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MSK Flashcards

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1
Q

unhappy triad

A

contact sports d/t lat force applied to planted leg
ACL, MCL, medical meniscus (attached to MCL)
lat meniscus actually more common

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2
Q

prepatellar brusitis

A

aka housemaids knee

d/t repeated kneeling

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3
Q

rotator cuff mm innervation

A

C5-6

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4
Q

medial epicondylitis

A

aka golfers elbow
repetitive flexion or idiopathic
pain near medial epicondyle

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5
Q

lateral epicondylitis

A

aka tennis elbow
repetitive extension or idiopathic
pain near lat epicondyle

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6
Q

carpal tunnel associations

A

prego
RA
hypothyroidism

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7
Q

guyon canal

A

compression of ulnar n at wrist or hand

seen in cyclists

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8
Q

axilarry

A

C5-6
deltoid
loss of arm abductions >15 degress
loss of sensation over delt and lat arm

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9
Q

musculocutaneous

A

C5-7
loss of forearm flexion and supination
loss of sensation over lat forearm

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10
Q

radial

A 
C5-T1
wrist drop
loss of extension
decreased grip strength
loss of sensation over post arm/forearm and dorsal hand
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11
Q

median

A 
C5-T1
'Ape hand' 
'popes blessing'
loss of flexion of wrist and lat fingers, thumb opposition, lumbricals on 2nd and 3rd digit
loss of sensation over thenar eminence
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12
Q

ulnar

A 
C8-T1
ulnar claw 
proximal- radial deviation of wrist upon flexion 
loss of wrist flexion 
medial 2 lumbricals
loss of senation over medial 1.5 fingers
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13
Q

recurrent brr of median n

A

C5-T1
‘ape hand’
loss of thenar group
no loss of sensation

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14
Q

obturator

A

L2-4

decreased thigh sensation (medial) and decreased adduction

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15
Q

femoral

A

L2-4

decreased thigh flexion and leg extension

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16
Q

common peroneal

A

L4-S2
foot drop- inverted and plantar flexed at rest
steppage gait
loss of sensation on dorsum of foot
PED: Peroneal Everts and Dorsiflexes, if injured goot dropPED

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17
Q

tibial

A

L4-S3
inability to curl toes and loss of sensation on sole of foot
proximal lesions- foot everted at rest
can be d/t bakers cyst
TIP: Tibial Inverts and Plantar flexes, if injured cannot stand of TIP toes

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18
Q

superior gluteal

A

L4-S1
trendelenburg gait
loss of glut medium and minimus

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19
Q

inferior gluteal

A

L5-S2
difficulty climbing Strauss, rising from seated position
loss of hip extension

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20
Q

herniated L3-L4

A

weakness of knee extension

decreased patellar reflex

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21
Q

herniated L4-5

A

weakness in dorsiflexion

difficulty in heel walking

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22
Q

herniated L5-S1

A

weakness of plantarflexion
difficulty in toe walking
decreased achilles reflex

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23
Q

achondroplasia

A

failure of longitudinal bone growth ->
membraneous ossfication not affected -> big head
constitutive activation of FGFR3 inhibits chondrocyte proliferation
85%+ sporadic
AD w/full penetrance (homo lethal)
MCC of dwarfism

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24
Q

osteopetrosis

A

failure of normal bone resorption
thickened dense bones that fracture
pancytopenia, extramedullary hematopoiesis
mutations in carbonie anhydrase II cannot create acidic environment
x-ray bone-in-bone appearance
can cause CN palsies
bone marrow transplant

