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Step 1 > PP Musculoskeletal, Skin, and Connective Tissue > Flashcards

PP Musculoskeletal, Skin, and Connective Tissue Flashcards

1
Q

What is Hairy leukoplakia?

A

White painless plaque on the tongue that can’t be scraped off
EBV mediated
Occurs in HIV + pt

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2
Q

what aere 1st degree burns?

A

red (epidermnis)

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3
Q

what are 2nd degree burns?

A

blisters (hipodermis)

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4
Q

what are 3rd degree burns?

A

painless nueropathy (dermis)

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5
Q

what diseases have palms and sole rashes?

A

“TRiCKSSS”

  • Toxic Shock Syndrome
  • Rocky mountain spotted fever
  • Coxsackie A: Hand-Foot-Mouth disease
  • Kawasaki
  • Scarlet fever
  • Stahp Scaled Skin}- Syphilis
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6
Q

what is Erythema Multiforme?

A

target lesions (viral, drugs)

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7
Q

what is Stevens Johnson síndrome?

A

Erythema Multiforme Mjor (mouth, eye, avgina)

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8
Q

what is toxic epidermal necrolysis?

A

Steven Jonson w/skin sloughing

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9
Q

what is Pemphigus Vulgaris?

A

Ab against desmosomes => circular immunofluoresence, in epidermis, oral lesions, + Nikolsky sign

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10
Q

what is Bullous Pemphigoid?

A

Ab against hemidesmososmes => linear immunofluoresence, subepidermal, “floating” keratinocytes, eosinophils, (-) Nikolsky sing

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11
Q

what is Atopic dermatitis (Eczema)?

A

dry flaky dermatitis in skin flexures “itch tha rashes”

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12
Q

what is Nummular dermatitis?

A

circular eczemz

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13
Q

what is Spongiotic eczema?

A

weeping eczema: scratching causes oozing “like a sponge”

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14
Q

what is Lichenification?

A

scratching => thick leathery skin

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15
Q

what is Pityriasis Rosea?

A

“herald patch” fallow days later by “Christmas tree” distribution
Self-resolving in 6-8weeks

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16
Q

what is Lichen Planus?

A

pruritic, purple, polygonal planar papules and plaques
Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
A/w hepatitis C

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17
Q

what is Scabies?

A

linear excoriation “burrows” in webs of fingers, toes, belt line (Sarcoptes faces)

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18
Q

what does UV-A causes?

A

aging

Dominant in tanning and photoaging

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19
Q

what does UV-B causes?

A

Sunburns

Can lead to impetigo and skin cancer

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20
Q

what ar teh ABCDE’s that indicate worse prognosis of sking cáncer?

A
  • asimetric
  • irregular borders
  • color differences
  • > 6mm diameter
  • evolution over time
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21
Q

what does the Clark level tell you?

A

invasión of melanoma

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22
Q

what does Breslow´s classification tell you?

A

depth of melanoma

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23
Q

where are Malignant Melanomas usually found?

A

Males: back
Females: leg

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24
Q

what is the precursor of a Malignant Melanoma?

A

hutchison´s greckle

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25
Q

what are the types of Malignant Melanomas?

A
  • Superficial spreading: most common, flat Brown
  • Nodural: worst prognosis, black, dome-shape
  • Lentigo malignant melanoma: elderly pts, fair-skin
  • Acrolentigous: AIDS pts, dark skin
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26
Q

where are Squamous Cell carcinomas usually found?

A

Face, lower lip, ear and hands.
Locally invasive
Rarely metastasize
Histology: keratin pearls

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27
Q

what is the precursor of Squamous Cell carcinoma?

A

Actinic keratosis (red scaly plaque)

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28
Q

what are the types of Squamous Cell carcinoma?

A

Bowen´s disease: SCC in situ on uncircumcised penis dorsum

Verrucous carcinoma: wart on foot

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29
Q

where are Basal Cell carcinomas usually found?

A

In sun exposed areas of the body
Locally invasive
Almost never metastasize
Pink, pearly nodules

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30
Q

what are the type of Basal Cell carcinoma?

A

Nodula: waxy nodule w/ central necrosis
Superficial: red scaly plaques, like eczema
Pigmented: looks like melanoma
Sclerosing: yellow waxy palques

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31
Q

what is Acne Rosaces?

A

blush all the time

worse w/stress / alcohol

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32
Q

what is a Brown Recluse Spider Bite?

A

painful black necrotic lesion

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33
Q

what is cellulitis

A

Acute, painful, spreading infection of dermis and subcutaneous tissue
Usually from: * S. pyogenes, * S. aureus

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34
Q

what is Cutaneous Anthrax?

A

painless black necrotoc lession

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35
Q

what is Decubitus Ulce?

A

bedsore

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36
Q

what is a DVT?

A

blood clot in veins

associated w/ hypercoagiulable state

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37
Q

what is Erysipelas?

A

shiny red
usually on face
associated w/ Step pyogenes

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38
Q

what is Miliaria?

A

“Heat rash”: burning, itching papules on trunk

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39
Q

what is Molluscum Contagiosum?

