MSK Flashcards Preview

Step I > MSK > Flashcards

Flashcards in MSK Deck (79):
1

unhappy triad

contact sports d/t lat force applied to planted leg
ACL, MCL, medical meniscus (attached to MCL)
lat meniscus actually more common

2

prepatellar brusitis

aka housemaids knee
d/t repeated kneeling

3

rotator cuff mm innervation

C5-6

4

medial epicondylitis

aka golfers elbow
repetitive flexion or idiopathic
pain near medial epicondyle

5

lateral epicondylitis

aka tennis elbow
repetitive extension or idiopathic
pain near lat epicondyle

6

carpal tunnel associations

prego
RA
hypothyroidism

7

guyon canal

compression of ulnar n at wrist or hand
seen in cyclists

8

axilarry

C5-6
deltoid
loss of arm abductions >15 degress
loss of sensation over delt and lat arm

9

musculocutaneous

C5-7
loss of forearm flexion and supination
loss of sensation over lat forearm

10

radial

C5-T1
wrist drop
loss of extension
decreased grip strength
loss of sensation over post arm/forearm and dorsal hand

11

median

C5-T1
'Ape hand'
'popes blessing'
loss of flexion of wrist and lat fingers, thumb opposition, lumbricals on 2nd and 3rd digit
loss of sensation over thenar eminence

12

ulnar

C8-T1
ulnar claw
proximal- radial deviation of wrist upon flexion
loss of wrist flexion
medial 2 lumbricals
loss of senation over medial 1.5 fingers

13

recurrent brr of median n

C5-T1
'ape hand'
loss of thenar group
no loss of sensation

14

obturator

L2-4
decreased thigh sensation (medial) and decreased adduction

15

femoral

L2-4
decreased thigh flexion and leg extension

16

common peroneal

L4-S2
foot drop- inverted and plantar flexed at rest
steppage gait
loss of sensation on dorsum of foot
PED: Peroneal Everts and Dorsiflexes, if injured goot dropPED

17

tibial

L4-S3
inability to curl toes and loss of sensation on sole of foot
proximal lesions- foot everted at rest
can be d/t bakers cyst
TIP: Tibial Inverts and Plantar flexes, if injured cannot stand of TIP toes

18

superior gluteal

L4-S1
trendelenburg gait
loss of glut medium and minimus

19

inferior gluteal

L5-S2
difficulty climbing Strauss, rising from seated position
loss of hip extension

20

herniated L3-L4

weakness of knee extension
decreased patellar reflex

21

herniated L4-5

weakness in dorsiflexion
difficulty in heel walking

22

herniated L5-S1

weakness of plantarflexion
difficulty in toe walking
decreased achilles reflex

23

achondroplasia

failure of longitudinal bone growth ->
membraneous ossfication not affected -> big head
constitutive activation of FGFR3 inhibits chondrocyte proliferation
85%+ sporadic
AD w/full penetrance (homo lethal)
MCC of dwarfism

24

osteopetrosis

failure of normal bone resorption
thickened dense bones that fracture
pancytopenia, extramedullary hematopoiesis
mutations in carbonie anhydrase II cannot create acidic environment
x-ray bone-in-bone appearance
can cause CN palsies
bone marrow transplant

25

paget disease

disordered bone remodeling
increase in both osteoblastic and osteroclastic activity
mosaic pattern
long bone chalk-stick fractures
increased blood flow from AV shunts may cuase high-output heart failure
increased risk of osteogenic sarcoma
hat sized increased
hearing loss d/t narrowed auditory foramen

26

stages of pagets

lytic-osteoclasts
mixed-osteoclasts and blasts
sclerotic- osteroblasts
quiescent- minimal activity

27

causes of osteronecrosis

ASEPTIC
alcoholism
sickle cell
storage
exogenous/endogenous steroics
pancreatitis
trauma
idiopathc
caisson (the bends)

28

lab values osteoporosis

serum Ca, phos, ALP, PTH normal
decreased bone mass/DEXA

29

lab values osteomalacia

decreased Ca, phos
increased ALP, PTH
soft bones

30

lab values osteopetrosis

Ca normal or low
Phos, ALP, PTH normal
dense brittle bone

31

lab values pagets

normal Ca, phos PTH
elevated ALP
mosaic bone

32

lab hypervitaminosis D

Ca and phos high
normal ALP
high PTH
granulomatous diseases (sarcoid)

33

osteitis fibrosa cystica d/t primary hyperparathyroidism

increased Ca, ALP, and PTH
decreased Phos
brown tumors d/t fibrous replacement of bone

34

osteitis fibrosa cystica d/t secondary hyperparathyroidism

decreased Ca
increased Phos, ALP, PTH
compensation for ESRD

35

benign bone tumors

giant cell
osteochrondroma (MC)

36

Giant cell

20-40yr
epiphyseal end of long bones
benign, but locally aggressive
often knee
'soap bubble' on xray
multinucleated giant cells
Neoplastic cells are osteoblasts (express RANKL)
markers- alkaline phosphatase and ostocalsin

37

osteochondroma

MC benign bone tumor
males

38

malignant bone tumors

osteosarcoma/osteogenic sarcoma
Ewing sarcoma

39

osteosarcoma

2nd MC primary malignant bone tumor (after MM)
Bimodal 10-20 and >65
metaphysis of long bones, usually at knee
codmans triangle or sunburst on x-ray
aggressive Tx w/surgical resection and chemo

40

predisposing factors for osteosarcoma

pagets
bone infarcts
radiation
familial retinoblastoma
Li-fraumeni

41

Ewing sarcoma

boys

42

11,22

EWS-FLI1

43

joint findings in osteoarthritis

subchondral cysts
sclerosis
osterophyts
ebunation
synovitis
heverden nodes (DIP)
Bouchard nodes (PIP)
no MCP involvement