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25
paget disease
disordered bone remodeling increase in both osteoblastic and osteroclastic activity mosaic pattern long bone chalk-stick fractures increased blood flow from AV shunts may cuase high-output heart failure increased risk of osteogenic sarcoma hat sized increased hearing loss d/t narrowed auditory foramen
26
stages of pagets
lytic-osteoclasts mixed-osteoclasts and blasts sclerotic- osteroblasts quiescent- minimal activity
27
causes of osteronecrosis
``` ASEPTIC alcoholism sickle cell storage exogenous/endogenous steroics pancreatitis trauma idiopathc caisson (the bends) ```
28
lab values osteoporosis
serum Ca, phos, ALP, PTH normal | decreased bone mass/DEXA
29
lab values osteomalacia
decreased Ca, phos increased ALP, PTH soft bones
30
lab values osteopetrosis
Ca normal or low Phos, ALP, PTH normal dense brittle bone
31
lab values pagets
normal Ca, phos PTH elevated ALP mosaic bone
32
lab hypervitaminosis D
Ca and phos high normal ALP high PTH granulomatous diseases (sarcoid)
33
osteitis fibrosa cystica d/t primary hyperparathyroidism
increased Ca, ALP, and PTH decreased Phos brown tumors d/t fibrous replacement of bone
34
osteitis fibrosa cystica d/t secondary hyperparathyroidism
decreased Ca increased Phos, ALP, PTH compensation for ESRD
35
benign bone tumors
giant cell | osteochrondroma (MC)
36
Giant cell
``` 20-40yr epiphyseal end of long bones benign, but locally aggressive often knee 'soap bubble' on xray multinucleated giant cells Neoplastic cells are osteoblasts (express RANKL) markers- alkaline phosphatase and ostocalsin ```
37
osteochondroma
MC benign bone tumor | males
38
malignant bone tumors
osteosarcoma/osteogenic sarcoma | Ewing sarcoma
39
osteosarcoma
2nd MC primary malignant bone tumor (after MM) Bimodal 10-20 and >65 metaphysis of long bones, usually at knee codmans triangle or sunburst on x-ray aggressive Tx w/surgical resection and chemo
40
predisposing factors for osteosarcoma
``` pagets bone infarcts radiation familial retinoblastoma Li-fraumeni ```
41
Ewing sarcoma
boys
42
11,22
EWS-FLI1
43
joint findings in osteoarthritis
``` subchondral cysts sclerosis osterophyts ebunation synovitis heverden nodes (DIP) Bouchard nodes (PIP) no MCP involvement ```
44
RA etiology
autoimmune mediated by cytodines type III and IV hypersensitivity rxn
45
RA joints
pannus (MCP, PIP) sub-q rheumatoid nodules (fibrinoid necrosis) ulnar deviation of fingers subluxation rare swan neck and boutonniere deformities rare DIP involvement
46
predisposing factors to RA
females RF (anti-IgG) anti-CCP more specific HLA-DR4
47
sjogren syndrome
autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates females 40-60
48
findings of sjogren
inflammatory joint pain (can be associated w/RA) xerophthalmia xerostomia antinuclear Abs: SS-A/anti-Ro, SS-B (anti-La) b/l parotid enlargement
49
complications of sjogrens
dental carries | MALT lymphomas
50
what meds can decrease uric acid excretions
thiazide diuretics
51
what is associated w/overproduciton of uric acid
lesch-nyhans PRPP excess increased cell turn over (tumor lysis syndrome) von Gierke disease
52
gout crystals
needle shaped, neg bifringement | yellow under parallel light, blue under perpendicular
53
pseudogout
``` Ca pyrophophate crystals basophilc rhomboid cyrstals large joints (knee) >50, both sexes blue when parallel to light, yellow when perpendicular ```
54
pseudogout associations
homochromatosis hyperparathyroidism osteoarthritis
55
infectious arthritis
S. aureus Steptococcus Neisseria gonorrhea
56
seronegative spondyloarthropathies
``` HLA-B27, NO RF PAIR Psoriatic arthritis Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis ```
57
psoriatic arthritis
joint pain and stiffness associated w/psoriasis asymmetric and patchy involement dactylitis (sausage fingers) pencil-in-cup
58
ankylosing spondylitis
chronic inflammatory disease of spine and SI joint uveitis aortic regurg bamboo spine (vertebral fusion)
59
Reactive arthritis
Conjuctivits, urethritis, arthritis can't see, can't pee, can't climb a tree Post GI (shigella, salmonella, yersinia, campylobacter) or chlamydia infections
60
systemic lupus erythmatosus
``` women, repro age, black RASH OR PAIN rash (malar or discoid) arthritis soft tisseus/serositis hematologic disorders oral/nasopharyngeal ulcers renal disease/raynauds photosensitivity/postive VDRL/RPR anti-nuclear Abs immunsuppressants nerological disorders ```
61
CCD in SLE
cardiovascular disease infections renal disease
62
SLE nephritis
type III sensitivity rxn nephritic- diffuse proliferative glomerulonephritis nephrotic- membranous glomerulonephritis
63
libman-sacks endocarditis
SLE | nonbacterial wart-like vegetations on both sides of valve
64
SLE findings
antinuclear abs (ANA), not specific anti-dsDNA abs (specific, poor prognosis -> renal disease) anti-smith/anti-snRNP abs (specific, not prognostic) anti-histone- drug SLE decreased C3, C4, CH50 d/t IC formation
65
antiphospholipid syndrome
primary or secondary autoimmune MC d/t SLE history of thrombosis and/or spontaneous abortions lupus anticoagulant, anticardiolipin anti beta2 glycoprotein Abs false + VRDL d/t anditcoagulant and anticardiolipin Tx systemic anticoagulation
66
sarcoidosis
immune mediated widespread, noncaseating granulomas elevated ACE, CD4/CD8 ratio black females often asymptomatic, except for enlarged lymph nodes
67
sarcoidosis CXR
b/l adenopathy and coarse reticular opacities | CT better shows extensive hilar and mediastinal adenopathy
68
sarcoidosis is associated w/what?
``` restrictive lung disease (interstitial fibrosis) erythema nodosum lupus pernio bells palsy epithelioid granulomas uveitis hypercalcemia ```
69
epithelioid granulomas of sarcoidosis
schaumann and asteroid bodies
70
hypercalcemia of sarcoidosis
d/t increased 1 alpha hydroxylase mediated vit D activation in macros
71
polymyalgia rheumatica
pain and stiffness in shoulder and hips w/fever malaise, weight loss does not cause mm weakness women >50 associated w/temporal arteritis
72
labs in polymyalgia rheumatica
increased ESR, CRP | normal CK
73
Tx of polymyalgia rheumatica
rapid response to low dose corticosteroids
74
polymyositis and dermatomyositis
``` increased CK ANA+ anti-Jo1 anti-SRP anti-Mi2 Tx steroids followed by long term immunosuprresion (MTX) ```
75
polymyositis
progressive symmetric proximal mm weakness endomysial inflammation w/CD8 cells most often involves shoulders
76
dermatomyositis
``` similar to polymyositis but has malar rash gottrons papules heliotrope rash shawl and face rash mechanics hands increased risk of occult malignancy perimysial inflammation atrophy w/CD4 cells ```
77
sclerederma/systemic sclerosis
triad of autoimmunity, noninflammatory vasculopathy, collagen deposition w/fibrosis puffy, taught skin w/p wrinkles fingertip pitting sclerosis of renal, pulmonary (MCCOD), GI females
78
diffuse scleroderma
widespread skin involvement rapid progression early visceral involvement anti Scl-70/anti topoisomerase I
79
limited scleroderma
``` limited skin involvement, more benign anti-centromere CREST calcinosis raynauds esophageal dysmotility sclerodactyly telangiectasia ```
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