MSK Flashcards500-End

1
Q

How many degrees of freedom does the knee have?

A

6: 3 translational and 3 rotational. Obviously the flexion and extension is the “normal” degree of freedom, but the others are also significant particularly once ligaments are injured.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is varus/valgus rotation of the knee?

A

Valgus means pointing the tibia/fibia outward (duck feet), except when this happens at the knee joint instead of the hip joint (varus is the opposite)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the typical history for an ACL tear?

A

A pop or crack, pain and immediate swelling of the knee followed by instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What other common injuries associate with an ACL tear?

A

Meniscal damage, chondral injuries, and MCL/PCL/LCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is the MRI useful for diagnosing possible ACL damage?

A

Yes, it can visualize the ligaments and the meniscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Does the ACL always heal without surgery? What about the MCL?

A

No, probably due to the synovial environment; the MCL does heal since it is outside the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Can the ACL be sewn together? What is the typical surgery process?

A

There is low success rate with this; it is reconstructed through autograft or allograft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the two most common complications of ACL surgical repair? What is their collective incidence?

A

Stiffness and the graft not healing correctly; 2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are two options for treating a diagnosed ACL injury?

A

Rehabilitation with modified patient activity and surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long is rehab for an ACL surgery?

A

4-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What bone does the talus attach to inferiorly within the ankle?

A

Calcaneus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Are these two little bumps on the first metatarsal normal? What are they?

A

Yes; sesamoid bones (bones inside tendons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the sensory innervations for these three areas of the anterior (dorsal) foot?

A

Top to bottom, sural, saphenous, and superficial peroneal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What nerve provides sensory innervation to the part of the foot stimulated in the Babinski test?

A

Lateral plantar branch of the the medial plantar nerve (from the tibial nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Between toe fractures or metatarsal injuries, which are more likely to require surgery?

A

Metatarsals (they are often crush injuries of multiple bones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Are the toe bones hollow? What are the implications on surgical reduction?

A

Yes; a pin can be put in the medullary space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What kind of fracture is this? Why might it not heal?

A

Jones fracture; poor blood supply to this region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a Lisfranc fracture?

A

A tarsometatarsal joint dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment for this kind of fracture?

A

Open reduction internal fixation (surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What classification system is used for talus fractures? For calcaneus fractures?

A

Talus__Hawkins; Calcaneus__Sanders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What bone is fractured in this CT?

A

The head of the talus, also causing a dislocation of the subtalar joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tearing of what ligament has allowed the tibia to shift medially in this fibular fracture?

A

Deltoid (or talocrural) ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What condition along with its associated neuropathy can cause progressive deterioration of the ankle joint, including fractures?

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the two most common crystals found in synovial fluid that cause synovitis?

A

Monosodium urate (gout) and calcium pyrophosphate/dihydrate (pseudogout)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is gout predisposition inheritable? Does it occur more in men or women?

A

Yes; men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What serum abnormality precedes acute gout?

A

Asymptomatic hyperuricemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In familial gout, what enzyme deficiency is likely?

A

HGPRT or G6PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What social history is relevant to a diagnosis of gout?

A

Alcohol consumption, which can cause overproduction and underexcretion of uric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Is it more common for hyperuricemia to be caused by overproduction or underexcretion of uric acid?

A

Underexcretion (90%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What drugs can cause underexcretion of uric acid?

A

Diuretics, low dose aspirin, heparin, cyclosporine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which endocrine disorder can lead to hyperuricemia and gout?

A

Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Are first attacks of gouts usually monarticular or polyarticular? Which joint(s) are affected?

A

Monarticular; 1st MTP (podagra, big toe), dorsum of foot, ankle, knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What time of day does gout usually start?

A

Night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What happens without treatment of acute gout or pseudogout?

A

It resolves by itself over ~1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What variant of gout is seen here?

A

Podagra: 1st MTP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What organ system insufficiency exacerbated by obesity contributes the most to development of gout?

A

Renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Is synovial fluid from gout inflammatory? Are there increased WBCs?

A

Yes; yes, >5k up to 100k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is this slide of synovial fluid diagnostic of? Does it matter that the spikes are inside a cell?

A

Gout; yes, the uric acid crystals must be inside a neutrophil, because there are normally some free floating crystals in synovial fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

With what drugs is acute gout treated?

A

NSAIDs, colchicine, and intra-articular or systemic steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Is uric acid lowering therapy indicated for acute monarticular gout? Why or why not?

A

No, it is contraindicated__you only try it after recurrent attacks despite colchicine prophylaxis; trying to lower uric acid with drugs causes a large flux across plasma membranes, which can cause crystal formation in other joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What prophylaxis can be used to treat intercritical gout?