A 
Umbilicated, flesh-color papules w/ central dimple
pox virus (STD) parvovirus

*pathology: eosinophilia cytoplasmic inclusions bodies

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40
Q

what is Psoriasis?

A

Papule and plaques with silver scale on knees and elbows
Increase stratum spinosum and decrease stratum granulosum
- Auspitz sing: remove scale => pinpoint bleeding
A/w nail pitting and psoriatic arthritis

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41
Q

What is a Pyogenic Granuloma?

A

vascular nodule at site of previous injury

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42
Q

what is Seborrheic Dermatitis?

A

Greasy areas, dandruff in eyebrowns, nose, behind ears

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43
Q

what is Seborrheic Keratosis?

A

Flat, greasy, pigmented squamous epithelial priliferation with keratin-filled cyst ( horn cyst)
Looks “stuck on”
Common bening neoplasm in older person (GI)
Leser-Trelat sing-> sudden appearance of multiple seborrheic keratoses, indicate an underlying malignancy

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44
Q

what is Trombophebitis?

A

veins inflamation w/ thrombus

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45
Q

what is Vitíligo?

A

White patches

Cause by a decrease of Melanocytes

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46
Q

what is Xeroderma Pigmentosa?

A

bad DNA repair

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47
Q

what is Erythemna Chronicum Migrans?

A

Lyme disease (solitary lesión that spreads)

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48
Q

what is Erythema Infectiosum?

A

fifth disease “slapped cheeks” do to Parvovirus B19

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49
Q

what is Erythema Marginatum?

A

reumatic fever (red margins)

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50
Q

what is Erythema Multiforme?

A 
Iris-like target lesión do to:
HSV
Phenytoin
Barbs
Sulfas
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51
Q

what is Erythema Multiforme Mjor?

A

Steven Johnson síndrome ( >1 mucosal surface)

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52
Q

what is Erythema Nodosum? What diseases are a/w?

A

Subcutaneous fat inflammation ( painfull red nodules on anterior shins)
A/w sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep infection, IBD, Behcet disease

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53
Q

what is Erythema Toxicum?

A

Newborn beninh rash ( looks like flea bites w/ eosinophils)

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54
Q

where is CK-MM found?

A

muscle

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55
Q

where is CK-BB found?

A

brain

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56
Q

how does a neurogenic mucle disease presents?

A

distal weakness + fasciculations

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57
Q

how does a myophatic muscle diseae presents?

A

proximal weakness + pain

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58
Q

what is Duchenne´s MD?

A

dystrophin framershift
Gower sing
Clsf pseudohypertrophy

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59
Q

what is Becker´s MD?

A

Dystriphin missense

sx > 5 y/o

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60
Q

what is Myotonic Dystrophy?

A

Bird´s beak face

cant let go when shake hands

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61
Q

what is Myasthenic syndrome = Lambert-Eaton?

A

gets stronger as day goes by
stronger w / EMG
not small cell CA

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62
Q

what is Myasthenia gravis?

A

gets weak as the day goes by
stronger w/ Edrophonium}weaker w / EMG
rule out Thymoma

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63
Q

what is multiple sclerosis?

A

Anti-myelin Ab
Young woman w /visión problems
xs comes and go

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64
Q

what is Metachromatic Leukodystrophy?

A

Arylsulfatase deficiency

kids with MS presentation

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65
Q

what is Ataxia Telangectacia?

A

spider veins

IgA deficiency

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66
Q

what is Friedreich ataxia?

A

rinitis pigmentosa

scoliosis

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67
Q

what is Adrenal Leukodystrophy?

A

carnitine shuttle problema

adrenal failure

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68
Q

what is Guillain-Barre?

A

Ascending paralysis

2 weaks after URI

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69
Q

what is ALS?

A

middle age male w/ fasciculations, descending paralysis,

no sensory problems

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70
Q

what is Werdnig-Hoffman?

A

fasciculations in a newborn

no anterior horn

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71
Q

what is Polio?

A

asymetric dasciculation in child

2 wks after gastroenteritis

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72
Q

what is Choreoathetosis?

A

dance-like movements
wringing of hands
quivering voice

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73
Q

what is Atonic cerebral plasy?

A

no muscle tone

floppy

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74
Q

what is Slipped Capital Femoral Epiphysis?

A

obese boys w/ dull achy pain

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75
Q

what is Legg-Calves-Perthes?

A

limp ( femur head avascular necrosis)

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76
Q

what is Osgood-Schlatter?

A

A traction apophysitis of the tibial tubercle

  • growing pains
  • knee pain ( tibial tubercle avascular necrosis) common in adolescent
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77
Q

what is Septic Arthritis?

A

joint pain (staph aereus)

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78
Q

what is Ankylosing Spondylitis?

A

ligament ossification => vertebral body fusión, decrease lumbar curve, stiffer in morning, kyphosis, uveítis, HLAB-27

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79
Q

what is Cauda Equina Syndrome?

A

“Saddle anesthesia”: can¨t feel butt, thighs, perineum

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80
Q

where does bone cáncer metástasis occur from?

