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MSK Flashcards

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1
Q

Erb-Duchenne Palsy (“Waiter’s Tip”)

Def’n, Pres?

A

Superior Trunk (C5-C6) Brachial Plexus injury.

PRES:
- “Neonate with ARM PARALYSIS following difficult birth”

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2
Q

“Fall on an outstretched hand”

Bone + Nerve damaged?

A

Hook of Hamate -> Ulnar nerve

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3
Q

Bone Disease

Enzyme↑?

A

Alkaline phosphatase

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3
Q

Skeletal Muscle Injury / Damage

Enzymes↑(2)?

A
  • CKMB (SEVERE injury)

- LD4 + LD5 (damage)

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4
Q

Carpal Tunnel Sx

Def’n, Pres (3)?

A

Entrapment of Median nerve in carpal tunnel -> nerve compression.

PRES:

  • Paresthesia (Tinel sign)
  • Pain
  • Numbness in distribution of Median nerve
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5
Q

Acute Carpal Tunnel Sx

Cause?

A

CAUSE = Dislocation of Lunate

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6
Q

Guyon Canal Sx

Def’n, Pres (Epi)?

A

Compression of Ulnar nerve at wrist / hand.

PRES: Cyclists

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7
Q

Tetany

Mech, Causes (Electrolytic)?

A

Activation of all nerve cells in body -> muscle overstimulation ->
muscle spasms + cramps.

CAUSES:

  • ↓Ca
  • ↓Mg
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8
Q

Muscular Dystrophy

Inher, Def’n, Pres?

A

XR.

XR deletion of dystrophin gene.

PRES:
- Calf pseudohypertrophy

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9
Q

Duchenne Muscular Dystrophy

Def’n, Inher, Genetics, Pres (2)?

A

Deletion of dystrophin gene.

XR.

Frameshift DNA mutation.

PRES:

  • Calf pseudohypertrophy
  • “Child uses arms to stand up from squat”
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10
Q

Becker Muscular Dystrophy

** LESS severe than Duchenne **

Def’n, Inher, Pres (Epi + 1)?

A

Missense mutation in dystrophin gene.

XR.

PRES: Boys
- Slow, progressive muscle weakness

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11
Q

McArdle Disease

Def’n, Pres (5), Urine?

A

Muscle Glycogen Phosphorylase deficiency.

PRES:

  • Chronic exercise intolerance
  • Fatigue
  • Myalgia
  • Cramps

URINE:
- Myoglobinuria

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12
Q

Achondroplasia

Mech (2 steps), Inher (2), Genetics, Pres (2)?

A

MECH:
Impaired chondrocyte / cartilage prolif in growth plate ->
Failure of Endochondral Ossification = longitudinal bone growth.

INHER:

  • AD
  • > 85% mutations sporadic and assoc with increased paternal age

FGFR3 Activating Mutation (-> overexpression -> growth inhib).

PRES:

  • Short limbs / Dwarfism
  • “Large head relative to limbs” (b/c membranous ossification NOT affected)
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13
Q

McCune-Albright Sx (form of Polyostotic Fibrous Dyplasia)

Def’n, Assoc, Pres (2)?

A

Bone is replaced by fibroblasts, collagen and irregular bony trabeculae.

ASSOC:
- Precocious Puberty

PRES:

  • Multiple unilateral bone lesions
  • Cafe-au-Lait spots
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14
Q

Osteoporosis

Def’n / Mech (3 steps), 2 Types, Comp (2), Prev (2), Rx (3), CI?

A

↓TRABECULAR bone mass / density / interconnections ->
Porous bone ->
↑risk of fracture + thin cartilage between vert.

  • Type I = Postmenopausal (↓Estrogen -> ↑bone resorption)
  • Type II = Senile

COMP:

  • Compression / Vertebral Crush fractures
  • Colles fracture (fracture of distal radius)

PREV:

  • Regular WEIGHT-BEARING exercise
  • Adequate Ca + Vit D intake throughout adulthood

RX:

  • Calcitonin (inhibits osteoclasts)
  • Estrogen (inhibits bone resorption)
  • For severe cases: PTH or Bisphosphonates

CI:
- Glucocorticoids

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15
Q

Vertebral Crush Fractures

Def’n / Seen In, Pres (4: 3 + 1 sign)?

A

Possible comp of Osteoporosis.

PRES:

  • Acute back pain
  • Loss of height
  • Kyphosis
  • ‘Dowager’s Hump’
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16
Q

Paget’s Disease of Bone

Pres (6, incl Epi), Labs, Biopsy Finding, Comp (2)?

Study These Flashcards
A

PRES: Avg age > 60

  • “↑hat size” (bone enlargement that commonly affects skull)
  • “Lion-like facies”
  • Hearing loss (auditory foramen narrowing)
  • Bone pain (due to microfractures)
  • Arthritis

LABS:
- ALP ↑

FINDING:
- “Mosaic” / “Woven” pattern of lamellar bone

COMP:

  • High-Output Cardiac Failure (formation of A-V shunts in bone -> ↑blood flow)
  • Osteosarcoma
17
Q

Osteomyelitis

Pres (2)?