A

Colchicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What dietary modification may be suggested for somebody with intercritical gout?

A

Foods like red meat, seafood, or beans that are high in uric acid should be avoided, but most particularly alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

These small skin features are associated with what synovial disease?

A

Gout (these are small subcutaneous crystals of uric acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

This is an extreme example of what joint disease? The lesion has crystalline substance leaking from it.

A

Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the difference in function between a uricosuric agent and xanthine oxidase inhibitor?

A

Uricosuric agents increase excretion of uric acid, while xanthine oxidase inhibitors decrease production of uric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Would a gout patient who is an underexcreter receive a xanthine oxidase inhibitor or a uricosuric agent?

A

Uricosuric agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Of the following, label which are uricosurics and which are xanthine oxidase inhibitors (XOI):

__ Allopurinol

__ Probenecid

__ Oxypurinol

__ Febuxostat

A

__ Allopurinol: XOI

__ Probenecid: uricosuric

__ Oxypurinol: XOI

__ Febuxostat: XOI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Does pseudogout usually present as a monarticular or polyarticular disease? Is the first MTP a typical place for it?

A

Monarticular; no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the top four joints that pseudogout will present in?

A

Knee, ankle, hip, shoulder blade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Is synovial fluid in pseudogout inflammatory? Is it typically higher or lower in WBCs than gout?

A

Yes; lower, around 20-40k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What crystalline substance is found intracellularly in synovial fluid for a pseudogout patient?

A

Calcium pyrophosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the clue on this X-ray that the patient might have pseudogout? Is this clue specific for pseudogout in an older patient?

A

The thin line of calcification of cartilage along the joint margin (chondrocalcinosis); no, many older patients have it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What form of arthritis is a risk factor for pseudogout?

A

Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What endocrine disorders associate with pseudogout?

A

Hyperparathyroidism and hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How is pseudogout treated?

A

NSAIDs, colchicine, and intra-articular steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

This X-ray is from an elderly patient with localized tendonitis, with acute shoulder pain. What happened? What differentiates it from Milwaukee shoulder?

A

Calcific tendinitis: note the calcium hydroxyapatite deposition above the head of the humerus; it is in the tendon within the bursa, not the joint capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the typical gender and age for Milwaukee shoulder? What arm is usually affected?

A

Elderly women; dominant arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How is Milwaukee shoulder treated?

A

NSAIDs, colchicine, aspiration, intra-articular steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the name for crystal synovitis involving calcium hydroxyapatite deposition in the glenohumeral joint? What muscles can be torn in association with it?

A

Milwaukee shoulder; rotator cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the three layers of connective tissue within a muscle, from outermost to innermost? Which one surrounds individual fibers?

A

Epimysium, perimysium, endomysium; endomysium surrounds fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is this circular structure within a ped patient’s muscle? Is it normal?

A

A muscle spindle (not a vessel! it contains muscle fibers and growing nerves); yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How many types of myofibers are there? Which one is “fast twitch”? Which one has more fat?

A

Two types; fast twitch is type 2 (white); more fat is type 1 (red)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the two different kinds of fibers stained in this section of muscle?

A

Type 1 and type 2, which differentiates slow and fast twitch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which type of muscle fiber has more mitochondria?

A

Type 1 (slow twitch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is one “motor unit”?

A

An anterior horn motor neuron, its axon, and the muscle fibers it innervates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What neurotransmitter receptor is highly concentrated in these invaginations of the cell membrane? What enzyme is also there to prevent overstimulation?

A

ACh receptor; acetylcholinesterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What construct is used by the muscle to produce a coordinated Ca++ efflux from the sarcoplasmic reticulum in response to a propagated action potential?

A

T-tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Are neurogenic or myopathic causes of muscle disorders more common?

A

Neurogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What has happened to some of the myofibers in this muscle?

A

They have atrophied, becoming angular and shrunken

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Why might a group of myofibers fail to show a typical even distribution between Type 1 and Type 2 fibers?

A

If one type of motor neuron dies and its cells become detached and atrophy, they send signals to regain collateral innervation from the other type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Will an ALS patient show fiber type grouping on histological study of atrophic muscles?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Do you get neurogenic atrophy with a stroke? Why does atrophy occur on the side of the body contralateral side to the stroke?

A

No, because it is the UMN that is affected and not the LMN; atrophy occurs because of disuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Does disuse atrophy preferentially affect type 1 or type 2 myofibers?

A

Usually, type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Do myopathies tend to be proximal or distal? What about neuropathies?

A

Myopathies __ proximal (left);

Neuropathies __ distal (right, stocking/glove)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the inheritance pattern of Duchenne’s muscular dystrophy?

A

X-linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

When does Duchenne’s present?