A

breast
prostate
lung
kidney

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81
Q

what is Costochondritis?

A

Painful s2welling of chest joint-bone attachments

worse w/ deep breath

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82
Q

what is Disk Herniation?

A

Straight leg raise => shooting pain

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83
Q

what is Lumbar Stenosis?

A

MRI “bourglass”

low back pain

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84
Q

what is Ochronosis = Alkaptonuria?

A

kids with OA
black urine
homogentisic acid oxidase deficiency

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85
Q

what is Osteítis Fisbrosis cística?

A

inflammation of bone w/ holes

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86
Q

what is Osteogenesis Imperfecta?

A

blue sclera

multiple broken bone

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87
Q

what is Osteomalacia/ Rickets?

A 
soft bones (waddling gait)
craniotabes ( soft skull)
Rachitic rosary ( costochondral thickening)
Harrison´s Groove
Pigeon breast ( sternum protrusión)
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88
Q

what is Osteomyelitis?

A

infected bones

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89
Q

what is Osteonecerosis= Legg-Calve-Perthes?

A

Wedge-shape necrosis of femur head

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90
Q

what is Osteopetrosis?

A

decrease osteoclas activity => marble bones (obliterate own bone marrow)

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91
Q

what is Osteoporosis?

A

loss of bone matrix ( not calcification) => compression fractures

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92
Q

what is Osteosclerosis?

A

thick bones

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93
Q

what is Paget´s Disease?

A 
"My hat dosen´t fi"
paramyxovirus
increase osteoclast/blast
fluffy bone 
osteosarcoma
increase CO
heart failure
deafness
increase alkaline phosphatase alone
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94
Q

what is Rheumatoid Factor?

A

An IgM against IgG Fc

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95
Q

what are Tophi?

A

Gout crystals

+ Giant cells

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96
Q

what is Podagra?

A

Big toe inflammation

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97
Q

what ie CREST síndrome?

A 
Calcinosis
Raynaud´s 
esophageal dysmotility
Sclerodactyly
telangiectasia
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98
Q

what Ab is associated with CREST

A

Anti-centromere Ab

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99
Q

What diseases have Raynaud’s syndrome?

A

Scleroderma
Takayasu’s
RA
SLE

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100
Q

Which vasculitis has a high platelet count?

A

Kawasaki disease

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101
Q

Which vasculitis has a normal platelet count?

A

Henoch-Scjonlein purpura

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102
Q

What is Osteoarthritis?

A

Pain worse w/ activity, relieved by rest
PIP/DIP joints

  • the joint is NOT tender & systemic symptoms are absent
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103
Q

What is Rheumatoid Arthritis?

A

Morning stiffness lasting more than 30min and improving with use
MCP / PIP joint

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104
Q

What is STill’s disease?

A

Juvenile RA

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105
Q

What is Pseudogout?

A

Deposition of Ca Pyrophosphate crystals

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106
Q

What is Gout?

A

Urea te crystals in big toe

- birefringence

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107
Q

What is Myositis?

A

muscle inflammation it hurts

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108
Q

What is Dermatomyositis?

A

Myositis + rash

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109
Q

What is Fibromyalgia?

A

Widespread musculoskeletal pain (11 points)
MC in woman
A/w depression

110
Q

What is Polymyalgia Rheumatica?

A

Weak shoulders

Temporar arteritis

111
Q

What is SLE=Lupus?

A

Meet 4 criteria: “DOPAMIN RASH”

  • Discioid rash
  • Oral ulcer
  • Photosensitivity
  • Arthritis
  • Malar rash
  • Immunologic disorder: Anti-ds DNA, Sm, Cardiolipin Ab
  • Neurologic disorder: seizures or psychosis
  • Renal failure: DIE OF THIS
  • ANA
  • Serositis: pleuritis/ pericarditis ( Libman- Sacks endocarditis )
  • Hemolytic anemia
112
Q

What is Scleroderma?

A

Tight skin

Fibrosis

113
Q

What is Takayasu’s arteritis?

A

Pulseless Asian women

Aorta inflammation

114
Q

What is Polyarteritis Nodosa?

A

p-ANCA Ab
Attacks gut/ kidney
Hep B

115
Q

What is Wegener’s Granulomatosis?

A

c-ANCA Ab
Attacks ENT
Lungs
Kidney

116
Q

What is Goodpasture’s?

A

Anti-GBM Ab
Attacks lung/ kidney
RPGN

117
Q

What is Reiter’s syndrome?

A

Males that can’t see, can’t pee or climb a tree

118
Q

What is Sjögren’s syndrome?

A

Female that have

  • dry eye
  • dry mouth
  • RA
119
Q

What is Behcets syndrome?

A

Oral and genital ulcer

Uveitis

120
Q

What is Churg-Strauss?

A

Asthma
Eosinophils
Multiple-organ involved

121
Q

What is Felty’s syndrome?

A

RA
Leukopenia
Splenomegaly

122
Q

What is Kawasaki’s disease?

