RSL - Musculo

Question 1

Giant cell tumor: Histo / Location

Answer 1

Soap bubble lesion

Epiphysis

Question 2

Osteochondroma: Histo / Location

Answer 2

Bone covered with cartilage, exostosis / Metaphysis

Question 3

Osteosarcoma: Histo / Location

Answer 3

Sunburst, codman triangle / Metaphysis

Question 4

Ewing Sarcoma: Histo / Location

Answer 4

Small blue malignant cells, t(11;22), Onion skin periosteal reaction / Diaphysis

Question 5

Chondrocalcinosis on x-ray (findings on polarized light?)

Answer 5

Pseudogout

(crystals are blue when parrallel to light)

DDX/ gout has yellow crystals when parrallel to light

Question 6

Poly myositis

Answer 6

Proximal muscle weakness

Endomysial inflammation with CD8+ cells

increased CK, ANA⁺, Anti-Jo-1⁺, Anti-SRP⁺, Anti-Mi-2⁺

increased risk of malignancy

Treatment: Steroids + long term immunosuppression

Question 7

Dermatomyositis

Answer 7

CD4+

Perimysial inflammation

Malar skin rash

gottron papules (red knuckles)

heliotrope (periorbital rash)

“shawl and face” rash

“mechanics” hands

Increased risk of malignancy

increased CK, ANA+, Anti-Jo-1+, Anti-SRP+, Anti-Mi-2+

Treatment: Steroids + long term immunosuppression

Question 8

Urticaria

Answer 8

Hives

Pruritic wheals after mast cell degranulation

Superficial dermal edema, and lymphatic channel dilation

Question 9

Polymyalgia rheumatica

Answer 9

Women >50, associated with temporal (giant) cell arteritis

Does not cause muscle weakness

Increased ESR, CRP, Normal CK

Treat with corticosteroids

Question 10

Fibromyalgia

Answer 10

Women 20-50.

Dt/abnormal processing of painful stimuli

Widespread with paresthesias, poor sleep, fatigue, impaird concentration, psychiatric disturbances

worse with excersize

Absent joint / muscle inflammation

treat with excercise, TCAs, SNRIs, anticonvulsants

Question 11

Primary Intention wount healing

Question 12

Secondary intention

Question 13

Tertiary intention

Answer 13

Wound is cleaned, debrided, 4-5 days before closure

Purposely keep wound open

Ie. tissue grafts

Question 14

wound dehiscence

Answer 14

ruptureing of a previously closed wound

Question 15

nursemaids elbo

Answer 15

Annular ligament problems due to radial head subluxation

Reduction: fully supinate the forearm and flex the elbow

Question 16

Dactilytis in a child (painful hand swelling)

Answer 16

Suggestive of Sickle cell

Question 17

Baker cyst

Answer 17

Popliteal fluid collection. commonly related to chronic joint disease

Question 18

Guyan canal syndrome

Answer 18

ulnar nerve at wrist or hand

Question 19

tinel syndrome

Answer 19

tapping on wrist reduces symptoms

Question 20

phalen sign

Answer 20

Bending wrist exacerbates symptoms

Question 21

Osteonecrosis: MCC

Answer 21

medial femoral circumflex Artery

Question 22

Pseudogout deposition

Answer 22

Calcium pyrophosphate crystals within joint space.

Chondrocalcinosis on X-Ray

Question 23

Ankylosing spondylitis

Answer 23

Ankylosis, uveitis, aortic regurg,

Question 24

Antiphospholipid syndrom

Answer 24

Thrombosis or spontaneous abortion

+

Lupus anticoagulant, anticardiolipin, anti-beta2 glycoprotein

Question 25

Sarcoidosis: histology

Answer 25

Epithelioid granulomas containing microscopic Schaumann and asteroid bodies