MSK Path Flashcards by Poopy McPoopson

Short Limbs
Big Head
Normal lifespan
Fertile

Achondroplasia

Common cause of dwarfism

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Achondroplasia Mutation

FGFR3

On all the time –> inhibits chondrocyte proliferation

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Acute back pain
kyphosis
loss of height

Vertebral crush fracture

osteoporosis

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Osteoporosis

Trabecular (spongy( bone loses mass despite normal bone mineralization and labs

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Type 1 osteoporosis

Post menopausal

increased bone resorption due to decreased estrogen

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Type 1 osteoporosis common fxrs

Colles (distal radius)

Femoral neck

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Type II osteoporosis

Senile

men and women > 70

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Type II osteoporosis Prophylaxis

weight bearing exercise (increase mm. mass)

Ca and Vit. D intake

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Type II osteoporosis Tx

Estrogen (SERMS)
Calcitonin

Severe:
Bisposphonates
Pulsatile PTH

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Rx contraindicated in osteoporotic pts.

Glucocorticoids

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Failure of bone resorption due to defective osteoclasts
Thickened/dense bones prone to fxr
pancytopenia

Osteopetrosis

Osteoclasts can’t get acidic env. to resorb bone

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X-ray finding of osteopetrosis

Bone in bone

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Why do you get pancytopenia with osteopetrosis?

Bone fills marrow space inhibiting hematopoeiesis

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Osteopetrosis Tx

Bone marrow transplant

Osteoclasts come from stem cells–replace them

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Vitamin D deficiency in kids? Adults?

Kids–rickets (bowing of long bones)
Adults–Osteomalacia

Hyperactivity of osteoblasts –> inc. serum Alk Phos

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Increased osteoblastic and osteoclastic activity
chalk stick fxr
Normal Ca, P, PTH
Increased ALP
Increased Hat size and hearing loss

Paget’s Disease of bone

Hearing loss due to CN impingement

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Paget’s Disease of bone pattern

Mosaic woven bone pattern –> chalk stick fxr

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How does Paget’s Disease of bone cause high output heart failure?

Increased blood flow to bone due to increased AV shunts

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Cancer risk increased in Paget’s disease of bone

Osteogenic Sarcoma

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Bone diseases that impinge cranial nerves.

Osteopetrosis
Paget’s disease of bone

Bones thicken and narrow foramina

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Bone replaced by fibroblasts, collagen, and irregular boney trabeculae

Polycystic Fibrous Dysplasia

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McCune-Albright Syndrome

Polyostotic fibrous dysplasia

multiple unilateral bone lesions

Endocrine abnormalities (precocious puberty)
Cafe-au-lait spots

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Tumors common at knee (distal femur proximal tibia)

Giant Cell tumor

Osteosarcoma

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Tumors at metaphysis of long bones

osteosarcoma

otrochondroma

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Epiphyseal tumor

Giant Cell tumor

Men 30-60 Malignant Cartilaginous tumor expansile glistening mass in medullary cavity

Chondrosarcoma

Boys < 15 Diaphysis of long bone Onion skin appearance of bone anaplastic small blue cell malignant tumor

Ewing's Sarcoma

Ewing Sarcoma mutation

t(11:22) translocation 33--Ewing's jersey

10-20 y/o male Malignant bone tumor sunburst pattern on x-ray metaphysis of long bone--knee

Osteosarcoma

Codman's Triangle

elecation of periosteum seen in osteosarcoma

Male < 25 #1 benign bone tumor mature bone with cartilage cap

osteochondroma (exostosis)

Giant cell tumor of bone AKA

osteoclastoma

Giant cell tumor x-ray buzz

double bubble soap bubble

Spindle shaped cells multinucleated giant cells 20-40 y/o Tumor at knee

Giant cell tumor AKA osteoclastoma

Infectious Arthritis bugs

S. aureus Streptococcus N. gonorrhoeae

Sexually active | asymmetrical migratory arthritis

N. gonorrhoeae

Infarction of bone and marrow | pain with activity

Osteonecrosis (avascular necrosis)