Study These Flashcards
A

PRES:

  • Bone pain w systemic signs of infection
  • Lytic abscess surrounded by sclerosis on bone
18
Q

Osteitis Fibrosa Cystica

Cause, Pres?

Study These Flashcards
A

CAUSE = Hyperparathyroidism

PRES = “Brown tumors” (due to deposited hemosiderin from hem)

19
Q

Giant Cell Tumor of Bone (Osteoclastoma)

Location, XR Finding?

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A

Long bones (epiphysis): KNEE region- distal femur / proximal tibia.

XR FINDING:
- “Soap bubble” appearance on XR (lytic expansile lesion)

20
Q

Ewing Sarcoma

Def’n, Locations (4), Genetics, Pres (Epi)?

Study These Flashcards
A 
Anaplastic malignant (aggressive with early metastases) small 
round / blue-cell tumor.

Long bones (diaphysis), Scapula, Ribs, Pelvis.

11;22 translocation.

PRES: Boys

21
Q

Osteosarcoma

Assoc (6), Location, Pres (Epi), XR Findings (2 possible)?

Study These Flashcards
A

ASSOC: (Predisposing factors)

  • Rb suppressor gene
  • Familial Retinoblastoma
  • Li-Frameuni Sx (germline p53 mutation)
  • Paget’s Disease of Bone
  • Bone infarcts
  • Radiation

Long bones (metaphysis). ** Often around KNEE **

PRES: Men 10-20

XR FINDING:
- “Codman’s Triangle” or “sunburst pattern”

22
Q

Infectious Arthritis

2 Types?

Study These Flashcards
A
  • Septic

- Chronic

23
Q

Septic Infectious Arthritis

Causative Agents (3)?