A

“CRASH”

  • conjunctivitis
  • rash ( Palm/ sole)
  • aneurysm ( coronary artery) -> MI in kids
  • strawberry tongue
  • hot ( fever > 102 for at least 3 days + cervical lymphadenopathy)
123
Q

Which are the 3 type of skin cancer?

A 
BCC
SCC
Melanoma 
Most common: BCC > SCC > Melnoma
Risk of metastasize: Melanoma > SCC > BCC
124
Q

What is Dermatitis Herpetiforme?

A

Pruritic papules, vesicles and bullae
Deposits of IgA at the tip of dermal papillae
A/w celiac disease

125
Q

What is Acanthosis Nigrians?

A

Epidermal hyperplasia causing symmetrical hyperpigmented skin ( neck and axilla)
A/w hyperinsulinemia and visceral malignancy

126
Q

What is Actinic keratosis?

A

Premalingnat lesion caused by sun exposure
Precursor of SCC ( depend of degree of epithelial dysplasia)
Sand paper-like texture

127
Q

What is Impetigo?

A

Very superficial skin infection
Usually from: S. aureus or S. pyogenes
Contagious
Honey colored crusting

128
Q

What is Bullous impetigo?

A

Has bullae

Usually cause by S. aureus

129
Q

What is Necrotizing fasciitis?

A

Deeper tissue injury
From: anaerobic bacteria or S. pyogenes
Result in crepitus from methane and CO2 production
Causes bullae and a purple color to the skin

130
Q

What is Staphylococcal scaled skin syndrome (SSS)?

A

Exotoxin destroys keratinocytes attachments in the stratum granulosum only
Fever and erythematous rash with sloughing of upper layer of epidermis
Seen in newborn and children

131
Q

Which are the Rotator cuff muscles?

A

Supraspinatus (mc rotator cuff injury)
Infraespinatus ( pitching injury)
Teres minor
Subscapluris

132
Q

Unhappy triad/ knee injury?

A

MCL
ACL
Lateral meniscus

133
Q

Supraespinatus muscle?

A

Abduct arm initially

134
Q

Infraespinatus muscle?

A

Laterally rotates the arm

135
Q

Teres minor muscle?

A

Adducts and laterally rotates arm

136
Q

Subscapularis muscle?

A

Medially rotates and adducts arme

137
Q

Which are the wrist bone?

A

“Some Lovers Try Positions That They Can’t Handle”

  • scaphoid ( MC fracture carpal and is prone to vascular necrosis)
  • lunate ( dislocation may cause acute carpal tunnel syndrome)
  • trinquetum
  • pisiform
  • hemate
  • capitate
  • trapezoid
  • trapezium
138
Q

What is Carpal tunnel Syndrome?

A

Entrapment of median nerve in carpal tunnel -> nerve compression

139
Q

Which are the ligament involve in an Ankle sprain?

A 
Lateral ( MC)
1. Anterior Talofibular
2. Calcaneofibular
3. Posterior Talofibular 
Medial
1. Deltoid lig
140
Q

Axillary nerve?

A

(C5,C6)
Injury: fracture of the surgical neck of humerus, dislocation of humeral head
Motor defi: Deltoid - arm abduct at shoulder
Sign: Atrophied deltoid

141
Q

Radial nerve?

A

(C5-T1)
Injury: fracture midshaft of humerus
Motor defi: “BEST extensor” brachioradialis, extensors of wrist and finger, supinator, triceps
Sign: wrist drop

142
Q

Median nerve?

A

(C5-C8, T1)
Injury: fracture of the supracondilar humerus
Motor defi: opposition of thumb, lateral finger flexion, wrist flexion
Sign: “Ape hand”; “Pope’s blessing”

143
Q

Ulnar nerve?

A

(C8, T1)
Injury: fracture of medial epicondyle of humerus
Motor defi: medial finger flexion, wrist flexion
Sign: radial deviation of wrist upon wrist flexion

144
Q

Muculocutaneous nerve?

A

(C5-C7)
Injury: upper trunk compression
Motor defi: biceps, brachialis, coracobrachialis ( flexion of the arm at elbow)

145
Q

What is ER -Duchenne palsy “Waiter’s tip”?

A

Due to traction or tear of the upper trunk of the brachial plexus
C5 and C6 roots
Seen in infant following trauma during delivery
Findings: limb hang by side, medially rotates, forearm is pronated

146
Q

Winged scapula?

A

Lesion to the serratus anterior

A/w long thoracic nerve

147
Q

Which are the hand muscle?

A 
Thenar eminence (median)
Hypothenar eminence (ulnar)
Dorsal interosserous muscle - abduct finger
Palmar interosserous muscle - adduct finger
Lumbrical muscles flex at the MCP joint, extend PIP and DIP joint
148
Q

Which are the muscles of the Thenar eminence?

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

149
Q

Which are the muscles of the Hypothenar eminence?

A

Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi

150
Q

Obturator nerve?

A

(L2-L4)
Injury: Anterior hip dislocation
Motor defi.: thigh adduction

151
Q

Familiar nerve?

