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USMLE S1 > Rheumatology/Orthopaedics > Flashcards

Rheumatology/Orthopaedics Flashcards

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USMLE® Step 1 flashcards
1
Q

what is probenecid? caution?

what has a similar effect?

A

preventes reabsorption of uric acid in PCT

also inhibits secretion/clearance penicillin

caution: can precipitate uric acid crystals

Similar effect is acheived by salicylates at high-dose

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2
Q

what biological is useful in the treatment of GCA?

A

tocilizumab - anti IL-6 antibody as this is mediator of CD4+ T lymphocyte/macrophage inflammatory response

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3
Q

weakness of dorsiflexion and difficulty heel walking suggest disc heriation at what level?

A

L4-5

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4
Q

boney tumour that has bone pain resolving with aspirin

A

osteoid osteoma

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5
Q

name the nerve and artery that run by this bone/region:

surgical neck of humerus

A

axillary

posterior circumflex humeral artery

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6
Q

what are the distinguishing features of osteoblastoma from osteoid osteoma?

A

larger (>2cm)

found in vertebrae

unresponsive to aspirin

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7
Q

what bone cancer occurs on the surface of facial bones?

A

osteoma

associated with Gardner syndrome

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8
Q

nerve damage with # surgical neck of humerus

A

axillary nerve (C5-6)

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9
Q

nerve damage with medial condylar #

signs?

A

ulnar nerve

loss of wrist flexion and all other muscles in hand; sensation over hypothenar eminence and medial 1.5 fingers

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10
Q

osteonecrosis of the femoral head is caused by what, other than fracture? (4)

A
  1. sickle cell disease
  2. vasculitis (SLE)
  3. alcoholism
  4. high-dose corticosteroids
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11
Q

where does a Baker’s cyst form?

A

popliteal fluid collection in gasctrocnemius-semimembranosus bursa

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12
Q

back pain

focal tenderness with recent infection, IVDU or immunocompromise

A

vertebral osteomyelitis

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13
Q

nerve damage with midshaft # humerus

signs?

A

radial nerve

loss of extensors at elbow, wrist and fingers

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14
Q

considerations of scaphoid #

A

AVN and non-union due to retrograde blood supply

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15
Q

what are the side effects of colchicine?

A

mainly diarrhoea but also N&V, abdo pain sometimes - come on shortly after beginning therapy

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16
Q

anti-smooth muscle antibodies are associated with which condition?

A

autoimmune hepatitis

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17
Q

arm hanging by side, held in extension and internal rotation

indicates damage where in the brachial plexus? what is this called?

A

upper trunk - Erb palsy

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18
Q

what are the two growth factor essential for osteoclastic differentiation?

A

RANK-L and M-CSF

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19
Q

what is this and who gets it?

A

Greenstick fracture

incomplete fracture extending partway through width of bone following bending stress

children

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20
Q

growth of the lateral sestion of the growth plate outward leading to boney tumour with overlying cartilage

diagnosis?

what is the dangerous progression from this?

A

osteochrondroma

overlying cartilage growth plate can transform to costochondroma (malignant)

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21
Q

pathogenesis of McCune Albright Syndrome?

A

mutation of GNAS gene

constituative activation of G(s)/AC/cAMP cAMP activates melanocytes (cafe au lait spots), osteoclasts (lytic bone lesions), precocious puberty etc..

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22
Q

what is golfers elbow and what action predisposes to it?

A

medial epicondylitis

repetitive flexion (forehand)

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23
Q

what ligament separates the lesser and greater sciatic foramen?

A

sacrospinous ligament

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24
Q

pathogenesis of reactive arthritis?

A

immune complex deposition involving bacterial antigens from the precipitating GI/GU infection

campylobacter, clostridium, shigella, salmonella, yersinia, chlamydia

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25
Q

flaccid lower limbs and absent ankle reflexes

poorly developed sacrum

diagnosis and association?

A

caudal regression syndrome

poorly controlled diabetes, but not always

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26
Q

4 changes associated with degenerative arthritis of the spine

A
  1. bulging intraverterbral disc
  2. thickened ligamentus flavum
  3. hypertrophied/osteophitic facet joint
  4. foraminal stenosis
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27
Q

what is the difference between tamoxifen and raloxifene?

A

both selective estrogen receptor modulators

  • *tamoxifen** - strong breast antagonist, endometrial agonist, medium bone agonist
  • significant endometrial effects means only used in breast CA treatment*
  • *raloxifene** - bone agonist, antagonist on breast, antagonist on endometrium
  • perfect for breat CA and osteoporosis prevention*
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28
Q

which vessel is at risk of damage with a femoral neck #?

