msk

Question 1

during a clavicular fracture what muscle protects the subclavian vessels and brachial pleuxs

Answer 1

subclavius muscle

Question 2

the brachial pleuxs lies behind what part of the clavical and anterior to the first rib

Answer 2

middle 1/3

Question 3

which fracture of the femural head causes inc risk of osteonecrosis

?

Answer 3

subcapital fracture of the femoral neck

bc cut of blood supply by deep femoral artery

Question 4

legg-calve perthes disease

idiopathic avascular osteonecrosis of the capital epiphysis of femoral head

classic: boy 4-20 yo, unilateral painless limping

pt is at risk of devloping?

Answer 4

osteo arthritis

Question 5

positive thompson test detect?

Answer 5

achilles tendone rupture

no planter flexion of the foot with squeezing the calf muscle

know: that planter flexion of foot depends on an intact soleus muscle attached to an intach achilles tendon

Question 6

compartment syndrome is caused by?

trick question

Answer 6

compression of the small veins of the limb

know this!!!!

Question 7

on the boards

what disorder has an increase risk of recurrent shoulder dislocation

Answer 7

ehlers danlos syndrome

Question 8

what can cause a posterior shoulder dislocation

Answer 8

electrical injury / ightening strike, or severe epileptic seizures

Question 9

what ligament is most commonly injured in an anterior dislocation of shoulder

Answer 9

inferior glenohumeral ligament

Question 10

radial head subluxation

what ligmament is involved

Answer 10

annular ligament.

Question 11

ewings sarcoma is associated with what chromosomal translocation

Answer 11

t(11:22) –> activation of C-myc promotor –> massive production of EWS-FL-1

Question 12

osteochondroma

what part of bone

Answer 12

metaphysis of long bone

Question 13

osteoma

Answer 13

bone metaphysis

Question 14

osteoid osteoma

Answer 14

metaphysis of long bone

Question 15

osteoblastoma

Answer 15

epiphysis of long bones

Question 16

giant cell tumor

Answer 16

epiphysis of long bone

Question 17

giant cell tumor

Answer 17

epiphysis of long bones

Question 18

osteosarcoma

Answer 18

metaphysis of distal femur, proximal tibia

Question 19

chondrosarcoma

Answer 19

pelvis, shoulder, spread from the medulla through the cortex into the soft tissue

Question 20

ewing sarcoma

MUTATION in?

derived from

Answer 20

diaphysis of long bones

t (11;22) –> activation C-MYC promotor –> massive production of EWS-FL-1

derived from neuroectoderm

Question 21

what causes the pain in osteoma

which allows it to be treated with aspirin

Answer 21

excessive prostaglandin E2 production

Question 22

what bone tumor is proliferation of

malignant OsteoBLAST`

Answer 22

osteroSARCOMA

Question 23

RB mutation put a person at risk for

familial retinoblastoma and ?

ON BOARDS

Answer 23

osteoSARCOMA

Question 24

pt presents with

inc alk phos

bone pain

swelling

xray shows elevation of periosteum

Answer 24

osteosarcoma

Question 25

xray shows lifting of the periosteum ( codmans triangle) and Sunburrst growth pattern (due to?)

Answer 25

calcified malignant cells in osteosarcoma

Question 26

what bone tumor histo shows anaplastic **small blue cells** (arranged in pseudorosette patterns

Answer 26

ewing.

Question 27

what bone tumor has osteo**clastic** giant cells and originates from **monocytes** in epiphysis usually seen in **women**

Answer 27

giant cell tumor benign

Question 28

soap bubbe appearance on xray

Answer 28

giant cell tumor.

Question 29

which bone disease has **persistent primary spongiosa** (endochondral bone / calcified cartilage) ?

Answer 29

osteopetrosis

Question 30

pathogenesis of osteopetrosis in adults

Answer 30

chloride channel mutation ----\> prevention of bicarbonate exchange --\> block the proton pump formation

Question 31

**low serum ca** **high Alk phos** **normal serum phosphate**

Answer 31

osteopetrosis

Question 32

cause of anemia in osteopetrosis and tx

Answer 32

deficient marrow bone marrow transplant

Question 33

xray for pt with osteoporosis will show

Answer 33

**radiolucency!!!**

Question 34

pts with osteoporosis have A. thin corticol bone B. thin trabecular bone C. both are thin ?

Answer 34

**both thin cortical** and **trabecular**

Question 35

bone mineral density scan will be abnormal in a pt with A. bulimia B. Anorexia ?

Answer 35

**anorexia** **pts can develop osteoporosis**

Question 36

all the following can cause hypogonal states renal insufficiency --\> osteodystrophy )( no a-1 hydroxy) endocrine disorders (hyper PTH) thyrotoxicosis) GI disorders (celiac and crohns disease both cause def in vit D) drugs: steroids, antiepileptics (barbs, phenytoin --\> inc metabolism fo vit D ) anticoagulants (heparin --\> inc osteoclast activity) PPIs (dec ca reabsorption) rosiglitazone, plogitazone )dec osteobastic bone formation)

Answer 36

## Footnote **osteporosis**

Question 37

how do you develop osteoporosis after post menopause

Answer 37

over expression of RANK receptors in **hypoestrogenic, --\>** inc bone resorption due to inc osteoclastic actibvity.