A

(L2-L4)
Injury: pelvic fracture
Motor defi.: thigh flexion and leg extension

152
Q

Common peroneal nerve?

A

(L4- S2)
Injury: Trauma or compression of lateral aspect of leg or Fibula neck fracture
Motor defi.:Foot eversion and dorsiflexion; Toe extension; Foot drop; Foot slap; Steppage gait

153
Q

Tibial nerve?

A

(L4- S3)
Injury: knee trauma
Motor defi.: Foot inversion and plantarflexion; Toe flexion

154
Q

Superior gluteal nerve?

A

(L4- S1)
Injury: Posterior dislocation or Polio
Motor defi.: thigh abduction

155
Q

Inferior gluteal nerve?

A

(L5- S2)
Injury: posterior hip dislocation
Motor defi.: can’t jump, climb stairs or rise from seated position

156
Q

Xeroderma pigmentosum

A

Defective nucleotide excision repair

157
Q

Basal cell carecinoma histology?

A

Basaltic cells with hyperchromatic nuclei.

158
Q

Honey- colored crusting

A

Impetigo

Tx:topical abx Mupirocin (Bactroban)

159
Q

Velvety, hyperpigmented plaques on the skin of neck and axillae

A

Acanthosis nigricans

  • in flexure regions
  • A/ w insulin resistance or obesity
  • A/w GI and lung malignancy
160
Q

Immmunofluorecens reveals linear patter (IgG C3) at epidermal ( basement mm.)- dermal junction

A

Bellos penhigoid

  • spares oral mucosa
  • biopsy: subepidermal cleavage

Tx:High potency topical glucocorticoid (Colbetasol)

161
Q

Acantholysis

A

Separation of epidermal cell

+ in pemphigus vulgaris

162
Q

Flaccid intraepidermal bullae?

A

Pemphigus vulgaris

  • causes acantholysis
  • IF: Ab around epidermal cells
163
Q

Kaposi sarcoma

A

Endothelial malignancy
A/w HHV-8 and HIV
Has lymphocytic infiltrates

164
Q

MC type of skin cancer; the lesión is a pearly-colored papeles with a translucent surface and telangectasis

A

BCC

165
Q

Flat-topped papules

A

Lichen planus

166
Q

Pinkish, scaling, flat lesions on the chest and back?

A

Tinea (pityriasis) vesicolor

*Maleasar furfur

167
Q

Dewdrops on a rose petal

A

Lesions of primary varicella

168
Q

“Crearle cap”

A

Seborrheic dermatitis

  • adherent greasy scales with a mildly erythematous base seen on scalp
  • predilection for areas with oily skin
169
Q

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women

A

Lichen sclerosis

170
Q

Exophytic nodules on the skin with varying degrees of scaling or ulceration

A

SCC

*2nd MC type of skin cancer

171
Q

Espongiosis

A

Epidermal accumulation of edematous fluid in intracellular space

  • eczematous dermatitis
172
Q

Nikolsy sign

A

+ pemphigus vulgaris ( separation of epidermis upon manual stroking of skin)

  • bullous pemphigoid
173
Q

Cytoplasmic vacuolization (koilicytosis) forming perinuclear halos

A 
Verruca vulgaris ( common warts)
Due to HP
  • non-umbilicated, skiing-colored papules or growth
  • ITCHIng
174
Q

Auspitz sign

A

Psoriasis

175
Q

Radial head subluxation

A

Nursemaid elbow

  • common in preschool
  • axial traction of forearm with elbow extended ( child pulled, lifted, swung by)
  • presents: arm held extended & probated. No swelling, deformities or focal tenderness.
  • Tx: Hyperpronation of forearm or supination of forearm & flexión of elbow
176
Q

Patellofemoral stress syndrome

A

Overuse injury commonly seen in runners

  • Anterior knee pain that worsens upon descending steps or hills.
177
Q

Inflammatory causes of low back pain

A

Ankylosis spondylitis, Reactive arthritis, Psoriatic arthritis, IBD

  • better with activity or exercise
  • no improvement with rest
  • gradual unset
  • HLA-B27 present
178
Q

An X-ray finding of an expansive & eccentric lytic area suggestive of?

A

“Soap - bubble “ appearance of Giant cell tumor of bone ( Osteoclastomas)

179
Q

Enthesitis

A

Characterized by information and pain at site of tendon and ligament attachment to bone.

  • Seen in Ankylosis spondylitis ( inflammatory cause of lower back pain)
180
Q

Spondylolisthesis

A

A developmental disorder characterized by a forward slip of vertebra ( L5 over S1)

*a palpable “step-off” is detected on examination if the problem is severe

181
Q

Polyarticular Juvenile idiopathic arthritis

A

Autoimmune disorder of childhood make by symmetric arthritis of the upper and lower extremity.

  • Labs: systemic inflammation including increase in inflammatory markers (ESR, CRP), Hyperferritinemia, Hypergammaglobulinemia & Thrombocytosis.
  • Anemia is commonly seen due to the chronic inflammation &a decrease in Fe.
182
Q

Trendelenburg sign

A

A drooping of the contralateral pelvis that occurs when the pt stands on one foot.