A

medial femoral circumflex artery

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29
Q

back pain

pain with spinal extension (standing), walk around with hunched back

A

spinal stenosis

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30
Q

type 1 muscle also known as?

how dose it work?

where in the body is it found?

A

slow twitch fibres

red from increased myoglobin and mitrochondria, more oxidative phosphorylation; high endurance

postural maintenance - paraspinal muscles, rectus abdominis etc

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31
Q

association with myositis(es)

A

visceral organ solid tumour e.g. gastric adenocarcinoma

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32
Q

what is the effect of anti-epileptics on bone?

A

increase vitamin D catabolism = osteoporosis

specifically phenobarbital, phenytoin, carbamazepine

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33
Q

what is tennis elbow and what action predisposes to it?

A

lateral epicodylitis

repetitive extension (backhands)

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34
Q

what is the Ewing Sarcoma translocation?

A

t(11;22)

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35
Q

serum marker of osteoblast activity?

how can you tell this from liver or placenta released ALP?

A

alk phos

bone ALP denatures in heat (bone - boil), electrophoresis and specific monoclonal antibodies

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36
Q

woven bone is found where in genetically normal individuals?

A

following # and Paget’s disease

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37
Q

what does an osteoclast secrete to break down bone?

A

H+ and collagenases

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38
Q

bisphosphonates are structurally similar to what compound? how does this make it work?

A

pyrophosphate

competitively binds hydroxyapatite in bone, stopping osteoclasts’ ability to break it down

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39
Q

what is Charcot-Marie-Tooth disease? mutation symptoms classic finding

A

genes affecting proper myelin sheath

hammer toe, foot drop, polyneuropathy champagne-bottle legs (distal muscle wasting)

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40
Q

what structures pass through the greater sciatic foramen?

A

piriformis, originating from the anterior aspect of sacrum

gluteal (sup and inf) and sciatic nerves

gluteal vessels (sup and inf)

piriformis syndrome - muscle injury and hypertrophy, sciatica-like symptoms; muscle tender with deep palpation and stretching

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41
Q

tingling of the hand when held at 90deg flexion suggests?

A

carpel tunnel syndrome

(Phalen maneuver)

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42
Q

what are the cancers associated with familial retinoblastoma?

A

bilateral retinoblastoma

osteosarcoma in teenage years

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43
Q

onion skin appearance on x-ray…

pathoG?

A

Ewing Sarcoma

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44
Q

anti-desmoglein 1 and 3 antibodies are associated with which condition?

A

pemphigus vulgaris

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45
Q
A
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46
Q

myositis antibodies

A

ANA

Anti-Jo-1 (a.k.a. anti-histidyl-tRNA synthetase)

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47
Q

name the nerve and artery that run by this bone/region:

distal humerus/cubital fossa

A

median

brachial

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48
Q

inability to anchor scapula to the thoracic cage resulting in inability to ABduct arm over 90deg

where is the injury, how do you get it and what is the sign called?

A

long thoracic nerve supplying serratus anterior

axillary node clearance/stab wound

winged scapula

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49
Q

diagnosis?

A

osteoid osteoma

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50
Q

what primaries give osteolytic boney mets?

A

multiple myeloma

NSCLC, NHL, RCC, melanoma

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51
Q

anteriomedial supracondylar # risks which nerve?

A

median

52
Q

what three diseases are caused by parvovirus B19?

A
  1. erythema infectiosum
  2. acute arthropathy
  3. aplastic crisis
53
Q

nerve damage with lateral traction on neck during delivery

A

upper trunk, C5-7, musckulocutaneous nerve damage

Erb’s palsy

54
Q

what is leflunomide? indications?

A

inhibits dihydroorotate dehydrogenase, blocks pyrimidine synthesis. inhibits T cell proliferation

RA and psoriatic arthritis

55
Q

describe the injury resulting from significant axial traction of the radius in children

strategy for reduction?

A

subluxation of radial head

annular ligament displaces over the head of the radius and slips into the radiohumeral joint, where it becomes trapped causing pain

complete supination of forearm then complete flexion of elbow

56
Q

what is teriparatide? How is it given? indications?

contraindications

A

recominant PTH analog, increases osteoblast activity to lay down more bone

daily SC injection

osteoporosis, c/o bisphosphonates. this stimulates bone growth versus inhibiting resorption

do not use: Paget’s disease of bone or unexplained alk phos elevation; increases risk of osteosarcoma

57
Q

consideration of lunate dislocation

A

impingement on the carpal tunnel leading to carpal tunnel syndrome

58
Q

in the sarcomere, what bands contact and what band stays equal length?

