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USMLE STEP 1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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USMLE® Step 1 flashcards
1
Q

What does genitofemoral nerve innervate?

A

Sensory: scrotum/labia majora
Motor: cremaster

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2
Q

This provides sensory innervation to anterior and lateral thigh

A

Lateral femoral cutaneous (L2-L3)

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3
Q

Genitofemoral nerve arises from what roots?

A

L1-L2

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4
Q

This provides sensation to the medial thigh and motor input to obdurate externus, adductor longs, adductor breves, gracious, pettiness, and adductor magnus

A

Obturator nerve (L2-L4)

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5
Q

This nerve provides sensory input to the anterior thigh and medial leg; motor innervation for quadriceps, iliacus, pectineus, sartorius

A

Femoral nerve (L2-L4)

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6
Q

The sciatic nerve (L4-S3) innervates which muscles?

A

hamstrings (semitendinosus, semimembranosus, long and short head of bicep femoris) and adductor magnus

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7
Q

The sciatic nerve continues down the posterior aspect of the thigh and splits into which 2 nerves?

A

Tibial nerves medially and common peroneal nerves laterally

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8
Q

Common (fibular) peroneal nerve arises from what roots?

A

L4-S2

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9
Q

Foot drop is caused by an injury to what nerve?

A

Common (fibular) peroneal nerve

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10
Q

A patient who is unable to stand on tiptoes most likely injured what nerve?

A

Tibial nerve (L4-S3)

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11
Q

What nerve roots does superior gluteal nerve arise?

A

(L4-S1)

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12
Q

What does superior gluteal nerve innervate?

A

gluteus medius, gluteus minimus, tensor fascia latae

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13
Q

A patient whose left hip tilts downward while walking has a lesion on what nerve?

A

Right superior gluteal nerve (Trendelenburg sign)

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14
Q

A patient with right superior gluteal nerve injury will likely show pelvis tilt to which hip while standing?

A

Right

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15
Q

What innervates gluteus Maximus?

A

inferior gluteal nerve (L5-S3)

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16
Q

A patient with difficulty climbing stairs and standing from a sitting position likely injured what nerve and muscle?

A

inferior gluteal nerve and gluteus maximus

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17
Q

This nerve provides sensation to the perineum and motor innervation to external urethral and anal sphincters

A

Pudendal (S2-S4)

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18
Q

What nerve root is affected when a patient presents with weakness of knee extension and decreased patellar reflex?

A

L4

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19
Q

Weakness of dorsiflexion and difficulty in heel walking is a clinical finding of which injured nerve root?

A

L5

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20
Q

Weakness of plantar flexion, difficulty tip-toeing and decreased achilles reflex signifies what nerve root injury?

A

S1

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21
Q

In the sarcomere, which bands shorten?

A

H and I band

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22
Q

Muscle spindle is activated by?

A

muscle stretch

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23
Q

What type of sensory axon is associated with muscle spindle?

A

Type Ia and II

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24
Q

Golgi tendon organ is stimulated by

A

increase in muscle force

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25
Q

What type of sensory axon is associated with Golgi tendon organ?

A

Type Ib

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26
Q

what type of ossification is defective in achondroplasia?

A

endochondral ossification

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27
Q

This is a RANKL decoy receptor that binds RANKL therefore preventing RANK-RANKL interaction causing decrease in osteoclast activity

A

Osteoprotegerin (OPG)

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28
Q

How does estrogen protect bone?

A

estrogen inhibits apoptosis of osteoblasts while promoting osteoclast apoptosis

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29
Q

What is the protein activated that gives rise to achondroplasia and what is its mode of inheritance?

A

Fibroblast Growth Factor Receptor 3 (FGFR3). Achondroplasia is autosomal dominant (AD)

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30
Q

This protein inhibits chondrocyte proliferation

A

Fibroblast Growth Factor 3 (FGFR3)

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31
Q

This is a condition wherein there is loss of trabecular (spongy) and cortical bone lose mass despite normal bone mineralization

A

Osteoporosis

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32
Q

What is used in the treatment of osteoporosis?