A

5 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Is a diagnosis of muscular dystrophy supported by a positive Gowen’s sign? What is Gowen’s sign?

A

Yes; walking the body into an upright position with the arms and hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What X-linked recessive condition is associated with the following presentation in a 5 year old?

A

Duchenne’s muscular dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What gene is affected by Duchenne’s muscular dystrophy? Where is the gene within the genome? Is it a large or small gene?

A

Dystrophin; small arm of X chromosome; very large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

This mother was stained for the dystrophin protein and the following pattern results. What is her likelihood for each of her sons in developing Duchenne’s?

A

50%, since the mom is clearly a carrier (mosaic pattern), and the disease is X-linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Collectively, muscular dystrophies are diseases of what molecular complex? What does it connect?

A

The dystrophin-glycoprotein complex; the basal lamina, sarcolemma, and F-actin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the difference between Becker’s and Duchenne’s muscular dystrophies?

A

The same gene (dystrophin) is involved, but the mutation causes a less severe phenotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the most common dystrophy that presents in adults?

A

Myotonic dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the genetic basis for myotonic dystrophy? What neurodegenerative disease is caused by a similar kind of mutation?

A

A mutation in the myotonin kinase gene, specifically an expansion of a trinucleotide repeat; Huntington’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Does the number of repeats in myotonin kinase correlate proportionally or inversely with the age of onset of myotonic dystrophy?

A

Inversely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What type of myofiber is preferentially affected by a congenital myopathy? How does the patient present?

A

Type 1 myofiber; “floppy baby”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Malignant hyperthermia results from a mutation in what gene? What tissue type causes the release of heat in this disease?

A

Ryanodine receptor; muscle fibers continuously burning energy and contracting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is a “ragged red” segment of muscle?

A

An area where abnormal mitochondria have undergone extreme proliferation due to some abnormality in the mtDNA, and may be visible with red mitochondrial stains or with strange crystal inclusions under EM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is an intrinsic inflammation of many skeletal muscles called?

A

Polymyositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is happening to this muscle fiber? If this is happening throughout normal muscles in the body, what condition is this?

A

It is being invaded by immune cells, and will eventually become necrotic; polymyositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the clinical opposite of myasthenia gravis, whereby the strength of an NMJ increases with repetitive stimulation? What cancer does that disease associate with?

A

Eaton-Lambert, a disease of the presynaptic axon terminal; small cell lung carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the most often cause of cancer affecting the bone?

A

Metastatic bone disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are the two most common sources of cancer cells that metastasize to bone?

A

Prostate and breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the two most common primary malignant bone tumors?

A

Osteosarcoma and chondrosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Are osteoid osteomas and osteoblastomas benign or malignant?

A

Benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Are osteosarcomas benign or malignant?

A

Malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Why are osteoid osteomas painful? Why is this relieved by NSAIDs like ASA?

A

Prostaglandin E2 is secreted by proliferating osteoblasts; ASA inhibits prostaglandin production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What part of the bone are osteoid osteomas found in?

A

Diaphysis, cortical bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What differentiates osteoid osteomas from osteoblastomas on histological examination?

A

They are similar in that the structure is disrupted within cortical bone, but osteoblastomas do not have a reactive periphery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Are osteoblastomas generally larger or smaller than osteoid osteomas?

A

Larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Do osteosarcomas tend to present in teens or older patients?

A

Teens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is this fluffy stuff surrounding the figure in this malignancy?

A

Osteoid depositing into the soft tissue by a osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Do osteosarcomas arise in the epiphysis, metaphysis, or diaphysis of a long bone?

A

Metaphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What kind of a bone tumor is this? It is the most common primary malignancy of bone.

A

Osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

How does osteosarcoma spread? Where is the typical metastatic destination? How is it treated?

A

Hematogenously; lungs; pre-op chemotherapy and surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

As opposed to central osteosarcomas, where the tumor is within the metaphysis, what is an osteosarcoma that is on the surface of the bone called?

A

A parosteal osteosarcoma

107
Q

What is the most common benign bone tumor? What does it look like?

A

Osteochondroma; A neoplastic outgrowth recapitulating the growth plate, usually with a stalk, from the metaphysis

108
Q

How are osteochondromas treated?

A

Complete excision (surgical)

109
Q

Do osteochondromas ever stop growing?

A

Yes, when skeletal maturity is reached

110
Q

A bony outgrowth from a metaphysis is examined histologically and many features of the growth plate are found. What sort of bone tumor is this? Is it malignant?

A

Osteochondroma; no

111
Q

What genes are mutated in hereditary osteochondromatosis, where osteochondromas occur simultaneously in multiple bones?

A

EXT1 or EXT2

112
Q

What bone abnormality is seen here? How do these patients present?