A

H and I bands contract, bringing Z lines closer together

A band is always equal length

59
Q

back pain

radiates to leg, neuro findings, positive straight leg raise

A

radiculopathy (disc herniation)

60
Q

what primaries give osteoblastic lesions?

A

prostate

small cell lung CA, hodgkin’s lymphoma

61
Q

modern name for Churg-Strauss?

A

eosinophilic granulomatosis with polyangiitis

62
Q

RA affects what part of the spine?

A

cervical spine

63
Q

back pain

positional that is relieved by rest

A

degenerative, OA

64
Q

multinucleated giant cell with over 100 nuclei from bone biopsy

suggestive of what disease?

A

Paget’s disease of the bone

65
Q

absent motor component of cremasteric reflex

nerve and nerve roots?

A

genitofemoral nerve, L1-2

66
Q

what is keratoderma blenorrhagicum?

A

blistering of the sole of feet in reactive (Reiter’s) arthritis

67
Q

name the nerve and artery that run by this bone/region:

pop fossa

A

tibial

popliteal

68
Q

risk factors for elderly onset osteosarcoma?

A

Paget’s disease of bone (also leads to high output cardiac failure)

radiation exposure

69
Q

what is the mechanism for urinary/faecal incontinence following childbirth?

A

stretch damage to the pudendal nerve (S2-4)

normally controls external urethral and anal sphincters

70
Q

what medication is implicated in drug-induced lupus?

A

heart: procainamide, hydralazine
bugs: isoniazid, minocycline, quinidine

71
Q

a lateral ankle sprain most common tears which ligament only?

A

anterior talofibular ligament

worse injuries can also tear the calcaneofibular ligament or posterior talofibular ligament

72
Q

osteoma benigin or malignant?

A

benign

73
Q

back pain

young man, relieved by exercise

A

spondyloarthropathy

74
Q

3 main antibodies for systemic sclerosis

A

anti-topoisomerase I (anti-Scl70)

anti-centromere

anti-RNA Pol III

75
Q

polyarteritis nodosa is associated with what infection?

A

hepatitis B

76
Q

weakness of plantar flexion and toe-walking, decreases achilles reflex suggests disc heriation at what level?

A

L5-S1

77
Q

what are the two factors responsible for the differentiation of osteoclast precursors?

A
  1. M-CSF
  2. RANK:RANK-L binding

OPG binds RANK-L, inhibiting RANK activation. low OPG:RANK-L ratio needed for osteoclast precursor differentiation

78
Q

pleimorphic cells producing osteoid on biopsy

radiograph shown below

what are the classic radiological findings shown?

A

osteosarcoma

destructive lesion, sunburst pattern, Codman’s triangle (periosteum lifts off bone)

79
Q

carpal tunnel syndrome is associated with what systemic conditions?

A
  1. pregnancy
  2. endocrinopathy - diabetes, hypothyroidism, acromegaly
  3. dialysis-related amyloidosis
  4. Rh arthritis
80
Q

endomyseal mononuclear infiltrate with patchy muscle fibrosis is suggestive of which disease?

A

polymyositis

81
Q

where do cartilage tumours arise?

A

medulla

82
Q

tumour in young adults with multinucleated giant cells and stromal cells

where is it found?

A

giant cell tumour

only tumour found in epiphysis

83
Q

who gets Ewing Sarcoma?

where does it occur?

A

male children

diaphysis of long boneinside the medullary cavity

84
Q

where do you find chondrosarcoma versus chondroma?

A

CSoma - malignant in pelvis or central skeleton

Coma - benign in small bones of hand and feet

85
Q

what is the effect of PPI on bone?

A

inhibit Ca++ absorption = osteoporosis

86
Q

name the nerve and artery that run by this bone/region:

posterior to medial malleolus

A

tibial

posterior tibialis

87
Q

what test should be done before starting anyone on etanercept?

A

etanercept = TNF-alpha blocker.

can lead to activation of latent TB

test with Tuberculin skin test before starting

88
Q

what is a specific marker of bone osteoclast activity?

A

urine deoxypyridinoline

89
Q

symptoms of polyarteritis nodosa? (classify in 4)

A
  • GI - ischaemia/infarction, bleeding
  • Msk - myositis, arthritis
  • Nervous - mononeuritis multiplex, peripheral neuropathy
  • Kidney - glomerulonephritis, hypertension
90
Q

what is the diagnosis and what is the radiological sign?

A

giant cell tumour

soap-bubble appearance

91
Q

3 extraskeletal manifestations of ank spond

A
  • respiratory - chest wall becomes stiff giving type 2 respiratory failure
  • cardiovascular - ascending aortitis, aortic root dilatation and aortic insufficiency
  • opthalmic - uveitis
92
Q

vasculitis with eosinophilia suggests?