Question 38

uncomfortable intercouse, irregular menses, irritability 45 yo female amenorrhea this describes what

Answer 38

**climacteric period (**pre menopause)

Question 39

on the boards pt treated with **fluoroquinolones** for few weeks hes an athelete and heard a popping after jumping **+ thompson test** (no planter flexion of the foot w/ squeezing the calf)

Answer 39

**achilles tendon rupture**

Question 40

child with thinning of occiptial and parietal bones --\> craniotabes (thinning and softening of skull) delayed closure of fontanelle and bow legs. protrusion of sternum short stature what labs do you expect

Answer 40

**low ca** **low phosphate** **mild inc in alk phos** mild inc in secretion of PTH

Question 41

on the boards **elderly pt** **w/ malnutrition** and **living at home w/ no UVR exposure** what would be the best marker of what this pt is deficient in ?

Answer 41

**osteomalacia** **25 hydroxycholecalciferol**

Question 42

if you see increase alk phos what would you check to see if its from live or bone

Answer 42

**gamma-glutamy transpeptidase** elevated in liver pathology

Question 43

in pagets disease what are the two complications that can lead to death

Answer 43

**1. high output heart failure** from **ateriovenous shunts** in vascular boney lesions **inc risk** of **osteosarcoma**

Question 44

radiographic clue for ## Footnote **osteomalacia**

Answer 44

looser zones defective calcification --\> inc osteoid

Question 45

radiographic clue for osteoporosis/osteopenia

Answer 45

increased **radiolucency**

Question 46

radiographic clue for radiographic clue for hyperparathyroidism

Answer 46

**subperiosteal reabsorption**

Question 47

radiographic clue for mosaic pattern (puzzle pieces stuck together)

Answer 47

pagets

Question 48

**activating** mutation in the fibroblast growth factor receptor gene 3 (FGFR3) --\> negative effect on cartilage growth. what type of bone formation is this?

Answer 48

**endochondral bone formation** not intramembranous bone fromation (flat bones of face, skull, calvice, whre mesenchymal membrane is transfored into spongy bone.)

Question 49

bon the boards look for young pt with **bone pain, swelling** (usually near the knee), pathological fractures and elevated alkaline phosphatase

Answer 49

osteosarcoma

Question 50

what ligament does the radial head slip out of in radial head subluxation

Answer 50

**annular ligamnet.**

Question 51

on boards a pt who is unable to abduct or extend/flex his arm

Answer 51

frozen shoulder

Question 52

if a pt has a **pertrochanteric fracture of the femur. (below the neck)** will there be osteonecrosis

Answer 52

no bc still supplied by retinacular blood vessels. however a **subcapital fracture** of the femoral neck will

Question 53

**medial** longitudinal arch structures touching ground?

Answer 53

**calcaneus** **talus,** **navicular** **cuneiforms** **metatarsals 1-3**

Question 54

**Lateral** longitudinal arch structures touching ground

Answer 54

calcaneus cuboid 4th and 5th metatarsals

Question 55

**transverse arch**

Answer 55

**cuboid** **cuneiforms** **metatarsals**

Question 56

are you going to give prednisone orally for OA

Answer 56

**NO** **only intraarticular**

Question 57

question pt comes in with spasticity due to spinal cord injury what will you give and its moa?

Answer 57

**baclofen** activates GABA **B!!!** know that baclofen withdraw symptoms resemble benzos and alcohol withdraw.

Question 58

Q on boards pt develos interstitial **lung disease** with **pleural effusion** you figure out this is caused by RA what type of effusion and you expect Glucose and LDH levels to be

Answer 58

**exudate** **glucose levels** are very **LOW (\<25)** and **high LDH** (exudate)

Question 59

RA pt with baker cyst can mimic DVT what study should you order

Answer 59

US

Question 60

on the boards if a young woman w/ SLE wants to become pregnant what should you discontinue and start?

Answer 60

discontinue **cyclophosphamide** and select **mycophenolate mofetil.**

Question 61

Q pain in the groin

Answer 61

avascular necrosis of hip[

Question 62

local tenderness on the outer aspect of the greater trochanter

Answer 62

**trochanteric bursitis**

Question 63

Q monoarthritis w/ redness, tenderness and fever

Answer 63

**aspirate** **think septic arthritis**

Question 64

Q **groin pain increases** w/ **abduction** and normal hip joint

Answer 64

**sartorius muscle** injury during sports (soccer game)

Question 65

Q low back pain with point tenderness in the gluteal region **externally rotated lower limb**

Answer 65

**piriformis spasm** **fatty wallet syndrome**