MSK

Question 1

achondroplasia - gene mutation, pathophys

Answer 1

• most common inherited form of dwarfism
• mutation in FGF-3 (fibroblast growth factor 3)
• results in premature endochondral ossification leading to proximal limb shortening, frontal bossing, etc

Question 2

ankylosing spondylitis (genetic factors, associated complications)

Answer 2

• HLA-B27

- uveitis and aortic regurg

Question 3

osteogenesis imperfecta (type of collagen and affected tissues, genetics)

Answer 3

• defect in formation of type I collagen, due to AD mutation
• collagen I important in tensile strength, affected tissues: bone, skin, tendons, ears, teeth (blue sclera)
• defect in translation of mRNA

Question 4

radial nerve innervation

Answer 4

• anterior compartment of the forearm except flexor carpi ulnaris and ulnar portion of flexor digitorum profundi
• thenar muscles and first and second lumbricals in the hand

Question 5

ulnar n. innervation

Answer 5

• flexor carpi ulnaris and ulnar portion of the flexor digitorum profundi
• all of the muscles of the hand except thenar and lumbricals

Question 6

median n. innervation

Answer 6

-entire posterior compartment of the forearm

Question 7

heberden’s nodes

Answer 7

-enlargement of DIPs

Question 8

RA vs OA

Answer 8

-OA: heberden’s nodes, weight bearing joints, degenerative disease, progressive, better after rest

Question 9

giant cell arteritis

Answer 9

• common cause of unilateral or bilateral blindness
• associated with HA, fatigue, and polymyalgia rheumatologica (PMR)
• tx: high dose corticosteroids

Question 10

gout (diagnosis (crystals), extraarticular manifestations and tx, both acute and chronic)

Answer 10

• negatively birefringant
• gout nephropathy and tophi are most common
• acute tx: indomethacin (or other NSAID) to treat inflammation and pain, colchicine
• chronic tx: allopurinol (decrease uric acid formaiton) and/or probenecid (increase excretion in urine)

Question 11

4 muscles of jaw movement

Answer 11

• M’s munch and lateral lowers
• masseter, medial pterygoid and teMporalis
• lateral pterygoid
• all innervated by V3

Question 12

ehlers-danlos (genetics, collagen type, sequelae)

Answer 12

• defect in collagen cross-linking
• collagen type III
• sequelae: scoliosis, vascular disorders, spontaneous ruptures of vessels and organs, retinal detachment

Question 13

prostate cancer (associated lesion?)

Answer 13

-osteoblastic lesion

Question 14

guillen-barre

Answer 14

• autoimmune, destruction of schwann cells
• starts distally, ascends symmetrically
• often follows camp. jejuni infection

Question 15

cremaster muscle

Answer 15

• derived from internal oblique

Question 16

sero-negative spondyloarthropathy

Answer 16

• reactive arthritis

- extra-articiular manifestations: conjunctivitis, arthritis

Question 17

lyme disease (signs and symptoms) FAKE

Answer 17

-FAKE

facial nerve palsy, oligoarthritis, kardiac block, erythema migricans

Question 18

ANCA vasculitides (what does ANCA mean, 3 vasculitides and p-ANCA vs c-ANCA)

Answer 18

• antineutrophil cytoplasmic antibody
• allergic granulomatosis and angiitis (churg-strauss)… eos, allergies/asthma… p-ANCA
• microscopic polyangiitis… p-ANCA
• granulomatosis and polyangiitis (wegners)… c-ANCA

Question 19

rocky mountain spotted fever (common symptoms, causative agent, tx)

Answer 19

• rash starting on palms of hands and soles of feet, fever
• caused by rickettsia rickettsii, obligate intracellular parasite bacterium
• tx: tetracycline antibiotics ASAP

Question 20

polyarteritis nodosum

Answer 20

• affects small to medium arteries, especially renal, GI and cardiac
• up to 20% of pts have Hx of HBV
• tx: with immunosuppression: glucocorticoids and/or cylcophosphamide

Question 21

beurger’s vasculitis

Answer 21

• affects arteries of the extremities: claudication and raynauds
• often heavy smokers–> tx: quit smoking

Question 22

takayasu’s vasculitis

Answer 22

• fibrotic thickening of the aortic arch (sometimes pulmonary arteries and rest of aorta)
• weaker pulses in upper extremities than lower
• tx: with steroids are CABG in non-responsive pts.