A

Enchondroma (cartilaginous tumor within metaphysis); sometimes asymptomatic, but usually with symptoms of stress fractures (swelling, pain)

113
Q

What is Ollier disease? Is it hereditary? What is the primary manifestation?

A

It is also called enchondromatosis, and is the presence of many enchondromas in the body; no; malformed limbs

114
Q

When enchondromatosis presents with hemangiomas, what is the syndrome called?

A

Maffucci syndrome

115
Q

This is a malignant tumor in which malignant cells produce condroid matrix__what is it called?

A

Chondrosarcoma

116
Q

In a patient with enchondromatosis, what may some of the enchondromas develop into without treatment?

A

Chondrosarcoma

117
Q

What can an enchondroma be indifferentiable by morphology alone on histological or imaging studies?

A

Grade 1 chondrosarcomas

118
Q

Where will chondrosarcomas metastasize?

A

Lungs, skin and soft tissue

119
Q

Is surgical excision or chemotherapy preferable when treating chondrosarcomas?

A

Excision, since chemotherapy response is poor.

120
Q

What is the 2nd most common primary malignancy of bone in children, usually affecting the diaphysis of long bones and presenting as a painful and warm enlarging mass?

A

Ewing’s sarcoma

121
Q

What type of chromosomal abnormality is associated with Ewing’s sarcoma?

A

Translocations

122
Q

What is this bone tumor (more common in children than adults) which shows an “onion skin” periosteal reaction?

A

Ewing sarcoma

123
Q

Why might you use FISH as a diagnostic tool when suspecting Ewing’s sarcoma?

A

The typical cause of Ewing’s is a translocation, which FISH is good at visualizing

124
Q

Where will Ewing’s sarcoma typically metastasize? What are available treatments?

A

Lungs; chemotherapy and surgical resection

125
Q

Are fibrous cortical defects common? Is treatment necessary?

A

Yes, up to 50% of children; generally, no

126
Q

What cell types comprise a fibrous cortical defect?

A

Fibrous tissue, histiocytes

127
Q

When a fibrous cortical defect keeps growing instead of regressing, what is it called? Would this fibroma require treatment? Assuming no fracture, when must they be treated?

A

Non-ossifying fibroma; yes (there is a clear pathological fracture); when they reach >50% of the total bone diameter

128
Q

What are these lesions characteristic of?

A

Non-ossifying fibromas (metaphyseal, eccentric, well-circumscribed, slightly sclerotic rim)

129
Q

What common benign fibroosseous tumor that manifests with intramedullary proliferation of fibrous tissue and woven bone is also a component of McCune-Albright syndrome?

A

Fibrous dysplasia

130
Q

When does monostotic fibrous dysplasia present?

A

Early adolescence

131
Q

What fibroosseous tumors have caused the craniofacial abnormalities in this patient?

A

Polyostotic fibrous dysplasia

132
Q

What two syndromes include polyostotic fibrous dysplasia? What other symptoms are included in these syndromes?

A

McCune-Albright and Mazabraud; McCune-Albright: precocious puberty and cafe-au-lait spots, Mazabraud: soft tissue myxomas

133
Q

What is the treatment for fibrous dysplasia? Can anything be given for symptomatic pain relief?

A

Surgical resection or curettage; bisphosphonates

134
Q

Giant cell tumors are different from other bone tumors in that they can be located in a unique part of the bone, which is where? What joint are they most commonly in?

A

Epiphysis (which is unique) as well as metaphysis; knee

135
Q

What kind of tumor is this, which is more common in women and presents with arthritis-like symptoms? What information here is most suggestive of the type?

A

Giant cell tumor; this tumor is unique for invading the epiphysis, and being more common in females

136
Q

What is the naming system for a mesenchymally derived malignant tumor?

A

It includes “sarcoma” in the name, which means fleshy (Greek)

137
Q

With a below the knee amputation, can a patient live a normal life with a prosthesis?

A

Yes, they can run, play ball, etc. with a prosthesis and physical therapy

138
Q

Is a giant cell tumor a benign indolent or a benign active/aggressive tumor?

A

Active/aggressive

139
Q

Do giant cell tumors usually occur before or after the growth plates have sealed? Where do they localize before the growth plates seal?

A

After; before (in a child), they are restricted to the metaphysis

140
Q

What surgical technique is being used here?

A

Cryosurgery

141
Q

Do small round blue cell tumors produce osteoid matrix? What common sarcoma of the bone is comprised of this cell type?

A

No; Ewing’s sarcoma

142
Q

Does Ewing’s sarcoma generally have a lytic or an overgrowth effect on a bone?

A

A lytic effect

143
Q

What part(s) of the bone are Ewing’s Sarcoma usually found in?