*due to muscle weakness of Gluteous medius & Gluteus minimus as result of Superior gluteal nerve damage

183
Q

Valgus vs. Varus laxity

A

Valgus-> MCL tear
* laxity when leg is forced to abduction

Varus-> LCL tear

184
Q

Malignancy causes of low back pain?

A

Metastatic cancer to bone:

  • H/O Malignancy
  • age > 50
  • Worse at night
  • cauda equina syn
185
Q

Most beneficial Tx option in preventing long term morbidity in pt with septic joints?

A

Surgical drainage & debridement

186
Q

Myasthenia graves Vs. Lambert Eatin syndrome

A

MG: auto-ab against post-synaptic acetylcholine receptors in NMJ.
* presents: ocular fatigue ( ptosis, diplopia) & muscular weakness
with preserved reflexes

LEMS: auto-ab against the voltage gated Ca channel in presynaptic motor nerve terminal.
* presents: proximal muscle weakness with decrease/absent tendon-
Reflexes

187
Q

Pseudogout

A

A form of acute arthritis induce by the release of Calcium pyrophosphate dehydrate crystals from sites of chondrocalcinosis into the joint space.

  • often occurs in the setting of recent surgery or medical illness.
188
Q

Myotonia

A

Delayed muscle relaxation

189
Q

Infectious causes of low back pain

A 
Osteomyelitis,Discitis, Abscess
- due to: recent infection
                IV drug user
                Diabetes
* fever, exquisite point tenderness 
*MRI is the Dx image
190
Q

Rafionuclide bone scan are used to evaluate?

A

Malignancy
Infections
Inflammatory diseases of bone

191
Q

Neurogenic Arthropathy

A

Charcot joint

  • complication of neuropathy & repited joint trauma
  • affects weight bearing joints
  • manifest with: functional limitation deformity, degenerative joint
  • X-ray: loss of cartilage, osteophyte development, lose bodies
192
Q

Sharp, localized pain & tenderness over the anterior-medial part of the tibial plateau just below the joint line of the knee.

A

Pes anserius syn

  • valgus stress test will not agraviate the pain
  • normal x-ray
193
Q

In case of amputation injury, what is the best next step with the amputated limb?

A

Amputated part should be wrapped in saline-moistened gauze, sealed in a plastic bag, place on ice

194
Q

A dashboard knee injury results in?

A

Disruption of the posterior cruciales ligament PCL

195
Q

Chondrocalcinosis

A

Calcification of articular cartilage

* seen in Hemochromatosis

196
Q

Posas sign

A

Abd pain with hip EXTENSION

-clinical presentation in a Psoas abscess

197
Q

Legg-Calve-Perthes disease Vs. Slipped Capital Femoral Epiphysis

A

LCP-> idiopathic AVN(osteonecrosis) of the femoral head.
-> boys 4-10y/o peak at 7y

SCFE-> separation of the proximal femoral epiphysis.
-> boy 11-13y/o in Obese adolescent

  • bouth present with limited abduction & internal rotation of the hip
198
Q

What time of exam should accompany all clavicle fx & why?

A

A neuronascular exam.

* due to the proximity to the subclaviar art. & brachial plexus

199
Q

Clinical manifestations of SLE?

A
  • symmetric migratory arthritis (hand, knee)
  • serositis: pleurisis, pericarditis, peritonitis
  • thromboembolic event
  • fever, fatigue, weight loss
  • butterfly rash and photosensitivity

*Labs: hemolytic anemia, thrombocytopenia, leukopenia
Hypocomplemenmia (C3 &C4) decreases
Antibodies: ANA & anti-dsDNA, anti-Sm
Renal: proteinuria, increase Cr

200
Q

Triad of clinical findings of Fety syndrome?

A

Inflammatory arthritis

  • > erosive joint disease & deformi
  • > rheumatoid nodules
  • > vasculitis( mononeuritis, necrotizing skin lesions)

Neutropenia
Splenomegaly

201
Q

Indication for imaging in low back pain?

A

X-ray: osteoporosis, compression fx, malignancy, ankylosis spondylitis

MRI: sensory/motor deficit, cauda equina syn, epidural abscess/ infection

202
Q

Musculoskeletal causes of low back pain

A
  1. Mechanical ( muscle strain, spasm, degenerative arthritis)
  2. Herniated disk
  3. Spinal stenosis: better with spine flexión
  4. Compression fx
203
Q

Symptoms of meniscal tear?

A

Acute “popping” sensation from twisting injury of the knee
Slow onset joint effusion
Impaired knee extension
Pain exacerbated with squatting

  • presents: “catching” sensation, “locking”, reduce range of motion
204
Q

Pt with pseudogaut should be evaluated for secondary causes like?

A

Hyperparathyroidism
Hypothyroidism
Hemochromatosis

205
Q

Shoulder dislocation

  1. Anterior
  2. Posterior
A

Anterior: -MC - Axillary nerve damage
- pt holding arm in Abd & external rotation

Posterior: - in seizure ( eclampsia) pt
- pt holding arm in Add & internal rotation

206
Q

Early physical sings of Compartment syn?