A

Churg-Strauss

93
Q

rotator cuff muscles

A

SItS

supraspinatus, infraspinatus, teres minor, supscapularis

94
Q

weakness of knee extension and decreased patellar reflex suggests what level disc herniation?

A

L3-4

95
Q

what primaries give mixed boney mets?

A

GI and breast CA

96
Q

a benign tumour of osteoblasts surrounded by rim of sclerotic/reactive bone

diagnosis?

A

osteoid osteoma

97
Q

excessive MMP at the site of a joint injury leads to what?

A

contracture

98
Q

what medication dose is affected by allopurinol?

A

increases azathioprine and 6mercaptopurine conc

both are normally metabolised by xanthine oxidase

99
Q

what is the cell lineage of Ewing Sarcoma?

A

neuroectoderm

100
Q

anti-neutrophil myeloperoxidase means…

A

it’s a pANCA

Churg-Strauss (eGPA)

101
Q

anchondroplasia is associated with what gene mutation?

A

FGFR3 leads to premature ossification and fusion of the growth plates, normal torso but short limbs, especially proximally

102
Q

type 2 muscle also known as?

how does it work?

A

fast twitch

white fibres from less mitochondria and myoglobin, more anaerobic glygolysis

103
Q

foot drop is a lesion of what nerve and nerve roots?

A

common peroneal

L4-S2

104
Q

how does calcium induce smooth muscle contraction?

A

calcium bind calmodulin

activates myosin light chain kinase, phosphorylates MLC

MLC-P = contraction

105
Q

which bones undergo membranous ossification?

A

clavicle, calvarium (frontal, parietal and occipital), facial bones

106
Q

what is pegloticase?

A

recombinant uricase

catalyzes uric acid to allantoin, water-soluble produce with renal clearance

prophylactic/long term treatment for gout

107
Q

hand held in MCP extension and DIP/PIP flexion

where is the lesion and what is this called?

A

traction/tear of the lower trunk -

Klumpke palsy

also seen in thoracic outlet syndrome (+vascular compression)

108
Q

what is the cell signalling pathway implicated in the pathogenesis of Paget’s disease of the bone? 3 phases of history of the disease?

A

RANK and NF-kappaB activation

osteoclastic - breakdown of bone.

Mixed - new bone formation

osteosclerotic - osetoblasts lay down dense, hypoplastic, mosaic pattern, weak bone and eventually overgrows. prominent cement lines

109
Q
A
110
Q

who gets osteoid osteoma?

where in the body is it found?

A

young adults <25 y/o

cortex of diaphysis of long bone

111
Q

what is the triad of McCune Albright syndrome?

A
  1. fibrous dysplasia
  2. café au lait spots
  3. endocrinopathy
112
Q

antiphospholipid antibody syndrome is associated with which antibodies?

A

anti-cardiolipin

113
Q

circulating antibodies against collagen IV means what?

A

anti-GBM antibodies

Goodpasture’s disease

114
Q

back pain

worse at night, constant, no response to positional change

A

boney met in spine

115
Q

how does nitric oxide induce smooth muscle relaxation?

A

NO stimulates conversion of GTP to cGMP

cGMP activates MLC-phosphatase

dephosphorylated MLC relaxes muscle

116
Q

nerve damage with supracondylar #

signs?

A

median nerve

loss of wrist flexion and LLOAF, sensation over thenar eminence and lateral 3.5 fingers

117
Q

pathologic # or bone pain

lesion in metaphysis of long bone

diagnosis?

A

osteosarcoma

118
Q

what drugs directly inhibit bone formation leading to osteoporosis?

A

glucocorticoids, TZDs, unfractionated heparin

119
Q

name the nerve and artery that run by this bone/region:

axilla/lateral thorax

A

long thoracic

lateral thoracic

120
Q

knee trauma, Baker cyst or tarsal tunnel syndrome

what nerve can these damage? what nerve roots?

presentation?

A

tibial

L4 - S3

loss of sensation to sole of foot, cannot stand on tip toes, cannot flex toes

121
Q

achondroplasia is a defect in what process?

A

endochondral ossification

122
Q

inheritance pattern of achondroplasia?

A

AD

123
Q

bones of the hand

A

scaphoid, lunate, triquetrum, pisiform

hamate, capitiate, trapezoid, trapezium

so long to pinky, here come the thumb

124
Q

what is Tinel sign?

A

tingling of median nerve distribution on repetitive tapping of the wrist

125
Q

anteriolateral supracondylar # risks which nerve?

A

radial nerve

126
Q

name the nerve and artery that run by this bone/region:

midshaft of humerus

A

radial

deep brachial

USMLE S1 (16 decks)

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