A

Diaphysis and metadiaphysis

144
Q

How many Codman’s triangles can be found in this osteosarcoma?

A

Four, one for each corner of the elevation of the periosteum where the sarcoma has penetrated the cortical bone

145
Q

In this MRI, is the bone tumor in the top half or bottom half of the bone? What kind of tumor is it?

A

Top half; Ewing’s Sarcoma (it is in the diaphysis, in an adult, and the density is reduced)

146
Q

Will osteosarcomas typically grow through the growth plate?

A

No

147
Q

A patient has osteosarcoma. If there is neurovascular involvement and tumor fungation, how does this play into the decision on whether surgery will be limb sparing or involve amputation?

A

Both of those conditions are indications for amputation

148
Q

Do you need serum rheumatoid factor to diagnose rheumatoid arthritis?

A

No

149
Q

Does rheumatoid tend to affect the upper extremities or lower extremities more?

A

Upper extremities

150
Q

Are gold, methotrexate, and D-Penacillamine palliative or remittive treatments for rheumatoid arthritis?

A

Remittive

151
Q

Does aspirin, heparin, or diuretics change the risk profile for gout?

A

Yes, they are all risk factors for gout

152
Q

What is ochronosis? What crystal synovitis is it a risk factor for?

A

The accumulation of homogentisic acid in connective tissues; pseudogout

153
Q

What is this condition, presenting with acute pain, limited range of motion and calcium hydroxyapatite deposition in this one joint? Can it be treated with colchicine?

A

Milwaukee shoulder; yes

154
Q

An elderly male patient with debilitating constitutional symptoms, arthritis/arthralgias, and serositis should be immediately screened for what history in order to rule out what poorly understood autoimmune condition?

A

Medication history, to rule out drug-induced lupus

155
Q

Procainamide, hydralazine, isoniazid, phenytoin, chlropromazine and quinidine are all exposure risks for what autoimmune geriatric condition that prefers males?

A

Drug-induced lupus

156
Q

How is drug-induced lupus treated?

A

Remove the drug that is inducing it

157
Q

What syndrome (first described at Mount Sinai) presents in patient over 60 with nontender pain and stiffness of the pectoral and pelvic girdles but no evidence of synovitis?

A

Polymyalgia rheumatica

158
Q

How is polymyalgia rheumatica treated?

A

Low dose prednisone

159
Q

Does polymyalgia rheumatica follow the stocking glove pattern?

A

No, it is restricted to the pelvic and pectoral girdles

160
Q

What serum test is elevated in polymyalgia rheumatica?

A

Erythrocyte sedimentation rate

161
Q

Does polymyalgia rheumatica cause muscle atrophy? What about limited range of motion?

A

No; and no

162
Q

Of polymyalgia rheumatica, rheumatoid arthritis, polymyositis, and fibromyalgia, which is most likely to associate with elevated creatine kinase? Elevated erythrocyte sedimentation rate?

A

Elevated creatine kinase: polymyositis;

Elevated ESR: polymyalgia rheumatica

163
Q

What arteritis presenting in the elderly associates with an increased erythrocyte sedimentation rate?

A

Giant cell (temporal) arteritis

164
Q

Are there alternatives to steroids for treating giant cell arteritis?

A

Yes, methotrexate and dapsone

165
Q

Greater trochanteric bursitis presents with what chief complaint? How is it differentiated from osteoarthritis of the hip?

A

Hip pain and trouble walking; This bursitis will localize to the outside of the hip, while true osteoarthritis will localize to the inside of the groin

166
Q

For pain in an elderly patient that localizes to the outside of the hip by the greater trochanter, what else is on the differential besides greater trochanteric bursitis?

A

Referred lumbar pain

167
Q

What bursitis is this? Does it present with limited range of motion or weakness?

A

Olecranon bursitis; no to both

168
Q

What is this condition, perhaps presenting with a complaint of “hot knee”? How do you know if it is extra-articular or not?

A

Prepatellar bursitis; if the patient is flexing and extending without pain, they do not have septic arthritis, otherwise they would hold the knee in one position

169
Q

If a patient presents with diffuse medical knee pain, but exam of the knee is normal (typical range of motion, no tenderness, no swelling except perhaps on the anteromedial leg 5 cm below knee) what bursitis is likely?

A

Anserine bursitis

170
Q

What is SPONK? What is the age and gender of the typical patient? How does it present?

A

Spontaneous osteonecrosis of the knee (usually femoral condyles, as in the right of the image); elderly woman; hyperacute onset of severe knee pain

171
Q

What is the difference between a strain and a sprain?

A

Strain: musculo-tendonous injury; sprain: ligamentous injury

172
Q

If the patient has weakness on one side of the hip, how can this be elicited when telling the patient to stand on one leg?