A

Extremity tightness
Weakness
Pain with passive motion
Pain out of proportion to injury

  • untreated: paralysis , muscle contracture, sensory deficit, infection, skin ulceration & necrosis
  • Tx: fasciotomy if pressure is > 20-30mmhg
207
Q

Diagnosis of Myopathy with normal ESR & increase CK

A
  1. Station-induce myopathy: muscle pain/tenderness with or without weakness
  2. Hypothyroid myopathy: features of hypothyroid +
    • > pain, cramps & weakness involving proximal muscle
    • > delayed tendon reflexes & myoedema
208
Q

Diagnosis of Myopathy with normal ESR and CK

A

Glucocorticoid- induced myopathy

  • > progressive proximal muscle weakness & atrophy without pain or tenderness
  • > Lower extremity muscles are more involved
209
Q

Diagnosis of Myopathy with increase ESR and normal CK

A

Polymyalgia rheumatica

  • > muscle pain & stiffness in the shoulder & pelvic girdle
  • > tenderness with decreased ROM at shoulder, neck and hip
  • > responds rapidly to Glucocorticoid
210
Q

Diagnosis of Myopathy with increase ESR and CK

A

Inflammatory myopathys

  • > muscle pain, tenderness and proximal muscle weakness
  • > skin rash and inflammatory arthritis my be present.
211
Q

Acute monoarthritis with fever?

A

Septic arthritis

  • A/w restricted ROM
  • common in pt with underlying joint disease
212
Q

Reactive arthritis

A

Reiter syndrome
-Triad: conjunctivitis, uveitis, arthritis (can’t see, pee or climb a tree)

*2 subtypes: post- enteric(GI bugs) and post-venereal (chlamydio)

213
Q

Golfer’s elbow

A

Medial epicondolitis
Repetitive flexión
C5,6

214
Q

Bone pain, bone enlargement, arthritis

A

Paget disease of bone

  • increase osteoblasts and osteoclasts activity
  • normal Ca and phosphate, increase ALP
215
Q

Patella fx

A

Inability to EXTEND the knee

216
Q

Achondroplasia

A

Failure of longitudinal bone growth
- endochondral ossification ( short limbs)

FGFR3
AD

217
Q

Triad of:

  1. Autoimmunity
  2. Non inflammatory vasculopathy
  3. Collagen deposition with fibrosis
A

Scleroderma (systemic sclerosis)

218
Q

Primary malignant bone tumors

A

Osteosarcoma ( codman triangle, sunburst)

Edwing sarcoma “onion”

219
Q

Polymyositis/ Dermatomyositis

A

Progressive symmetric proximal muscle weakness

  • increase CK
  • (+ )ANA, anti-Jo-1, anti-SRP and anti-Mi-2
  • Polymyositis: increase CD8
  • Dermatomyositis: increase CD4, malignancy, malar rash, gottron papules and heliotropic rash
220
Q

Anti- U1 RNP antibody

A

A/w Mixed connective tissue disease

221
Q

Polymyalgia rheumatica

A

Pain and stiffness in shoulder and hip

  • increase ESR, increase CRP and normal CK
  • A/w TGCA
222
Q

Pseudogout

A

Rhomboid crystals that are weakly brirefringent under polarized light

223
Q

Musculocutaneous nerve

  1. Inervates
  2. Provides
  3. Drive from
A
  1. Foramen flexors ( biceps) & choracobrachialis ( flexes and adduct the arm)
  2. Sensory innervation to the lateral forearm
  3. Upper truck (C5-C7)
224
Q

Long thoracic nerve injury

A
  • during axillary lymph node dissertation
  • paralysis of Serratus Anterior M.
  • wining of the scapula
  • C5-C7
225
Q

L4

- sensory loss: lower anterolateral thigh, knee and medial calf & foot

A

Patellar reflex

226
Q

3 MC carpal bone injury

A
  1. Scaphoid Fx: MC, a vascular necrosis
  2. Lacunate dislocation: acute CTS
  3. Hook of the Hemate: fall on outstretched hand, ulnar nerve injury
227
Q

Type IV collagen

A

Basement mm
Lens
Defective in Alport syndrome ( can’t see, pee, hear a thing)

228
Q

Prescription of monosodium ureate crystals

A

Gout

229
Q

Antinuclear antibodies

A

SEL, non specific

230
Q

Anti- body highly specific for SEL

A

Anti-Smith antibodies

231
Q

Piriformis syndrome

A

Compression of the Sciatic nerve in the Foramen

*Due to Piriformis muscle injury or hypertrophic

232
Q

Tennis elbow

A

Lateral epicondylitis
Repetitive EXTENSION
C6-8

233
Q

Osteopetrosis

A

Failure of normal bone resorption due to defective osteoclasts.