A

Bisphosnates
Teriparatide
SERMs
Denosumab (Monoclonal antibody against RANKL)

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33
Q

Entrapment of the median nerve in car tunnel causing paresthesia, pain, and numbness.

A

Carpal Tunnel Syndrome

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34
Q

What condition will bring about thenar eminence atrophy but spare sensation?

A

Carpal tunnel syndrome

35
Q

Compression of the ulnar nerve at wrist. Classically seen in cyclists

A

Guyon canal syndrome

36
Q

Clavicular fracture will result in what clinical manifestations?

A

Shoulder drop and shortened clavicle

37
Q

Where is the weakest point of the clavicle and where does clavicular fracture occur most?

A

Weakest part is the junction between the middle and lateral 3rd.
middle third is the most common site of fracture

38
Q

What is the most common cause of osteomyelitis?

In sexually actively?

In patients with sickle cell?

IV drug users?

A

S aureus

N gonorrhea

Salmonella

Pseudomonas

39
Q

Non inflammatory thickening of abductor pollicis longus and extensor pollicis brevis causing pain and tenderness at radial sryloid

A

De Quervain tenosynovitis

40
Q

This is a common cause of shin pain and diffuse tenderness in runners caused by bone resorption that outpaces bone formation

A

Medial tibial stress syndrome (shin splints)

41
Q

This is an idiopathic avascular necrosis of femoral head causing insidious onset of hip pain

A

Legg-Calve-Perthes disease

42
Q

What is the mode of inheritance of achondroplasia?

A

AD with full penetrance

43
Q

Failure of normal none resorption d/t defective osteoclasts causing thickened, dense bones that are prone to fracture

A

osteopetrosis

44
Q

What is the mutation associated with osteopetrosis?

A

mutations that impair the ability of osteoclasts to generate acidic environment that is necessary for resorption (ie. Carbonic Anhydrase II)

45
Q

Defective mineralization of osteoid or cartilaginous growth plates most commonly d/t vit D deficiency

A

Osteomalacia/Rickets

46
Q

This is a disorder of bone remodeling caused by increased osteoclastic activity followed by increased osteoblastic activity causing formation of poor-quality bone

A

Osteitis deformans (Paget disease)

47
Q

Hyperactivity of osteoblasts will show an increase in what lab value?

A

ALP

48
Q

The lab values in Paget disease is expected to be:

A

normal Ca, PO4, and PTH

49
Q

What pattern would you see in an X-ray of Paget disease?

A

mosaic pattern

50
Q

Patients with osteitis deforming (Paget disease) will have an increased risk for formation of what malignancy?

A

osteosarcoma

51
Q

What is the most common cause of death in patients with osteitis deforming (Paget disease)?

A

High output heart failure

52
Q

What causes hearing loss in osteitis deforming (Paget disease)

A

narrowing of the auditory canal

53
Q

Causes of avascular necrosis of bone

A

Corticosteroids, fx, sickle cell, Gaucher disease

54
Q

Most common benign tumor of the bone that arises in metaphysis of long bones

A

Osteochondroma

55
Q

Primary bone tumor that arises in the surface of facial bones and associated with Gardner syndrome

A

Osteoma

56
Q

How can you differentiate osteoid osteoma from osteoblastoma?

A

osteoid osteoma < 2cm, responds to NSAIDS

osteblastoma >2 cm, does not respond to NSAIDS

57
Q

This is the only bone tumor that arises in the epiphysis of long bones

A

Giant cell tumor

58
Q

This is a malignant tumor of chondrocytes that are common in the medulla of the pelvis, proximal femur, and humerus

A

Chondrosarcoma

59
Q

This is a bone malignancy where there is anapestic small blue cells of neuroectodermal origin and resemble lymphocytes

A

Ewing sarcoma

60
Q

How can you differentiate Ewing sarcoma from lymphoma and osteomyelitis?

