MSB pathology

Question 1

How to treat trochanteric bursitis? (Inlammation of gluteal tendon and bursa lateral to greater trochanter)

Answer 1

NSAIDs, heat, stretching

Question 2

Housemaids knee AKA..

Answer 2

prepateller bursitis

Question 3

Causes of housemaids knee?

Answer 3

repeated trauma/pressure from excessive kneeling

Can be from gout/infection as well

Question 4

What is a bakers cyst?

Answer 4

popliteal fluid collection that commonly communicates with synovial space

Question 5

What pathologies is bakers cyst related to?

Answer 5

Rheumatoid and osteoarthritis

Question 6

How does a rupture of a bakers cyst present?

Answer 6

similar to DVT

Question 7

What is De Quervain tenosynovitis?

Answer 7

Thickening of abductor pollicis longus and extensor policies brevis. Pain or tenderness at radial styloid

Question 8

What is a positive Finkelstein test

Answer 8

pain at radial styloid with active or passive stretch of thumb tendons

Question 9

Presentation of gangliion cyst

Answer 9

fluid-filled swelling overlying joint or tendon sheeth, most commonly on dorsal side of wrists

Question 10

Presentation of illiotibial band syndrome

Answer 10

pain at lateral femoral epicondyle from overuse of lateral knee (common in runners)

Question 11

Limb compartment syndrome defining criteria

Answer 11

Difference than 30 mmhg or less between the tissue compartment and diastolic bp

Question 12

Medial tibial stress syndrome presentation

Answer 12

Shin pain in runners and military recruits

Question 13

Medial tibial stress syndrome aka

Answer 13

shin splints

Question 14

Plantar fascitis

Answer 14

Inflammation of plantar aponeurosis characterized by heel pain - worse with first steps in the morning

Question 15

What is developmental dysplasia of the hip?

Answer 15

Abnormal acetabulum development in newborns that results in hip instability/dislocation

Question 16

What is the confirmatory test for developmental dysplasia of the hip?

Answer 16

ULTRASOUND (not xray bc cartilage isn’t ossified)

Question 17

What is Legg-Calve-Perthes disease?

Answer 17

Idiopathic avascular necrosis of the femoral head

Question 18

who gets Legg-Calve-Perthes disease?

Answer 18

Children aged 5-7,more commonly males

Question 19

What will the initial XRAY of Legg-Calve-Perthes disease look like?

Answer 19

Normal, initially

Question 20

What is Osgood-Schlatter disease (traction apophysitis)?

Answer 20

Overuse injury caused by repetitive strain and chronic avulsion of secondary ossification center of proximal tibial tubercle

Question 21

Who gets Osgood-Schlatter disease ?

Answer 21

teengers after their growth spurt. Common in runners and jumping atheletes

Question 22

What is patellofemoral syndrome and who gets it?

Answer 22

overuse injury that commonly presents in young, female athletes as anterior knee pain
-gets worse with prolonged sitting or weight-bearing on flexed knee

Question 23

How to treat patellofemoral syndrome?

Answer 23

NSAIDs and thigh muscle strengthening

Question 24

Slipped capital femoral epiphysis presentation?

Answer 24

Seen in obese preteens early adolescent children with hip/knee pain and altered gait

Question 25

Slipped capital femoral epiphysis treatment

Answer 25

surgery

Question 26

What is a greenstick fracture?

Answer 26

incomplete fracture following bending stress

Question 27

What is a torus fracture?

Answer 27

when the cortex buckles on one side due to compression

Question 28

Pathophys of achondroplasia

Answer 28

Constitutive activation of fibroblast growth factor receptor inhibits chondrocyte proliferation -often from autosomal dominant mutation

Question 29

Osteoporosis pathophys

Answer 29

trabecular and cortical bone los mass and interconnections - due to increased bone resorption related to decreased estrogen and old age - may be secondary to drugs

Question 30

Which drugs may promote osteoporosis?

Answer 30

Steroids, alcohol, anticonvulsants, anticoagulatnts, etc.

Question 31

Why do many anticonvulsants promote bone loss?

Answer 31

They upregulate CYP450 which increases vit D breakdown

Question 32

Diagnosis of osteoporosis

Answer 32

DEXA scan with T-score <2.5 or by fragility fracture (hip or vertebra fracture from fall at normal height)

Question 33

Treatment of osteoporosis

Answer 33

bisphosphonates, teriparatide, SERMs, rarely calcitonin, denosumab

Question 34

Osteopetrosis pathophys

Answer 34

Defective osteoclasts lead to failure of normal bone resorption ->thickened, dense bones that are prone to fracture Caused by mutations in carbonic anyhydrase II

Question 35

What mutation occurs in osteopetrosis?

Answer 35

Carbonic anyhdrase II

Question 36

Osteopetrosis complications

Answer 36

overgrowth of cortical bone fils. marrowspace --> pancytopenia, intramedullary hematopoiesis, may result in cranial nerve impingement and palsies

Question 37

Treatment for osteopetrosis

Answer 37

Bone marrow transplant - may be curative as osteoclasts derive from monocytes

Question 38

Infantile form of osteopetrosis inheritance

Answer 38

autosomal recessive

Question 39

Albers-Schonberg disease

Answer 39

autosomal dominant form of osteopetrosis

Question 40

Pathophys of osteomalacia/rickets

Answer 40

Defective mineralization of osteoid or cartilaginous growth plates

Question 41

Xray findings in osteomalacia

Answer 41

Looser zones (pseudofractures)

Question 42

Xray findings in rickets

Answer 42

epiphyseal widening and metaphyseal cupping/fraying

Question 43

clinical findings in children with rickets

Answer 43

Bow legs (genu varum), bead-like costochondral junctions(rachitic rosary), craniotabes (soft skull)

Question 44

Labratory findings in osteomalacia/rickets

Answer 44

``` Low vitamin D Low serum Ca Increased PTH Decreased serum phosphate Increased ALP from osteoblasts ```

Question 45

Osteitis deformans aka

Answer 45

Pagets disease

Question 46

Pagets disease pathophys

Answer 46

Increased osteoclast and osteoblastic activity causes increased bone remodelling. Forms poor quality bone.

Question 47

Lab values in pagets disease

Answer 47

everything normal except increased ALP

Question 48

Complictions of pagets disease

Answer 48

Chalk stick fractures High output heart failure (arteriovenous shunts) Osteosarcoma Hearing loss

Question 49

Four stages of pagets disease

Answer 49

Lytic - osteoclasts Mixed - osteoclasts + osteoblasts Sclerotic - osteoblasts Quiescent - minimal osteoclast/osteoblast activity

Question 50

Treatment of pagets

Answer 50

bisphosphonates