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MSK Flashcards

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1
Q

Which MSK condition is caused by an overuse injury of repetitive strain and chronic avulsion of the secondary ossification center of the proximal tibial tubercle?

A

Osgood Schlatter Disease
AKA traction apophysitis

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2
Q

Who is more pronged to Osgood Schlatter Disease?

A

Young males after growth spurt that run or jump with progressive anterior knee pain

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3
Q

What is Patellofemoral Syndrome?

A

Overuse injury common in young females, anterior part of the knee, exacerbated by prolonged sitting or weight bearing on a flexed knee

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4
Q

What is Legg - Calve Perthes Disease?

A

Idiopathic avascular necrosis of femoral head. COMMONLY IN MALES 5 - 7 YEARS OLD presenting with a limp and insidious hip pain

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5
Q

Who will have most likely develop slipped capital femoral epiphysis?

A

Obese young adolescent with hip/knee pain and altered gait.

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6
Q

What is a greenstick fracture?

A

Incomplete fracture extending partway through width of the bone, following bending stress, bone fails on tension side

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7
Q

What is the pathophysiology of Achondroplasia?

A

Failure of longitudinal bone growth, activation of fibroblast growth factor receptor inhibits chondrocyte proliferation. They will have short limbs and normal size torso and head or large head

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8
Q

What causes Osteoporosis?

A

Decrease in bone mass, increase in bone resorption (osteoclasts) related to a decrease in estrogen and old age. Can be secondary to drugs, hyperparathyroidism, malabsorption and multiple myeloma

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9
Q

How do you diagnose Osteoporosis?

A

DEXA x-ray at the lumber spine, total hip and femoral neck with a T score of less than 2.5 or by fragility fracture at the hip or vertebrae

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10
Q

How do you prevent Osteoporosis?

A

Regular weight bearing exercises and Ca+ and vitamin D intake
Tx: Bisphosphonates, teriparatide, SERMs,

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11
Q

If a patient presents with a Colle’s fracture, kyphosis, acute back pain, loss of height, vertebral compression fractures, femoral neck and distal radial fracture, what is the likely diagnosis?

A

Osteoporosis

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12
Q

What is Osteopetrosis?

A

Failure of normal bone resorption due to defective osteoclasts, thickened, dense, brittle bones that are prone to fracture.

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13
Q

What causes Osteopetrosis?

A

Mutation (CAII) impairs the ability of osteoclast to generate acidic environment necessary for bone resorption.

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14
Q

What can Osteopetrosis result in?

A

Cranial nerve impingement and palsies due to narrowed foramina.

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15
Q

Defective mineralization of what will cause osteomalacia/rickets?

A

Osteoid or cartilaginous growth plates (children) most commonly due to a vitamin D deficiency

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16
Q

What are the clinical features of Rickets?

A

Bowlegs (genu varum), beadlike costochondral junctions, craniotabes, increase in ALP and PTH, decrease in Ca, Vitamin D and PO43

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17
Q

Which bone disease is caused by bone remodeling, increased in osteoclasts and osteoblast?

A

Paget’s Disease
Osteitis Deformans

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18
Q

What are the vital levels of Paget’s Disease?

A

Normal Serum Ca+, phosphorus and PTH levels
Increased ALP
Mosaic pattern of woven and lamellar bone, long bone chalk stick fractures

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19
Q

What can Paget’s disease lead to?

A

Increase in blood flow causing high cardiac output failure and increase in the risk of osteosarcoma

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20
Q

What are some clinical features of Paget’s disease?

A

Males, increased in hat size, hearing loss due to skull deformity

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21
Q

What are the stages of Paget’s disease?

A

First Stage: Lytic (osteoClasts)
Intermediate (mixed): Osteoclast and Osteoblast
Mosaic, Sclerotic/blastic: osteoblast

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22
Q

What is the tx for Paget’s disease?

A

Bisphosphonates

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23
Q

What is the pathophysiology of Avascular necrosis of bone?

A

Insufficiency of medial circumflex femoral artery, infarction of bone and marrow

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24
Q

What are some causes of Avascular necrosis of bone?

A

CAST Bend LEGS
Corticosteroids, Alcohol, Sickle cell, Trauma, SLE, Legg CalvePerthes, Gauchers, slipped capital femoral epiphysis