  • carbonic anydrase II mutation
  • thickened bone prone to fx
234
Q

Landmarks Dermatomes

T4,T7,T10,L1,L4,S2-4

A 
T4- nipple
T7- xiphoid process 
T10- umbilical 
L1- inguinal ligament 
L4-knee
S2,3,4- erectior &sensation of penil and anal zone
235
Q

Osteonecrosis

A

Infarction of bone

* MC site is the Femoral head

236
Q

“Foot drop”

A

Injury of Common peroneal nerve

237
Q

Mosaic pattern of woven & lamellar bone

A

Paget disease ( osteitis deformans)

238
Q

Loss of dorsal foot sensation
Impaired dorsiflexion &
Eversion resulting in “foot drop”

A

Common peroneal nerve injury

239
Q

Type III collagen

A

Ehlers-Danlos syndrome ( vascular defect)

240
Q

Extension of the thigh

A

Gluteus Maximus

  • supplie by Inferior gluteal nerve
241
Q

Erbs palsy

A

Waiters tip

Traction or tear of Upper trunk C5-6

242
Q

Bone pain, worse at night and relieve by Aspirin

A

Osteoid osteoma

* Diaphisis ( tibia, femur)

243
Q

Mid shaft fx of the Humerus can result in injury of?

A

Deep brachial artery
Radial nerve

  • bought run together along the posterior aspect of the humerus
244
Q

Thoracic outlet syndrome

A

Compression of lower trunk and subclavian vessels

245
Q

External hip rotation

A

Piriformis muscle

246
Q

Antibodies to ………… peptides/ proteins have a high specific for RA

A

Citrulinate

247
Q

“ Onion skin”, periosteal reaction in bone

A

Edging sarcoma

A/w t(11:22)

248
Q

Codman triangle or sunburst pattern on X-ray

A

Osteosarcoma

249
Q

Seronegative Spondyloarthropathies

A 
Arthritis without Reumatoid factor
A/w HLA-B27 (MCH class I)
- PAIR: psoriasis arthritic, ankylosis spondolitis, IBS, reactive arthritis
250
Q

“Soap bubble” appearance on r-ray

A

Giant cell tumor “Osteoclastoma”

251
Q

Primary bening bone tumor

A 
Osteoclastoma
Osteochondroma
Osteoma
Osteoid osteoma 
Osteoblastoma
252
Q

“Empty-can” test

A

Isolates the action of the Supraspinatus muscle

253
Q

Osteomalacia

A

Decrease mineralization of osteoid

MCC is vit. D defi
* presents: bone pain, muscle weakness and increase fx

*labs: increase ALP and PTH, decrease Ca, phosphorus and 25OH-D

254
Q

Sistic nerve

A

L4-S3
Innervates posterior thigh

*splits into: common peroneal n. & tibial n.

255
Q

Defective protein in Marián syndrome

A

Fibrillin 1

256
Q

Rotator cuff muscles

A

Supraspinatus- Ab
Infraspinatus- lat rotation
Teres minor- Ad, lat rotation
Subscapularis- Ad, internal rotation

257
Q

Pudendal nerve

A

Innervation to the perineal region

258
Q

Tubercular (spongy) bone losses mass & interconnections

A

Osteoporosis

259
Q
  • Hilar & mediastinal Adenopathy
  • Hypercalcemia
  • Uveitis
  • RLD ( interstitial fibrosis)
A

Sarcoidosis

* common autoimmune disease in young african American women

260
Q

Unhappy triad

A

ACL
MCL
Medial meniscus

261
Q

The superior gluteal nerve innervates?

A

Gluteus medius, minimus and tensor fascia latae m.

  • they abduct the thigh
262
Q

Antinuclear antibodies SS-A (anti-Ro)

SS-B (anti-La)

A

Sjogres syndrome

263
Q

The femoral N.
1. Innervates
2 provides sensation

A
  1. Muscle of the anterior compartment of the thigh
    - quadriceps
    - sartorius
    - pectineus
    * responsible for knee extension and hip flexion
  2. Anterior thigh & medial leg
264
Q

Goodpasture syndrome

A

Autoantibodies against

  • glimerular bm ( RPGN)
  • alveolar bm ( hemorrhage)
  • Anti-GBM
265
Q

Obturator nerve

A

Addiction of the thigh

266
Q

Sudden upward on the arm at the shoulder can damage?

A

Lower trunk C8-T1

  • klumpke palsy
  • finger clumsiness
  • claw hand deformities
  • absent grant reflex
267
Q

Tibial nerve

  1. Innervates
  2. Provides sensation to
A
  1. Posterior compartment of leg and plantar aspect of foot.
    - flexion of the knee & digits
    - plantar flexion
  2. Leg ( except medial side and plantar foot)
268
Q

Weakened plantar flexion
Decrease inversion of foot
Decrease sensation at the sole of the foot

A

Tibial nerve injury

269
Q

Medication to DX Myasthenia gravís

A

Edrophonium

270
Q

Back pain that is exacerbated by standing & walking, but relieved with sitting and hyperflexion of the hip

A

Spinal stenosis

271
Q

Immune mediated, widespread non caseating granulomas, increase ACE levels and CD4/CD8 ratio

A

Sarcoidosis

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