A

The patient’s iliac crest on the side opposite to the weak leg will sag

173
Q

What is this condition? What are three classifications of its cause?

A

Scoliosis; idiopathic, congenital, and neurogenic

174
Q

What variant of scoliosis is caused by cerebral palsy, spina bifida, or spinal cord injury? Is this variant braceable?

A

Neurogenic scoliosis; no

175
Q

What is this cause for this variant of scoliosis?

A

Failure of formation of certain vertebrae, causing congenital scoliosis

176
Q

Is this variant of scoliosis congenital or idiopathic?

A

Idiopathic, since the bones themselves are formed correctly

177
Q

Above what age does idiopathic scoliosis become more common in girls than boys?

A

6 years old

178
Q

Explain the Risser sign. For what skeletal abnormality is it used in formulating a prognosis?

A

The Risser sign is based on a line in a child’s pelvis signifying its stage of calcification; it is used in prognosing idiopathic scoliosis

179
Q

For what degrees of curvature will bracing be used to treat adolescent idiopathic scoliosis? At what curvature will surgical fusion be considered?

A

25-45_; 50_ will allow consideration of fusion

180
Q

This 13 year old overweight boy complains of right hip and knee pain for four months. On physical exam, moving the right hip is painful and it can’t rotate internally more than 10 degrees. Here is the X-ray: what is the condition? What is the most straightforward surgical treatment?

A

Slipped capital femoral epiphysis (the growth plate is slipping), shown by the Klein’s lines not being symmetrical, and it is more typical in obese adolescent males; in situ pinning to stabilize the growth plate

181
Q

What are possible complications of in situ pinning for slipped capital femoral epiphysis?

A

Avascular necrosis, incorrect pin placement, chondrolysis

182
Q

Torticollis (tight SCM muscle) and metatarsus adductus are associated with what congenital problem of the hips?

A

Developmental dysplasia of the hips

183
Q

What are the Ortolani, Galeazzi, and Barlow tests used to diagnose? Do they elicit pain?

A

Developmental dysplasia of the hips; no pain

184
Q

What skeletal abnormality of an infant is demonstrated here, with Shenton’s lines drawn over the medial sides of the heads of the femurs and the acetabular index overlaid in yellow?

A

Developmental dysplasia of the hip

185
Q

What is an osteotomy?

A

A surgical procedure whereby a bone is cut to shorten, lengthen, or change its alignment.

186
Q

By what age is the majority of acetabular shape development determined?

A

8 years old

187
Q

With what complaint did this 16 year old patient present? What developmental abnormality is probable?

A

Left groin pain and problems abducting hip; developmental dysplasia of the hip

188
Q

What is the mnemonic for diagnosing clubfoot?

A

CAVE: Cavus, adductus, fixed varus, fixed equinus

189
Q

Can clubfoot be treated by casting?

A

Yes, it is called the Ponseti technique

190
Q

Children typically have tremendous remodeling potential after bone fractures. Which fractures in long bones can affect proper growth? They are classified using a system by Salter-Harris.

A

Fractures of the growth plate

191
Q

Are buckle fractures and greenstick fractures more common in adults or peds?

A

Peds

192
Q

How many subtypes of juvenile idiopathic arthritis are there?

A

3

193
Q

What social history among adults is associated with an increased likelihood of acute rheumatic fever?

A

Exposure to many children, e.g. schoolteachers and daycare workers

194
Q

Loss of function of what HEENT system is linked to cases of pauciarticular juvenile idiopathic arthritis?

A

Eyesight, because of scarring in the iris

195
Q

Out of iridocyclitis and sacroiliitis, which is more likely to affect males? What are both of these subtypes of?

A

Sacroiliitis; juvenile idiopathic arthritis

196
Q

Is the variant of juvenile idiopathic arthritis that is positive for rheumatoid factor a systemic or polyarticular arthritis? Is it more severe or less severe than the other variants?

A

Polyarticular; more severe

197
Q

With the onset of juvenile idiopathic arthritis, what extra-articular manifestations can result?

A

Iridocyclitis (anterior uveitis), fever, anemia, malaise, rash, organomegaly

198
Q

Are children with polyarticular juvenile idiopathic arthritis at greater risk for shorter stature?

A

Yes

199
Q

What is the abnormality of the jaw seen here?

A

Micrognathia

200
Q

What is a rare adult disease that mirrors the features of juvenile idiopathic arthritis?

A

Adult Still’s disease

201
Q

What is the criteria used for diagnosing rheumatic fever called? What are the five major criteria?

A

Revised Jones Criteria; Arthritis, carditis, chorea, erythema marginatum (pink rings on the trunk and limbs), nodules

202
Q

What lab test is used to diagnose rheumatic fever?