Question 23

kawasaki’s

Answer 23

• oral erythema, conjunctivitis, edema and erythema of soles and palms, fever and enlarged nodes
• often self limited
• tx: with IV IG

Question 24

toxic shock syndrome

Answer 24

• tsst-1, superantigen produced by staph infection
• creates non-specific activation of t-lymphocytes
• gram positive cocci on culture

Question 25

most commonly injured ligament in ankle sprain

Answer 25

-anterior talofibular ligament

Question 26

radial nerve innervates...

Answer 26

BEST - brachioradialis - extensors of wrist and fingers - supinator - triceps

Question 27

most common cause of osteomyelitis in kids

Answer 27

-staph aureus

Question 28

winging scapula

Answer 28

- injury to serratus anterior or long thoracic n. | - C5,6 and 7

Question 29

anti-jo-1 antibodies

Answer 29

- polymyositis and dermatomyositis | - other signs/symptoms: symmetric proximal muscle weakness, heliotrope rash, elevated muscle enzymes

Question 30

sjøgrens

Answer 30

- typically women, 35-45 - dry eyes, dry mouth and some other autoimmune or connective tissue disease - HLA DR-3

Question 31

polymyositis vs dermatomyositis

Answer 31

- both: symmetric progressive proximal muscle weakness - poly: shawl rash, CD-8 T cells - dermato: shawl and malar rash, CD-4 T cells, increase risk of malignancy, mechanics hands, gottron papules

Question 32

osteomyelitis (common causes)

Answer 32

-IV drug users–> pseudomonas

Question 33

3rd branchial arch

Answer 33

-stylopharyngeus, innervated by CN IX

Question 34

injuries of superior and inferior gluteal n. (common associations and affected movements)

Answer 34

- superior: unable to stabilize hip when walking, swing straight leg circumferentially, associated with polio - inferior: difficulty standing or jumping, defect with innervation to gluteus maximus, associated with hip dislocation

Question 35

common type of fracture in child abuse

Answer 35

-spiral (twisting arm)

Question 36

ewing's sarcoma

Answer 36

- boys under 15, aggressive, but responsive to chemo - small blue cells - 11-22 translocation (patrick ewing's number was 33)

Question 37

osteosarcoma

Answer 37

- young men, 10-20 years old, often at metaphysis of long bones - most common malignant tumor of the bone

Question 38

waiters tip palsy

Answer 38

- stretching of C5-C6 nerve roots during birth, affects superior trunk - arm is adducted, flexed and medially rotated

Question 39

association with giant cell arteritis

Answer 39

-polymyalgia rheumatica

Question 40

JIA (juvenile idiopathic arthritis)

Answer 40

- spiking and remitting fever that coincides with salmon-pink rash, also joint pain - no Rh factor typically - tx: NSAID, corticosteroids, IVIG etc

Question 41

osteopetrosis

Answer 41

- failure of osteoclasts, bone marrow is replaced by bony matrix–> hematopoeisis fails, starts producing extramedullary - brittle bones - AD: less malignant, can be found incidentally - AR: more malignant, usually fatal in utero or perinatal period

Question 42

RRF (ragged red fibers)

Answer 42

- mitochondrial inheritance myopathy | - all kinds of bad symptoms

Question 43

rhuematic fever

Answer 43

- group a beta-hemolytic strep (strep pyogenes) | - 2 of 5: migratory polyarthritis, carditis, subQ nodules, spreading circular erythema, chorea

Question 44

most common hernia and anatomical predisposition

Answer 44

-indirect, due to failure of processes vaginalis to close

Question 45

formation of long bones vs facial bones and skull bones (type of ossification)

Answer 45

- long bones: endochondral ossification, osteoblasts deposit minerals over hyaline cartilage mold - facial/skull bones: membranous ossification, osteoblasts weave bone de novo

Question 46

Tom, Dick And Very Nervous Harry

Answer 46

-Tibialis posterior, flexor Digitorum longus, posterior tibial Artery, Vein, Nerve and flexor Hallucis