Osteonecrosis causes

trauma high dose corticosteroids EtOH Sickle Cell Anemia

Most common site for osteonecrosis

femoral head

HLA-B27+ Arthritis without Rheumatoid Factor Male

Seronegative spondyloarthropathies

``` Skin rash joint pain Dactylitis Pencil in cup finding on xray HLA-B27+ ```

Poriatic Arthritis 1/3 of psoriasis pts. sausage fingers

stiff spine due to fusion of joints--bamboo spine HLA-B27 uveitis Aortic regurgitation

Ankylosing Spondylitis

Crohn's and UC associated with what joint diseases?

Ankylosing Spondylitis | peripheral arthritis

``` Conjunctivitis Urethritis Arthritis Post GI or chlamydia infxn HLA-B27+ ```

Reactive Arthritis (Reiter's Syndrome) "I can't see, pee, climb trees"

Marker specific for Rx induced lupus

Antihistone Ab

Why is there a false + on Syphilis RPR/VDRL with SLE pts?

Antiphospholipid Abs cross react with cardiolipin used in tests

Kidney syndromes associated with SLE

1. Diffuse proliferative GN (nephritic) | 2. Membranous GN (nephrotic)

Markers for SLE

ANA--sensitive but not specific dsDNA--specific, poor prognosis Anti-Smith (anti-Sm)--very specific, not prognostic

Sx of SLE

``` Fever fatigue weight loss Liebman-Sacks endocarditis hiar adenopathy Raynaud's Malar rash (butterfly) arthritis Neurologic Sx photosensitivity ```

Liebman-Sacks Endocarditis

verrusous sterile vegetations on both side of heart valve associated with SLE

``` Immune mediated widespread noncaseating granulomas elevated ACE Hypercalcemia bilateral hilar denopathy on chest xray Black female Enlarged lymph nodes ```

Sarcoidosis

Sarcoidosis associated with

restrictive lung disease erythema nodosum uveitis hypercalcemia

Mechanism of hypercalcemia with sarcoidosis

elevated 1-alpha Hydroxylase mediated vit. D activation in epithelioid macrophages

Sarcoidosis Tx

Steroids

Microscopic findings of sarcoid (buzz words)

Schaumann bodies Asteroid Bodies

``` Pain/Stiffness in shoulder and hips fever malaise weight loss femal > 50 Increased ESR, normal CK NO MM. WEAKNESS ```

Polymyalgia rheumatica

Polymyalgia rheumatica associated with

Giant Cell Temporal Arteritis

Tx Polymyalgia rheumatica

Low dose steroids

``` Woman 20-50 chronic widespread MSK pain Stiffness parasthesia poor sleep fatigue ```

Fibromyalgia

Progressive symmetrical proximal mm. weakness (shoulders most common) endomysial inflammation CD8+ mediated

Polymyositis

Progressive symmetrical proximal mm. weakness malar rash Grottron's papules heliotrope rash CD4+ cells

Dermatomyositis

What do you need to worry about with dermatomyositis pts.

Occult malignancy

Cells involved in Polymyositis and dermatomyositis

Poly--CD8+ | Derm--CD4+ D is 4th letter of alphabet

Poly/Dermatomyositis Labs

Increased CK ANA+ anti-Jo-1 Ab's

Poly/Dermatomyositis Tx

Steroids

#1 NMJ disease

Myasthenia Gravis

Proximal mm. weakness that improves with use

Lambert Eaton

Lambert Eaton Pathophys

auto-Ab against presynaptic Ca channel --> decreased ACh released

Myasthenia Gravis pathophys

Ab against post synaptic ACh receptors

MG associated with

Thymoma | Thymic Hyperplasia

Lambert Eaton Associated with

Small Cell CA of lung

Metaplasia of Skeletal mm. to bone following trauma UE and LE most commonly

Myositis Ossification