MSK path 1

Question 1

Granulomatous / destruction of internal elastic membrane; Aorta & major branches
large arteries

Answer 1

Giant Cell (temporal) arteritis 
(GCA)

Question 2

Granulomatous of aorta, females <50 y/o
PULSELESS disease
Ischemic bowel disease, pulmonary, coronary, renal arteries also affected
large arteris

Answer 2

Takayasu

Question 3

Fibrinoid necrosis
NO GLOMERULONEPHRITS  BUT it does affect the kidneys (renal involvement  severe HTN (RBCs in urine , NOT CASTS)
NO ANCA (RATHER, IMMUNE COMPLEXES!  30% a/w Hepatitis B
NO PULMONARY INVOLVEMENT
Many stages evident in biopsy
Wrist and Foot drop due to ulnar & common fib involvement

Answer 3

Polyarteritis Nodosa
(PAN)

Question 4

Mucucutaneous lymph node syndrome
Coronary artery involvement
Children (tx: IgG and AsA)

Answer 4

Kawasaki Diseasea

Question 5

Limited – only respiratory
Systemic – involves renal arteries (glomerulonephritis – focal segmental)
c-ANCA

Answer 5

Wegeners aka

Ganulomatosus w/ polyangiitis (GPA)

Question 6

Eosinophilic granulomatosus, respiratory tract
Asthma, Eosinophilia
P-ANCA

Answer 6

Churg-Strauss

Question 7

Fibrinoid necrosis but w/ NO GRANULOMAS
Hypersensitivity vasculitis
p-ANCA more than -ANCA , can have immune complexes (mistake on Pandout)
glomerulonephritis (75%) + pulmonary hemorrhage
also has neuropathy: wrist/ foot drop
All lesions about the same stage

Answer 7

Microscopic Polyangiitis

Question 8

IgA deposits in small vessels

Palpable purpura – legs to buttocks/ arthritis, abdominal pain, glomerulonephritis

Answer 8

Henoch-Scholein purpura

Question 9

HS rxn to tobacco component in heavy smokers

Can involve nerves and veins  severe pain & chronic ulcerations (stop smoking before progression to frank gangrene)

Answer 9

Thromboangiits Obliterans (Burger’s disease)

Question 10

Rotator Cuff Tendinitis - primary cause of pain

Answer 10

tendonitis

Question 11

Extensor radialis brevis

Pain w/ supination and wrist extension

Answer 11

Laterial epicondylitis

Tennis elbow

Question 12

Flexor carpi radialis

Pain w/ pronation & wrist flexion

Answer 12

Medial epiconylitis

Golfer/ pitchers elbow

Question 13

Flexor tenosynovitis (flexor digitorum, superficialis)

Answer 13

Trigger Fingers

Question 14

Inflammation of the sheaths of the extensor pollicis brevis & abductor pollicis brevis

Answer 14

De Quervain’s Tenosynovitis

Question 15

Burning or tingling in hand usually at night
Median nerve compression in carpal tunnel
*median nerve may also be compressed at the pronator teres)
Thenar atrophy, Tinel’s sign, Phalen test

Answer 15

Carpal Tunnel Syndrome

Question 16

Does communicate with the joint 
Point tenderness over greater trochanter, worsened w/ external rotation and abduction
Worsen when lying on same side 
Difference in leg length can cause this
Lateral thigh pain above the knee

Answer 16

Trochanteric Bursitis

Question 17

Lateral femoral cutaneous nerve (L2-L3) entrapment  diffuse lateral thigh pain (sites of compression = inguinal ligament, insertion of psoas

Answer 17

Meralgia paresthetica

Question 18

40% communicate with the knee; may rupture  medial ankle ecchymosis
seen from behind the patient

Answer 18

Popliteal cyst (Baker’s cyst)

Question 19

Superficial to kneecap swelling

Always consider sepsis

Answer 19

Prepatellar Bursitis

Question 20

may rupture  Thompson sign

Answer 20

Achilles Tendinitis

Question 21

Women in high heeled shoes! Pain in 3rd/4rth toes due to entrapment of interdigital plantar nerves

Answer 21

Morton’s neuroma

Question 22

Prominence of metatarsal head on either side of the foot

Answer 22

Bunionette

Question 23

Excessive proliferation of skin & bones at distal extremities – excessive collagen desposition
Full syndrome – periostitis of long bones
Chest malignancy & lung infections