A

Evidence of recent strep infection, such as antistreptococcal antibodies, group A strep on throat culture

203
Q

What is this skin condition called? What bacterial infection related condition is it related to?

A

Erythema marginatum; rheumatic fever (group A strep)

204
Q

Sometimes confused with the erythema marginatum of rheumatic fever, what skin condition actually is this, which presents often well-localized on somebody who has been outdoors? What disease is it indicative of? Does this disease cause arthritis in its initial stages like rheumatic fever does?

A

Erythema migrans (bullseye spreading rash); Lyme disease; no, only in later stages

205
Q

If somebody has carditis causing secondary heart blocks, some arthritis, and peripheral neuropathies like Bell’s palsy, what insect-borne bacterial infection can be suspected?

A

Borellia burgdorferi (Lyme)

206
Q

When does the incidence of arthritis peak throughout the course of Lyme disease?

A

Midcourse

207
Q

For early Lyme disease in children, what is usually prescribed? Why can’t you prescribe tetracycline? If Lyme disease shows cardiac involvement, how does the treatment regimen change?

A

Doxycycline or amoxicillin 10-21 days; side effect of yellowing teeth; IV ceftriaxone or penicillin

208
Q

What is the most common gram positive cocci to be observed in septic arthritis?

A

S. aureus

209
Q

What are the most common gram negative cocci to be found in septic arthritis in adults? In children?

A

Adults: N. gonorrhoeae and meningitidis; children: H. influenzae

210
Q

These symptoms are all diagnostic criteria for what arteritis presenting in children?

A

Kawasaki’s disease

211
Q

What is this X-ray pathognomonic for? Is it more common in children or adults?

A

Dermatomyositis; children

212
Q

The appearance of calcified lesions underneath the skin and in muscle are characteristic of what childhood condition? What facial symptom usually presents along with it?

A

Dermatomyositis; periorbital edema

213
Q

Is this more likely to be associated with dermatomyositis or polymyositis?

A

Dermatomyositis

214
Q

What systemic disease risk is increased by the presence of dermatomyositis and polymyositis, requiring increased regular scrutiny?

A

Cancer

215
Q

Does myositis necessarily present with pain? Is active or passive range of motion affected? Are the symptoms in proximal or distal joints?

A

Not always; Active range of motion is affected, not passive; proximal joints

216
Q

What two diseases are diagnosed by a muscle biopsy showing this result?

A

Polymyositis or dermatomyositis

217
Q

What are the most common prescribed drugs that can instigate myositis as an adverse effect?

A

Statins, steroids, colchicine

218
Q

What is this kind of fracture called? Is this more common in adults or children?

A

A greenstick fracture; children

219
Q

Is surgery required to correct a buckle fracture in a child?

A

No

220
Q

What is this? How is it treated?

A

Ganglionic cyst, usually appearing on the dorsum of the hand and seems to be an outpouching of the synovium; it is drained

221
Q

Does this fracture, called a Boxer’s fracture, need casting?

A

Typically, no

222
Q

Which carpal bone fracture, corresponding to pain in the anatomical snuffbox, has occurred here?

A

Scaphoid (lower left), compare with the following after healing

223
Q

What nodes corresponding to symptoms of osteoarthritis are seen in these hands, and in what joints?

A

Heberden’s nodes in the DIPs, Bouchard’s nodes in the PIPs

224
Q

What is “tennis elbow”?

A

Lateral epicondylitis, corresponding to pain here:

225
Q

In the case of irritation of the ulnar nerve after an elbow injury, what surgical technique can be used to preserve its function?

A

It can be moved under a muscle for better protection

226
Q

What is this? Is it a common cause of shoulder pain?

A

Calcification of the bursa causing bursitis; yes, the most common

227
Q

The patient complains that this bump has appeared in their biceps__is it cancerous? What is the treatment?

A

No, this is a result of a tear of the long head of the biceps; usually untreated, but can reattach the long head with surgery

228
Q

What is wrong with this shoulder?

A

It has been dislocated anterioinferiorly

229
Q

If a patient has a seizure, will the seizing rotator cuff muscles more likely cause an anterior or posterior dislocation of the shoulder?

A

Posterior, which is the opposite of the typical dislocation from a fall or injury

230
Q

How are tears of these two ligaments best diagnosed on X-ray if the initial presentation is subtle?

A

Have the patient hold weights in both arms and note the distance from the scapula to the clavicle

231
Q

What disease presents with diffuse aching for three months, local tenderness over many points of the body, disturbed sleep with morning stiffness, and has an incidence of 2-4% of industrialized countries?

A

Fibromyalgia

232
Q

What part of the brain is suspected to be defective in fibromyalgia, leading to improper processing of pain pathways?