A

testing for t(11;22) fusion protein causing onion skin periosteal reaction of bone

61
Q

What does rheumatoid factor in rheumatoid arthritis attack?

A

Rheumatoid factor - IgM antibody, targets Fc Region of IgG

62
Q

How does OA presentation differ from RA

A

OA - asymmetric pain on weight bearing joints that improve with rest

RA - pain, swelling, early morning stiffness, improved with use

63
Q

Joint findings in OA and RA

A

OA - osteocytes deposit at PIP (Bouchard) and DIP (Heberden)

RA - Pannus formation leads to Swan neck and Boutonnière deformity

64
Q

Rheumatoid nodules (fibrinoid necrosis with palisading histiocytes) in sub Q and lung (pneumoconiosis)

A

Caplan syndrome

65
Q

What condition can cause deposition of iron salts within the synovium that resembles OA?

A

Hemochromatosis

66
Q

Needle shaped crystals that are (-) birefringent under polarized light that turns yellow

A

Gout

67
Q

calcium pyrophosphate deposition disease (pseudo gout) is associated with what conditions?

A

hemochromatosis, hyperparathyroidism, joint trauma

68
Q

Calcium pyrophosphate deposition disease while show what kind of crystals?

A

rhomboid (+) birefringent that turns blue under polarized light

69
Q

What antibodies are positive in Sjogren syndrome?

A

RF, SS-A, SS-B

70
Q

This is referred to as arthritis without rheumatoid factor (no anti-IgG antibody) and is associated with HLA B-27

A

Seronegative spodyloarthritis

71
Q

What are the different types of seronegative spondyloarthritis?

A

Psoriatic arthritis
Ankylosing spondylitis
IBD
Reactive arthritis

72
Q

Sausage fingers associate with skin psoriasis and nail lesions

A

Psoriatic arthritis

73
Q

Symmetric involvement/fusion of the spine and sacroiliac joins causing spondylitis, uveitis, aortitis (regurg). Clasically presents with bamboo spine in X-ray and may cause restrictive lung disease

A

ankylosing spondylitis

74
Q

What is the triad seen in reactive arthritis?

A

Conjunctivitis, Urethritis, Arthritis

Can’t see, can’t pee, can’t bend my knee

75
Q

What are some bacterial causes of reactive arthritis?

A

Shigella, Yersinia, Chlamydia, Campylobacter, Salmonellla

76
Q

What type of hypersensitivity is seen in SLE?

A

Type III hypersensitivity

77
Q

An anti-SSA (+) pregnant woman has an increased risk for delivering a neonate with what cardiac problem?

A

congenital heart block

78
Q

What are the nonspecific and specific markers for polymyositis and dermatomyositis?

A

Nonspecific: CK, ANA

Specific:
Anti-Jo-1 (histidyl-tRNA synthetase)
Anti-SRP (signal recognition particle)
Anti-Mi-2 (helicase)

79
Q

Progressive symmetrical proximal muscle weakness, characterized by ENDOMYSIAL inflammation with CD8 T cells often involving the shoulders

A

Polymyositis

80
Q

This is similar to polymyositis but also involves Grotton papules, PERIMYSIAL inflammation in shawl and face distribution, increased risk for occult malignancy, and involvement of CD4 T cells

A

dermatomyositis

81
Q

This is a degenerative d/o characterized by muscle wasting resulting from replacement of skeletal muscle by adipose tissue

A

X-Linked Muscular Dystrophy (Duchenne Muscular Dystrophy)

82
Q

Duchenne Muscular Dystrophy is d/t deletion of what gene?

A

Dystrophin (largest gene in human genome and anchors muscle cytoskeleton to the ECM)

83
Q

Differentiate pathophysiology of Myasthenia Gravis from Lambert-Eaton Myasthenic Syndrome

A

Autoantibodies compete with ACh in postsynaptic ACh receptors in MG.

Lambert-Eaton has autoantibodies to presynaptic Ca channels –> decreased ACh release

USMLE STEP 1 (4 decks)

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