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Smart Decks > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Describe the changes to bone in Rickets

A
  1. Trabeculae are normal in number and size, but do not mineralize effectively
  2. Rim of uncalcified osteoid is much larger than normal
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2
Q

Are crystals in gout or pseudogout visible on x-ray?

A

Gout - no, they are monosodium urate crystals

Pseudogout - yes, they are calcium pyrophosphate dihydrate crystals

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3
Q

What are the metabolic side effects of glucocorticoids?

A
  1. hypocalcemia
  2. fluid retention
  3. hypokalemia
  4. hyperglycemia
  5. hypernatremia
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4
Q

Is celecoxib a sulfa drug?

A

YES, along with:

sulfonureas, sulfamethoxazole, sulfasalazine, and thiazide diuretics, furosemide, bumetanide

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5
Q

Pain at what location is pathognomonic for scaphoid fracture?

A

anatomic snuffbox – this should be fixed right away because risk of avascular necrosis

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6
Q

Which lumbricals does the median nerve innervate?

A

1st and 2nd (which move the 2nd and 3rd fingers–the pointer and middle finger)

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7
Q

What symptoms would be present in a common fibular nerve injury? What is another name for this nerve and how is it commonly injured?

A

Symptoms:
1. loss of sensation over dorsum of the foot (superficial fibular branch)
2. loss of dorsiflexion and toe extension (deep fibular branch)
AKA: Common peroneal nerve
Common injury: compression at the head of the fibula by bed rest, leg crossing, or hyperflexion of knee (vajrasana → “yoga foot drop”)

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8
Q

What type of collagen is affected in osteogenesis imperfecta? What ocular finding is present?

A

Type I; may present with blue sclera

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9
Q

Draw out the brachial plexus

A

see a picture to check

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10
Q

What is tacrolimus?

A

an immunosuppresant that inhibits calcineurin-mediated transcription of IL-2

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11
Q

Which levels innervate the anal wink?

A

S2-S4 via the pudenal nerve

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12
Q

What are the markers of osteoblast and osteoclast activity?

A

Osteoblast:
- bone specific alkaline phosphatase
Osteoclast:
- TRAP, urinary hydroxyproline, urinary deoxydyridinoline (most reliable)

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13
Q

Which gout drug has GI side effects such as nausea, vomiting, and diarrhea? What is its mechanism of action? Is it used for acute or chronic gout?

A

Colchicine; microtubule polymerization inhibitor; both

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14
Q

When overactive, this enzyme can lead to gout

A

PRPP (5’-phosphoribosyl-1’-pyrophosphate; increases purine production → uric acid)

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15
Q

What immune cell mediates the inflammation in gout?

A

neutrophils (they try to eat the crystals → release cytokines to recruit more neutrophils and cause inflammation)

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16
Q

What are the findings in alkaptonuria? What enzyme is deficient?

A
  1. Dark connective tissue (e.g. helix of ears)
  2. Brown pigmented sclerae
  3. Urine turns black on prolonged exposure to air
  4. Arthralgias (homogentisic acid damage to cartilage)
    Deficiency = homogentisate oxidase
    Pathway = Tyrosine → Fumarate
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17
Q

What are the top 2 causes of osteomyelitis in SS patients?

A
  1. Salmonella - most common

2. E. coli

18
Q

What is Ecthyma gangrenosum?

A

a rapidly progressive necrotic cutaneous infection caused by Pseudomonas in immunocompromised patients

19
Q

Key differences b/w polymyalgia rheumatica and fibromyalgia?

A
  1. Age: PMR is more common in ♀ > 50 vs. FM in F8 20 - 50
  2. Symptoms: PMR has fever and weight loss, FM has point tenderness
  3. Labs: PMR will have ↑ ESR, CRP, (normal CK)
  4. Treatment: PMR: low-dose corticosteroids vs. FM: exercise, antidepressants, anticonvulsants
20
Q

Inheritance of achondroplasia?

A

AD

21
Q

What is a common manifestation of sickle cell disease painful crisis in children?

A

Dactylitis (painful hand swelling)

22
Q

How does Paget’s disease start?

A

↑ osteoclast activity

4 stages: lytic, mixed, sclerotic, quiescent

23
Q

Intracellular levels of what substance activates the breakdown of glycogen?

A

Ca2+

24
Q

What is a central joint that can be affected in reactive arthritis?

A

sacroiliac joint (20% of cases) → sacroiliits

25
Q

What are the symptoms of polymyositis? Pathophys?

A

Progressive symmetric proximal muscle weakness; muscle damage → overexpression of MHC I on sarcolemma → CD8+ T cell infiltration → further damage

26
Q

What is etanercept? What do you have to check before using it?

A

TNF-α inhibitor; See if patient has TB b/c this class of drugs predispose to infection

27
Q

What are some prominent features of congenital hypothyroidism?

A 
Pot-bellied
Pale
Puffy-faced (course facial features)
Protruding umbilicus
Protuberant tongue
Poor brain development 
Pooped (lethargy, floppy)
Poor feeding
28
Q

What is Hirschsprung disease?

A

abnormal migration of neural crest cells into rectosigmoid colon → absence of ganglion cells in wall → abdominal distention, bilious emesis, failure to pass meconium

29
Q

What viral infection can closely mimic rheumatoid arthritis? How can you tell the difference?

A

Parvovirus; it will self-resolve

30
Q

What are the symptoms of scurvy? Who might get it?

A

Swollen gums,
bruising,
hemarthrosis,
anemia,
poor wound healing,
perifollicular and subperiosteal hemorrhages, “corkscrew” hair
People on “Tea and Toast” diet, homeless, alcoholics, drug users

31
Q

Where is collagen (proline and lysine residues) hydroxylated by vitamin C?

A

RER

32
Q

What is the most commonly injured structure in rotator cuff syndrome? How do you test for it?

A

Supraspinatus tendon because it gets impinged b/w acromion and head of humerus; “empty can” test is 90% specific (abduct arms 90 degrees, flex 30 degrees, point thumbs toward floor)

33
Q

What two signals produced by osteoblasts promote osteoclastic differentiation?

A
  1. Macrophage CSF

2. RANK-L

34
Q

What kind of hypersensitivity is MG?

A

II

35
Q

What protein is defective in Marfan’s? What is its function?

A

Fibrillin-1 - a component of microfibrils that forms a sheath around elastin

36
Q

Contrast the functions of golgi tendon organ and extrafusal fibers in the mm.

A

Golgi: senses when too much stretch → reflex relax
Muscle spindle (aka intrafusal fibers): mm. contracts to resist stretch
Note that golgi is in series and muscle spindle is parallel to muscle fibers

37
Q

What nerve passes through the obturator foramen? What action do the innervated muscles perform?

A

Obturator nerve → thigh adduction

38
Q

What two muscles does the median nerve pass between in the arm?

A

flexor digitorum superficialis and flexor digitorum profundus

39
Q

Injury to this nerve and muscle causes a winged scapula

A

long thoracic nerve to serratus anterior

40
Q

Does the PCL attach medially or laterally to the midline on the femur? What about the ACL?

A

PCL: medially
ACL: laterally

41
Q

Why is there hypercalcemia in sarcoidosis?

A

Activated T cells secrete IFN-gamma → ↑ 1α-hydroxylase in Mø → ↑ vit D → ↑ absorption of Ca2+ from GI and kidneys

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