Answer 23

Hypertrophic Osteoarthopathy

Question 24

Younger patients, outer membrane IA inactivates compliment
Tenosynovitis of wrists, ankles, fingers, toes – migratory arthralgia
Often follows menstruation
Better to culture GU or pharynx where bug originally came from
Staph aureus #1
GAS #2
Salmonella in Sickle cell pts

Answer 24

N gonorrhea

Question 25

Most common viral arthritis

Answer 25

Parvovirus (B19)

Question 26

Catcher Crouch Syndrome – lumbar radiculoneuropathy

Answer 26

Rubella

Question 27

Arthritis-urticaria syndrome | Explosive arthritic of the knee

Answer 27

Hepatitis B

Question 28

Cryoglobulinemia vasculitis, palpable purpura over lower legs Type II and III

Answer 28

Hepatitic C

Question 29

Large effusions, little pain – occurs months/ years after the tick bite! Over-diagnosed in south – more likely STARI Most often the knee or TMJ Larger joints

Answer 29

Lyme Disease

Question 30

Articular Syndrome - <24 hours, severe pain in all joints of the body Reactive arthritis – spondyloarthritis (could be a presenting sign of HIV) Psoriatic arthritis

Answer 30

HIV arthralgia

Question 31

Only seen in HIV pts | Salivary gland enlargement, CD*+ lymphocytosis, sicca, parotid gland

Answer 31

Diffuse Infiltrative Lymphocytosis Syndrome (DILS)

Question 32

Fetty Syndrome

Answer 32

from long-standing RA - enlarged spleen – a/w deforming nodules in joints

Question 33

Non-neoplastic reactive proliferation (fibroblastic – can develop several weeks after trauma) Mesenchymal reaction to injury May appear anywhere – most common on the flexor forearms Or the trunk

Answer 33

Nodular Fasciitis

Question 34

Deep tissue Bizzarre cells filled with lipid vacuoles Usually painless, located in deep soft tissue  can reach a large size before it is detected

Answer 34

Liposarcoma

Question 35

Reactive bone formation in the muscle as a result of injury – bone women in granulation tissue

Answer 35

Myositis Ossificans

Question 36

Children- infrabdominal Young adult – abdominal wall (during/after pregnancy) = desmoid (a/w Gardner syndrome & familial adenomatous polyposis Adult – extra-abdominal Bland spindle proliferation – no mitotic figures, no necrosis

Answer 36

Fibromatosis | desmoid tumor

Question 37

Soft tissue – painless mass It often arises in the soft tissues of the thigh and the posterior knee. It is generally a large, painless mass deep to fascia and has an ill-defined margin. Bone – painful – arises in metaphysis of femur or tibia

Answer 37

Fibrosarcoma

Question 38

typical spindle cells arranged in a “storiform” (woven mat) pattern are seen; to the right are the typical bizarre giant cells. By 1977, MFH was considered the most common soft tissue sarcoma of adult life. Despite the frequency of diagnosis, MFH has remained an enigma. No true cell of origin has ever been identified. May occur following radiation tx of another sarcoma

Answer 38

Malignant Fibrous Histiocytoma

Question 39

White fish flesh appearance Almost two-thirds of RMS cases develop in children under the age of 10 Mark w/ antibody to vimentin (intermediate cytoplasmic filament)

Answer 39

Rhabdomyosarcoma

Question 40

10% of adult sarcromas – found in a joint or deep soft tissue Arises from mesenchymal cells, not the synovium Most have t(X;18) translocation Biphasic pattern of spindle cells and epithelial cells – within soft tissue

Answer 40

Synovial Sarcoma

Question 41

Benign localized developmental arrest in the diaphysis | Monostotic or polystotic (risk for osteosarcroma – though this would arise in a different location – metaphysis!)

Answer 41

Fibrous Dysplasia

Question 42

(a/w café au lait skin spots, endocrinopathies Can involve the facial bones Benign localized developmental arrest in the diaphysis

Answer 42

McCune Albright syndrome

Question 43

Fibrous Cortical Defect > 5-6 cm: Few or no symptoms except pain Usually found incidentally on radiography Fractures can occur through the thinned cortex Eccentric Sharply delimited -scooped out -Storiform/ woven pattern/ fibroblast cell origin

Answer 43

nonossifying fibroma

Question 44

very bloody, cystic lesions. They appear like a “sponge filled with blood.” These too, may contribute to pathologic fracture and can be an operative challenge if not expected because of excessive bleeding.

Answer 44

Aneurysmal bone cysts

Question 45

Bone-forming tumor - osteoma Round tumors that project from sub- or endosteal surfaces of cortex Usually solitary; multiple seen in ....