A

Thalamus

233
Q

Does fibromyalgia tend to develop in the young or the elderly? What psychiatric disorder does it associate with?

A

Young only; depression

234
Q

A patient is carrying their arm in to see you, and has a swelling in the distal part of the limb. It is extremely painful, and sometimes follows trauma or MI. What is the likely diagnosis? How is it treated?

A

Reflex sympathetic dystrophy, also called Complex Regional Pain Syndrome; steroids

235
Q

What syndrome of the median nerve leading to numbness or tingling in the hands commonly results from rheumatoid arthritis?

A

Carpal tunnel

236
Q

Two kinds of tenosynovitis affecting the wrist are …?

A

DeQuervain’s and nodular

237
Q

Chronic corticosteroid use (in e.g., a patient with SLE) can lead to what joint disease that manifests with severe acute pain and this radiographic presentation?

A

Osteonecrosis (avascular necrosis of bone)

238
Q

Young boys, age 3-10, are at risk of developing what condition seen here?

A

Avascular necrosis of the femoral head

239
Q

What are clinical symptoms of a meniscal tear in the knee?

A

Pain, effusion, tenderness, clicking, (pseudo) locking and instability

240
Q

What is visualized on this arthroscopy of the knee?

A

Meniscal tear

241
Q

What ligament of the knee has been damaged here?

A

Medial collateral ligament

242
Q

Which tendon is torn to cause the patella to move inferiorly? Which ligament to move it superiorly?

A

Quadriceps tendon tear __ inferiorly; patellar ligament __ superiorly

243
Q

What side of the ankle (medial or lateral) has only one ligament? What is it called? What is the effect on the likelihood of injury to either side?

A

Medial; deltoid ligament; medial is more concerning if it is sprained/swollen

244
Q

What is the pathology of a mild sprain?

A

Hemorrhage in the ligament

245
Q

Does a partial tear of a ligament (moderate sprain) require surgery?

A

Usually, no, only complete separations of the ligament do

246
Q

What tendon connects to the fifth metatarsal at the site of this fracture? Does the fracture therefore occur during inversion or eversion stress?

A

Peroneus brevis; inversion stress

247
Q

This is a heel spur, caused by calcification from stress on what fascia?

A

Plantar fascia

248
Q

What is this called? What shoewear is a risk factor?

A

Bunion; high heels and pointy shoes

249
Q

Out of the types of seronegative spondylarthritis, which must be preceded by an infection (typically GI or genitourinary)?

A

Reiter’s (reactive) arthritis

250
Q

How can psoriatic arthritis be differentiated from rheumatoid arthritis?

A

Psoriatic is typically asymmetrical, presents with “sausage fingers,” onycholytic nails, and involves the DIPs

251
Q

In a patient with asymmetric symptoms of arthritis, axial skeleton involvement, and opthalmologic involvement, is the disease more likely to be rheumatoid arthritis or a seronegative spondylarthropathy?

A

Seronegative spondylarthropathy

252
Q

What is the “seronegative” in seronegative spondylarthropathies referring to?

A

Rheumatoid factor is absent

253
Q

Severe pitting of the nails like this, in association with asymmetric arthritis and no evidence of prior infection, is highly suggestive of what type of arthritis?

A

Psoriatic arthritis

254
Q

Are these knees on a 40 yo patient consistent with rheumatoid arthritis, and why or why not?

A

No, there is asymmetrical swelling of the left knee, so it is more likely a seronegative spondylarthropathy (e.g. psoriatic, reactive) or septic

255
Q

What is the most common nerve injury of the shoulder? What does it innervate?

A

Axillary nerve; deltoid and teres minor

256
Q

How is bursitis treated pharmacologically?

A

Cortisone injection

257
Q

What are bursae filled with? What differentiates them from synovial cavities?

A

Synovial fluid; they do not include articulating edges of bones, but just tendons, muscles, and bone that slide over each other near a joint

258
Q

Is the synovial fluid in an SLE (Lupus) patient inflammatory? Are glucose and protein normal?

A

No (WBC <3000); yes

259
Q

Is vasculitis an expected complication of scleroderma?

A

No

260
Q

Are pericarditis and myocarditis more suggestive of SLE (Lupus), scleroderma, or neither?

A

Neither, since they are possible consequences of both

261
Q

Why are GI symptoms so common in patients with scleroderma?

A

Dysmotility results from the obliteration of autonomic nervous function

262
Q

What is the “physis” of a bone referring to?

A

The growth plate

263
Q

How can a patient rupture a Baker’s cyst during typical daily activities? What will it manifest as?

A

Kneeling (e.g. scrubbing floor) or overuse of knee joint; it would manifest as a painful swelling of the knee, but with full range of motion