

Treatment for sarcoid

A

Steroids

61
Q

Lab findings and treatment for polymyalgia rheumatica

A

Elevated ESR with normal CK. Treat with prednisone

62
Q

What disorder besides SLE includes a malar rash

A

Dermatomyositis

63
Q

Findings in dermato and polymyositis

A

High CK, high Aldolase, positive ANA and positive anti-jo-1

64
Q

Finger ulceration and telangiectasias in a woman

A

CREST syndrome

65
Q

What causes the esophageal dysmotility of CREST syndrome?

A

Fibrous replacement of the muscularis

66
Q

Antibodies in diffuse scleroderma and CREST syndrome respectively

A

Diffuse scleroderma - SCL-70 antibody (which is anti-DNA topoisomerase 1). CREST - anti-centromere antibody

67
Q

CREST syndrome

A

Calcinosis (and anti-centromere), Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia

68
Q

Which has a worse prognosis, diffuse scleroderma or CREST?

A

Diffuse scleroderma

69
Q

Histologic appearance of warts

A

Epidermal hyperplasia, hyperkeratosis, koilocytosis

70
Q

Nevocellular nevus

A

Common mole. Benign

71
Q

Eczema location, triggers, and histology

A

Skin flexures. May be triggered by foods or other environmental factors. Will see spongiosis on microscopy

72
Q

Psoriasis location, and histology

A

Knees and elbows. Acanthosis with parakeratotic scaling (nuclei in cornuem). Increased spinosum, decreased granulosum, occasional neutrophils

73
Q

Vitiligo

A

Irregular areas of complete depigmentation. Caused by a decrease in melanocytes

74
Q

Infectious organisms of impetigo and potential results of the infection

A

S aureus or strep pyogenous. May result in rheumatic fever or post-strep GN

75
Q

What does PABA sunscreen block?

A

UVB (but not UVA)

76
Q

Pemphigus vulgaris

A

IgG against desmosomes (3 and 1). Positive Nikolskys sign

77
Q

Bullous pemphigoid

A

IgG against hemidesmosomes (epidermal basement membrane). Negative Nikolskys sign. Does not affect oral mucosa (unlike pemphigus vulgaris)

78
Q

Histology of actinic keratoses

A

Hyperkeratosis, parakeratosis, basal cell layer atypia. Risk of carcinoma is proportional level of dysplasia

79
Q

Mutation in melanoma

A

BRAF mutation in 40 to 60 percent

80
Q

What do prostaglandins and prostacyclins respectively do to uterine tone?

A

Prostaglandins increase uterine tone, prostacyclin decreases uterine tone

81
Q

What is the only LOX related drug approved for asthma in young kids?

A

Montelukast

82
Q

How big is COX-2 and when is it detectable?

A

72 KD. Only expressed during inflammation (COX-1 is constitutively expressed)

83
Q

List the NSAIDs (4)

A

Ibuprofen, naproxen, indomethacin, ketorolac

84
Q

Toxicities of NSAIDs

A

Renal damage, fluid retention, aplastic anemia, GI distress, ulcers

85
Q

What effect does celecoxib have on platelet aggregation?

A

None. It is anti-inflammatory without impairing platelet function

86
Q

What drug is used to prevent recurrence of colonic adenocarcinoma?

A

COX-2 inhibitors (may decrease adenomtaous polyp formation)

87
Q

Acetominophen

A

Reversibly inhibits COX (mostly in CNS). Not anti-inflammatory. Use to avoid Reyes syndrome. N-acetylcysteine is antidote

88
Q

List the bisphosphonates (5)

A

Etidronate, pamidronate, alendronate, risedronate, zoledronate (IV)

89
Q

Mechanism of bisphosphonates

A

Inhibit osteoclastic activity

90
Q

Uses and toxicities of bisphosphonates

A

Malignancy-associated hypercalcemia, Pagets disease, postmenopausal osteoporosis. Corrosive esophagitis, nausea, diarrhea, osteonecrosis of jaw

91
Q

Mechanism of Probenacid, Allopurinol, Febuxostat

A

Probenecid - inhibits reabsorption of uric acid in PCT. Allopurinol and febuxostat inhibit xanthine oxidase

92
Q

What should you not give with allopurinol?

A

Salicylates (all but highest doses depress uric acid clearance)

93
Q

Mechanism of colchicine

A

Stabilizes tubulin, impairing leukocyte chemotaxis and degranulation

94
Q

Etanercept

A

TNF-a inhibitor. Use in RA, psoriasis, AS

95
Q

Infliximab

A

Anti-TNF antibody. Use in Crohns, RA, AS

96
Q

Adalimumab

A

Anti-TNF antibody. Use in RA, psoriasis, AS

97
Q

Complication of TNF-a inhibitor therapy

A

Infection, especially reactivation of TB

98
Q

What structure may be damaged in a femoral neck injury

A

Medial circumflex artery

99
Q

What type of antibody is Rh factor?

A

IgM against IgG

100
Q

In which condition do you get fixing of the joint, RA or OA?

A

RA

101
Q

Why does alcohol make gout worse?

A

Metabolic acidosis. Uric acid has to compete with lactic acid and keto-acids created by alcohol for excretion

102
Q

Why are patients with AS often hunched over?

A

Because they have restrictive lung disease due to limitation of movement

103
Q

Dowagers hump

A

Osteoporosis

104
Q

Difference between osteomalacia and osteporosis (besides just degree)

A

Osteoporosis affects both mineral and organic component, osteomalacia is decreased mineral with normal organic component

105
Q

Most common benign bone tumor

A

Osteochondroma (exostosis)

106
Q

Most common cause of HCC in children

A

Alpha-1-antitrypsin deficiency

107
Q

What is going on in the thymus in MG

A

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
Q

If you have CREST plus kidney involvement, what is the diagnosis?

A

Progressive systemic sclerosis. CREST cannot involve the kidneys

109
Q

Racoon eyes, elevated serum CK, rash over PIP

A

Dermatomyositis. High association with cancer

110
Q

Type of hypersensitivity in atopic dermatitis

A

Type 1

111
Q

Cause of seborrheic dermatitis (dandruff)

A

Malassezia furfur

112
Q

Most common cause of tinea capitis

A

Trichopyton tonsurans

113
Q

All superficial dermatophyte infections besides tinea capitis are due to what?

A

Trychophyton rubra

114
Q

Rash on butt, oblong with red outside and pale in middle. Negative KOH prep

A

Pityriasis rosea. Non infectious. 3 days later it will return with rash in christmas tree distribion

115
Q

Which type of malignant melanoma can african american patients get?

A

Acrolentiginous (most aggressive, not related to radiation)

116
Q

Malignant melanoma on the face of an older patient

A

Lentigo maligna melanoma

117
Q

Most important prognostic factor in melanoma

A

Depth of invasion (will not metastasize if less than .76 mm)

118
Q

Contractures developing over a period of hours

A

Black widow bite (look for history of being in a basement or area which might have spiders)

119
Q

What type of toxins do the black widow and brown reculse respectively have

A

Black widow - neurotoxin, brown reculse - necrotoxin

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