Study These Flashcards
A
  • S aureus
  • Strep
  • Neisseria gonorrhoeae
24
GONOCOCCAL Septic Infectious Arthritis / Disseminated Gonococcemia Def'n, Pres (2)?
STD (Gonococcemia) in person that is missing C5-C9 -> Disseminated -> MIGRATORY arthritis. PRES: *Asymmetrical*. * "STD" * - Monoarticular arthritis - Pustules on palm
25
Chronic Infectious Arthritis Causative Infections (2)?
- Lyme Disease | - TB ( -> mycobacterial dissemination)
26
Reactive Arthritis / Reiter's Sx HLA, Mech, Pres (Triad)?
HLA-B27. MECH: HLA-B27 -> envir trigger = Chlamydia or GI infection. PRES: Male 1. Arthritis ("Achilles pain") 2. Conjunctivitis + Ant Uveitis (sterile) 3. Urethritis
28
Osteoarthritis Joints Affected, Pres, Joint Findings (4)?
PIP + DIP. PRES: "Swollen, hard + painful FINGER joints" - Pain in weight-bearing joints after use & improving with rest JOINT FINDINGS: - Osteophytes (bone spurs = rx to injury) - Heberden nodes: Osteophytes on DIP - Bouchard nodes: Osteophytes on PIP - Eburnation (polished "ivory-like" appearance of bone at site of cartilage erosion) - Subchondral Cysts - Sclerotic bone (close to joint)
29
RA Mech (incl H-S types), Antibodies (2), HLA Assoc, Joints Affected, Pres (Epi + CLUE + 6), Comp (2), Rx?
Inflammation. Type 3 + 4 H-S. - Rheumatoid factor (80% of patients) - Anti-Cyclic Citrullinated Peptide antibody (more specific) HLA-DR4. MCP + PIP. PRES: *Often symmetrical*. MC in Females. "Morning stiffness lasting > 30 min and improving with use." - Systemic infl - Joint Pannus - Boutonniere Deformity - Baker Cyst (behind knee / in popliteal fossa) - Subcutaneous rheumatoid nodules (fibrinoid necrosis) - Ulnar deviation of fingers COMP: - Sjorgen's Sx - Pericarditis RX: - Methotrexate
30
Sjogren's Sx Def'n, Assoc, Pres (Epi + 4), Labs, Comp (2)?
Autoimmune disorder char by destruction of EXOCRINE GLANDS (esp lacrimal +salivary glands). Can be a primary disorder or a secondary disorder assoc with another autoimmune disorder (eg RA). ASSOC: - RA PRES: Females 40-60. "Dry eyes, dry mouth, arthritis." - Xerophthalmia (↓tear production -> corneal damage): "Sand in my eyes". Dry eyes + conjunctivitis. - Xerostomia (↓saliva production): Dry mouth. - Bilateral Parotid enlargement - Arthritis LABS: Antinuclear Antibodies - SS-A and/or SS-B COMP: - Dental caries - MALT Lymphoma
31
SLE Pres (9: Epi, 3, 2, 5), Antibodies (5), Blood Findings (4) Comp / Causes of Death (3)?
PRES: Young female, MC African - Arthritis - Fever, Fatigue + Weight Loss - Photosensitivity - "Butterfly" facial rash - Oral / Nasopharyngeal ulcers - Neuro disorders (eg seizures) - Libman-Sacks Endocarditis - Renal Disease (Lupus Nephropathy + DP Glomerulonephritis) - Raynaud Phenomenon - Autoimmune (IgG) = Warm Agglutinin Hemolytic Anemia ANTIBODIES: - ANA (sensitive, not specific) - Anti-Smith (specific) - Anti-Cardiolipin (-> False + on Syphilis test) - Anti-Histone - Anti-dsDNA (specific & poor prognosis) BLOOD: - ↓C3 + C4 (due to IC formation) - Schistocytes - Neutropenia - Lymphopenia COMP: - Constrictive Pericarditis / Libman-Sacks Endocarditis (due to serositis -> effusions in lupus) - Renal Disease / Failure - Infections
32
Polymyalgia Rheumatica Assoc, Pres (Epi +2), Blood Findings (2), RX?
ASSOC: - Temporal Giant Cell Arteritis PRES: > 50 y.o, MC Females - Pain / stiffness in Shoulders + Hips - Fever, Fatigue + Weight Loss BLOOD: - ↑C-reactive protein - ↑ESR RX = Prednisone
33
Fibromyalgia Pres (Epi + 2)?
PRES: 20-50 y.o, MC Females - Widespread MSK stiffness, pain + paresthesia - Poor sleep + fatigue
34
Dermatomyositis Def'n, Pres (3, incl 3 rashes), Comp?
Infl disorder of skin + skeletal muscle. PERImysial infl w CD4+ T cells. PRES: Polymyositis + ... - Rashes - Malar rash (similar to SLE) - Heliotrope rash - "Shawl + Face rash" - Gottron Papules: red papules on elbows, knees + knuckles - "Mechanic's hands" COMP: -↑risk of occult malignancy
35
Pseudogout Def'n, Assoc (2), Micro Finding?
Precipitation of calcium pyrophosphate dihydrate crystals in joints. ASSOC: - Hemochromatosis - Hyper- + Hypoparathyroidism FINDING: - POSITIVELY birefringent RHOMBOID crystals (blue when parallel to light; yellow when perpendicular to light) * Contrast with Gout *
36
Gout Def'n, MC Locations (5), Cause, Mech (2), Seen In, Pres (6), Micro Finding?
Acute inflammatory MONOarthritis caused by precipitation of monosodium urate crystals in joints. External Ear, Elbows (olecranon bursa), Fingers, Achilles tendon, Big Toe. CAUSE = Hyperuricemia. MECH of Hyperuricemia: * 1. (90%) UNDEREXCRETION of uric acid. Mostly idiopathic, however can be exacerbated by certain meds (ie thiazide diuretics). 2. (10%) OVERPRODUCTION of uric acid. SEEN IN: - Lesch-Nyhan Sx PRES: MC in Males. "Sudden swollen + painful big toe." - Asymmetric joint distribution - Red, swollen + painful joints - Podagra - Tophi (Chronic Gout ONLY) - Acute attacks after large meal or alcohol consumption FINDING: - NEEDLE-shaped + NEGATIVELY birefringent crystals (yellow under parallel light; blue under perpendicular light) * Contrast with Pseudogout *
37
Polymyositis Def'n, Location, Pres?
Infl disorder of skeletal muscle. Char by ENDOmysial infl with CD8+ T cells. MC in Shoulders. PRES: *Symmetrical* - Progressive PROXIMAL muscle weakness
38
Psoriatic Arthritis (although seen in fewer than 1/3 of patients with Psoriasis) Pres (2), XR Finding?
PRES: *Asymmetric + Patchy involvement* - Joint stiffness + pain - Dactylitis ("sausage fingers") XR FINDING: - "Pencil in cup" deformity
39
Ankylosing Spondylitis Def'n + Location, HLA, Pres (3), Labs, XR Finding?
Chronic inflammatory arthritis of Spine + SI joint. Ankylosed joint = fixed. HLA-B27. PRES: - Stiff / ankylosed spine -> Hunched over back. "Pain in lower back / SI joint. Pain improves as day progresses". - Aortitis + Aortic Regurg - Uveitis -> risk of Blindness LABS: - Bl Gas abnormalities (hunched back affects chest cavity and ability to breathe) XR: - "Bamboo spine" on XR (due to vertebral fusion).
39
Seronegative Spondyloarthropathies 4 Types ("PAIR"), Def'n, Assoc, Pres (Epi)?
- Psoriatic Arthritis - Ankylosing Spondylitis - IBD - Reactive Arthritis / Reiter's Sx Arthrites without Rheumatoid factor. Strong assoc with HLA-B27. PRES: MC in Males

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