Answer 45

Gardner's syndrome

Question 46

Half involve the tibia and fibula. Usually they are cortical rather than medullary lesions. A prime characteristic of osteoid osteomas is that they are painful. They produce prostaglandin E2 and interestingly have a characteristic pattern of pain. They are more commonly painful at night and they are relieved by aspirin. Intake of alcohol causes a massive increase in pain

Answer 46

Osteoid osteoma

Question 47

benign cartilage capped tumors attached to the underlying skeletal system by a stalk displacement of growth plate in endochondral bones There is a condition of multiple hereditary exostosis which is autosomal dominant and may give rise to chondrosarcomas

Answer 47

Osteochondroma =Exotosis *metaphysis

Question 48

arise inside medullary cavities, typically in the hand and the feet, those tubular bones.

Answer 48

Chondroma | *diaphysis

Question 49

nonhereditary syndrome of multiple enchondromas

Answer 49

Ollier

Question 50

multiple enchondromas form as well as soft tissue hemangiomas.

Answer 50

Maffucci syndrome

Question 51

``` Multinucleated osteoclast type giant cells • Benign but uncommon • Locally aggressive • 20’s to 40’s • Cystic degeneration • Arise around knee > wrist Epiphysis ```

Answer 51

Giant Cell Tumor of Bone

Question 52

Prominent bone formation extends into soft tissue Lifted periosteum forms triangular shell of reactive bone: CODMAN TRIANGLE (arrow) Characteristic but not pathognomonic

Answer 52

Osteosarcoma

Question 53

Common sites include metaphysis around the knee in younger people. There is an association with retinoblastoma.

Answer 53

Osteosarcoma

Question 54

2nd most common primary malignant bone tumor | Surgery, insensitive to chemotherapy

Answer 54

Chondrosarcoma

Question 55

round blue cell tumor so known because of its characteristic, very high nuclear cytoplasmic ration, mostly nucleus 85% of these have genetic signatures which relate them to peripheral neuroectodermal tumors They arise in the medulla of the bone, primarily in diaphysis of long bones

Answer 55

Ewing’s sarcoma (peripheral primitive neuroectodermal tumor) *diaphysis

Question 56

anticipation with increased repeat expansions and more severe phenotypes in younger generations. Percussion and grip myotonia : Increased CGT repeats of DNA on chromosome 19,

Answer 56

Myotonic dystrophy

Question 57

muscle phosphorylase deficiency from which glycogen can not break down during exercise to produce ATP

Answer 57

McArdle’s Disease

Question 58

Anti-Jo-1/ Anti-Synthetase Syndrome

Answer 58

“Jo is the f-a-mily mechanic” | Mechanics hands

Question 59

Proximal and distal muscle weakness Poor response to steroid tx + neurological symptoms Basophilic w/ Gomori Trichome stain

Answer 59

Inclusion body myositis

Question 60

CD8 cells invade muscle w/ increased MHC I expression

Answer 60

Polymyositis

Question 61

20-50 y/o, CD4 & B cell activation  RF and aCCPs, symmatric Granulation tissue  pannus  joint erosion  fibrosis

Answer 61

RA

Question 62

Reduction in chondrocytes at growth plate • Most common cause of inherited dwarfism; autosomal dominant • Short extremities, normal trunk, large head, normal mentation

Answer 62

ACHONDROPLASIA

Question 63

Unbalanced and excessive osteoclast and osteoblast function; increased bone turnover • Osteolytic, mixed osteolytic-osteoblastic,

Answer 63

Paget dz

Question 64

Failure of the bone to mineralize properly in an adult

Answer 64

OSTEOMALACIA

Question 65

Increased bone activity + peritrabecular fibrosis + cystic brown tumors primary hyperparathyroidism

Answer 65

osteitis fibrosa cystica

Question 66

More lung disease than any other autoimmune | connective tissue disease

Answer 66

Scleroderma

Question 67

the most common | pleuropulmonary manifestation of lupus

Answer 67

pleuritis

Question 68

one of the most unpredictable and potentially serious adverse effects of methotrexate treatment

Answer 68

Pneumonitis

Question 69

myositis + arthritis + lung disease (20% of all)

Answer 69

Can be part of anti-synthetase syndrome

Question 70

NSIP 1. It has lymphoid follicles (germinal centers) [shown in panel A] 2. It is bronchiolocentric [shown in both panel A and panel B] 3. It has more lymphocytes [shown in both panel A and panel B] 4. It has macrophages and multinucleated giant cells [shown in panel B]

Answer 70

Sjogren's disease of lung