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25
Brown tumors due to fibroma replacement of bone, subperiosteal thinning, idiopathic or parathyroid hyperplasia (increase in PTH), adenoma carcinoma is which disease?
Osteitis Fibrosa Cystica (primary hyperparathyroidism)
25
Brown tumors due to fibroma replacement of bone, subperiosteal thinning, idiopathic or parathyroid hyperplasia, adenoma carcinoma is which disease?
Osteitis Fibrosa Cystica
26
How does secondary hyperparathyroidism differ from primary hyperparathyroidism?
Secondary hyperparathyroidism has a decrease in Ca+ and Primary hyperparathyroidism has an increase in PTH
27
Which primary benign bone tumor is most common in males under 25 at the metaphysis of long bones?
Osteochondroma
28
What primary bone tumor occurs in middle-aged males at the surface of the facial bones and associated with Garner syndrome?
Osteoma
29
What primary bone tumor presents with bone pain worse at night relieved by NSAIDs and is smaller than 2 cm?
Osteoid osteoma
30
What primary benign bone tumor is present at the cortex of long bone?
Osteoid osteoma
31
Which primary bone tumor is unresponsive to NSAIDS and larger than 2 cm?
Osteoblastoma
32
What is the location of Osteoblastoma?
Vertebrae
33
What primary benign cartilage disorder is located at the medulla of small bones of the hand and foot?
Chondroma
34
What is a Giant cell tumor?
Locally aggressive benign tumor, neoplastic mononuclear cells that express RANKL and reactive multinucleated giant cells
35
What will a Giant cell tumor appear as on an x ray and where is it located?
Soap bubble appearance Epiphysis of long bones (knee)
36
What is Osteosarcoma?
Pleomorphic osteoid producing cells (malignant osteoblasts) Presenting with pain and fractures
37
What is the location of Osteosarcoma?
Metaphysis of long bone, knee
38
What are the predisposing risks of Osteosarcoma?
Paget's, bone infarcts, radiation, familial retinoblastoma, Li-Fraumeni syndrome, typically less than 20-year-old males
39
Where is Chondrosarcoma located?
Medulla of the pelvis, proximal femur and humerus, in pts older than 50
40
Which malignant bone tumor is common in white males less than 15 years old?
Ewing's Sarcoma
41
What is the translocation of Ewing's sarcoma?
11:22, 11 + 22 = 33 (Patrick Ewing's Jersey #)
42
What is Ewing's Sarcoma?
Anaplastic small blue cells of neuroectodermal with an onion skin periosteal
43
Which site of the bone is Ewing's Sarcoma most likely to be located at?
Diaphysis of long bone, femur, pelvic
44
What is the pathogenesis of Osteoarthritis?
Mechanical- wear and tear destroying the articular cartilage, degenerative joint disorder Inflammation with inadequate repair
45
What are the predisposing factors of Osteoarthritis?
Age, female, obesity and joint trauma
46
What is the pathogenesis of Rheumatoid arthritis?
Autoimmune- inflammation induces a formation of a pannus (proliferative granulation tissue) that erodes articular cartilage and bone
47
What is the RF factor?
IgM antibody that targets IgG Fe region, anti-citrullinated
48
What are the predisposing factors for Rheumatoid Arthritis?
Female, HLADR4, tobacco smoking and positive RF factor
49
What are the clinical presentations of Osteoarthritis?
Pain in weight bearing joints after use (at night) improving with rest Asymmetric joint involvement Knee cartilage loss begins medially (bow leg) No systemic symptoms
50
What are the clinical presentations of Rheumatoid Arthritis?
Pain, fever, fatigue, weight loss, swelling and morning stiffness lasting long than 1 hour/ 30 minutes improving with use, systemic joint involvement
51
What are additional findings in RA?
1.) fibrinoid necrosis with palisading histocytes 2.) pneumonoconiosis- Caplan's syndrome 3.) ILD 4.) pleuritis 5.) Pericarditis 6) anemia 7.) neutropenia + splenomegaly = Felty syndrome 8.) AA amyloidosis 9.) Sjogren syndrome 10.) Scleritis 11.) Carpal tunnel
52
What are the predisposing factors of Gout?
1.) Obesity 2.) Alcohol/dehydration 3.) Thiazides 4.) HT 5.) Males 6.) Red meats and seafood 7.) Diabetes 8.) Dyslipidemia 9.) Hyperuricemia -caused by under excretion of uric acid of renal failure -caused by hyper excretion of uric acid by Lesch Nyhan syndrome and Von Gierke ) trauma/surgery
53
What are the symptoms of Gout?
Asymmetric joint distribution, swollen, red and painful, usually of the big toe MTP, TOPHUS FORMATION,
54
What is tx for acute Gout?
NSAIDs such as indomethacin, glucocorticoids, colchicine
55
What is the tx for chronic Gout?
Xanthine oxidase inhibitors such as allopurinol, febuxostat
56
What is Pseudogout/ calcium pyrophosphate deposition disease?
Occurs in patients over 50 yrs old in both sexes. Pain, swelling and acute inflammation around the knee
57
What other conditions can be associated with pseudogout/ calcium pyrophosphate?
Hemochromatosis, hyperparathyroidism, joint trauma
58
What would you see under a polarized light for Pseudogout/ calcium pyrophosphate?
cartilage calcification, blue rhomboid crystals
59
What is the tx for acute pseudogout/calcium pyrophosphate?
NSAIDs, colchicine, glucocorticoids
60
If a young male presents with daily spiking fevers, salmon pink macular rash, arthritis, anterior uveitis, leukocytosis, thrombocytosis, anemia, increased ESR and C reactive protein, what is the likely diagnoses?
Systemic juvenile idiopathic arthritis
61
What is the tx for systemic juvenile idiopathic arthritis?
NSAIDS, steroids, methotrexate, TNF inhibitors
62
What autoimmune disorder is characterized by the destruction of exocrine glands (lacrimal and salivary) by lymphatic infiltration, predominantly in 30-40 yrs old females?
Sjogren's Syndrome
63
What are the clinical features of Sjogren's Syndrome?
Inflammation joint pain, keratoconjunctivitis sicca (decreased tears), Xerostomia (decreased salvation), Rf factor and can be present with RA, enlarged parotoid gland
64
What are common causes of Septic Arthritis?
S. Aureus, Streptococcus, and Neisseria gonorrhea, unilateral, affected joint is swollen, red and painful. Synovial fluid is turbid/purulent

SD IV (1 decks)

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