44

RA etiology

autoimmune
mediated by cytodines
type III and IV hypersensitivity rxn

45

RA joints

pannus (MCP, PIP)
sub-q rheumatoid nodules (fibrinoid necrosis)
ulnar deviation of fingers
subluxation
rare swan neck and boutonniere deformities
rare DIP involvement

46

predisposing factors to RA

females
RF (anti-IgG)
anti-CCP more specific
HLA-DR4

47

sjogren syndrome

autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates
females 40-60

48

findings of sjogren

inflammatory joint pain (can be associated w/RA)
xerophthalmia
xerostomia
antinuclear Abs: SS-A/anti-Ro, SS-B (anti-La)
b/l parotid enlargement

49

complications of sjogrens

dental carries
MALT lymphomas

50

what meds can decrease uric acid excretions

thiazide diuretics

51

what is associated w/overproduciton of uric acid

lesch-nyhans
PRPP excess
increased cell turn over (tumor lysis syndrome)
von Gierke disease

52

gout crystals

needle shaped, neg bifringement
yellow under parallel light, blue under perpendicular

53

pseudogout

Ca pyrophophate crystals
basophilc rhomboid cyrstals
large joints (knee)
>50, both sexes
blue when parallel to light, yellow when perpendicular

54

pseudogout associations

homochromatosis
hyperparathyroidism
osteoarthritis

55

infectious arthritis

S. aureus
Steptococcus
Neisseria gonorrhea

56

seronegative spondyloarthropathies

HLA-B27, NO RF
PAIR
Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

57

psoriatic arthritis

joint pain and stiffness associated w/psoriasis
asymmetric and patchy involement
dactylitis (sausage fingers)
pencil-in-cup

58

ankylosing spondylitis

chronic inflammatory disease of spine and SI joint
uveitis
aortic regurg
bamboo spine (vertebral fusion)

59

Reactive arthritis

Conjuctivits, urethritis, arthritis
can't see, can't pee, can't climb a tree
Post GI (shigella, salmonella, yersinia, campylobacter) or chlamydia infections

60

systemic lupus erythmatosus

women, repro age, black
RASH OR PAIN
rash (malar or discoid)
arthritis
soft tisseus/serositis
hematologic disorders
oral/nasopharyngeal ulcers
renal disease/raynauds
photosensitivity/postive VDRL/RPR
anti-nuclear Abs
immunsuppressants
nerological disorders

61

CCD in SLE

cardiovascular disease
infections
renal disease

62

SLE nephritis

type III sensitivity rxn
nephritic- diffuse proliferative glomerulonephritis
nephrotic- membranous glomerulonephritis

63

libman-sacks endocarditis

SLE
nonbacterial wart-like vegetations on both sides of valve

64

SLE findings

antinuclear abs (ANA), not specific
anti-dsDNA abs (specific, poor prognosis -> renal disease)
anti-smith/anti-snRNP abs (specific, not prognostic)
anti-histone- drug SLE
decreased C3, C4, CH50 d/t IC formation

65

antiphospholipid syndrome

primary or secondary autoimmune
MC d/t SLE
history of thrombosis and/or spontaneous abortions
lupus anticoagulant, anticardiolipin anti beta2 glycoprotein Abs
false + VRDL d/t anditcoagulant and anticardiolipin
Tx systemic anticoagulation

66

sarcoidosis

immune mediated widespread, noncaseating granulomas
elevated ACE, CD4/CD8 ratio
black females
often asymptomatic, except for enlarged lymph nodes

67

sarcoidosis CXR

b/l adenopathy and coarse reticular opacities
CT better shows extensive hilar and mediastinal adenopathy

68

sarcoidosis is associated w/what?

restrictive lung disease (interstitial fibrosis)
erythema nodosum
lupus pernio
bells palsy
epithelioid granulomas
uveitis
hypercalcemia

69

epithelioid granulomas of sarcoidosis

schaumann and asteroid bodies

70

hypercalcemia of sarcoidosis

d/t increased 1 alpha hydroxylase mediated vit D activation in macros

71

polymyalgia rheumatica

pain and stiffness in shoulder and hips w/fever malaise, weight loss
does not cause mm weakness
women >50
associated w/temporal arteritis

72

labs in polymyalgia rheumatica

increased ESR, CRP
normal CK

73

Tx of polymyalgia rheumatica

rapid response to low dose corticosteroids

74

polymyositis and dermatomyositis

increased CK
ANA+
anti-Jo1
anti-SRP
anti-Mi2
Tx steroids followed by long term immunosuprresion (MTX)

75

polymyositis

progressive symmetric proximal mm weakness
endomysial inflammation w/CD8 cells
most often involves shoulders

76

dermatomyositis

similar to polymyositis but has malar rash
gottrons papules
heliotrope rash
shawl and face rash
mechanics hands
increased risk of occult malignancy
perimysial inflammation
atrophy w/CD4 cells

77

sclerederma/systemic sclerosis

triad of autoimmunity, noninflammatory vasculopathy, collagen deposition w/fibrosis
puffy, taught skin w/p wrinkles
fingertip pitting
sclerosis of renal, pulmonary (MCCOD), GI
females

78

diffuse scleroderma

widespread skin involvement
rapid progression
early visceral involvement
anti Scl-70/anti topoisomerase I

79

limited scleroderma

limited skin involvement, more benign
anti-centromere
CREST
calcinosis
raynauds
esophageal dysmotility
sclerodactyly
telangiectasia