Musculoskeletal: Leech Questions

Front 1

What is the most common form of arthritis?

Back 1

Osteoarthritis

Front 2

this problem Affects at least one joint in 80% of people over 70 years old

Back 2

Osteoarthritis

Front 3

Insidious onset of joint stiffness
Deep, aching joint pain, which worsens with repetitive motion
Decreased range of motion
Crepitus
Joint effusions and swelling
Osteophytes may cause nerve compression

this describes?

Back 3

osteoarthritis

Front 4

what is the major pathophysiology behind osteoarthritis?

Back 4

Degeneration and loss of articular cartilage

Front 5

where is OA commonly seen on the body?

Back 5

Weight-bearing joints --> knees, hips, and spine

Front 6

A systemic, chronic, inflammatory disease characterized by progressive arthritis, production of rheumatoid factor, and extra-articular manifestations

what is this?

Back 6

RA

Front 7

what causes RA?

Back 7

an autoimmune reaction triggered by an infectious agent in a genetically susceptible individual.

Front 8

what is the genetic predisposition seen in RA?

Back 8

HLA-DR4 and DR1

Front 9

patient comes in complaining of morning stiffness and symmetrical pain of the wrists. What does she likely have?

Back 9

RA

Front 10

what is Pannus formation and what is it seen in?

Back 10

proliferation of the synovium and granulation tissue over the articular cartilage of the joint

RA

Front 11

what is the major lab finding in RA?

Back 11

Rheumatoid factor (RF)

Usually an IgM autoantibody against the Fc fragment of IgG

Front 12

the titer of what lab finding correlates with the prognosis of the associated disease?

Back 12

Rheumatoid Factor for RA

Front 13

monosodium urate crystals in joints, resulting in recurrent bouts of acute arthritis describes?

Back 13

GOUT

Front 14

what leads to gout?

Back 14

overproduction of uric acid

Front 15

a 70 year old man comes in to your office with an exquisitely painful, inflamed big toe. What does he have?

Back 15

gout

Front 16

Deposition of calcium pyrophosphate crystals describes?

Back 16

pseudogout

Front 17

what are the crystals associated with pseudogout

Back 17

Deposition of calcium pyrophosphate crystals

Front 18

man comes in complaining of knee joint pain. You see a history of diabetes and hypothyroidism. You have ruled out osteoarthritis and RA, what is the likely cause? What lab finding would you see

Back 18

pseudogout

Deposition of calcium pyrophosphate crystals

Front 19

what is the most common dystrophy?

Back 19

x-linked Duchenne muscular dystrophy

Front 20

a boy is born with no seeming problems, yet he has become increasingly weak by age 5. By age 10 he is in a wheelchair. What is the problem?

Back 20

x-linked Duchenne muscular dystrophy

Front 21

Disease progresses relentlessly until death by the early twenties
Begins in the pelvic girdle muscles, then extends to the shoulder girdle
Heart and cognitive impairment appears to be a component of the disease

what is this?

Back 21

x-linked Duchenne muscular dystrophy

Front 22

Variation in fiber size
Increased numbers of internalized nuclei
Degeneration of muscle fibers
Regeneration of muscle fibers
Proliferation of enomysial connective tissue

are commonly seen in what?

Back 22

Duchenne muscular dystrophy and Becker muscular dystrophy

Front 23

where is the gene that is responsible for x-linked muscular dystrophy found?

Back 23

Xp21

Front 24

slowly progressive muscle weakness of the legs and pelvis, presents onset in adolescence. What is this?

Back 24

Becker muscular dystrophy

Front 25

what is the major difference btw Becker and Duchenne muscular dystrophy?

Back 25

Becker's has later onset in life

Front 26

a child is brought to the emergency department with a laceration that requires stitches. Upon administration of anesthesia, the patient starts to expeirence tachycardia, tachypnea, muscle spasms, and later hyperpyrexia. What does this patient have? What type of problem is this?

Back 26

Malignant hyperpyrexia (malignant hyperthermia)

Ion Channel Myopathies

Front 27

patient presents with muscle weakness that actually gets better with repeated contractions. What is this?

Back 27

Lambert-Eaton sydrome

Front 28

what is commonly associated with Lambert-Eaton syndrome?

Back 28

small cell carcinoma of the lung

Front 29

Your 68 y/o gent patient comes to you for evaluation of 25 pound weight loss (without intention) and proximal muscle weakness over a six month course. Physical exam shows that the weakness does not increase with repetitive motion. Most likely underlying mechanism for this is?



a. Diabetes mellitus

b. Becker muscle dystrophy

c. Toxic myopathy

d. Small cell lung carcinoma

e. Carcinoma of the thymus

Back 29

D

Front 30

pt is easily fatigued, exhibits ptosis, and gets more fatigued by the end of the day. What does this patient have? What is the mech?

Back 30

Myasthenia Gravis

Antibodies to AChR

Front 31

Achondroplasia is what?

Back 31

Most common form of inherited dwarfism

Front 32

what is the problem seen in Osteogenesis imperfecta

Back 32

abnormal synthesis of type I collagen

Front 33

a patient comes in with recurrent fractures. On exam you see a thin sclera with a blue hue. The patient is also hypermobile. What does this person have?

Back 33

Osteogenesis imperfecta (OGI) (“brittle bone disease”)

Front 34

a patient presents with deafness, small, fragile, and discolored teeth, and a thin dermis. The patient has a history of recurrent fractures. What do they have?

Back 34

osteogenesis imperfecta

Front 35

patient has excessive resorption of bone followed by disorganized bone replacement producing thickened but weak bone. What does this describe?

Back 35

Pagets

Front 36

a european man has an infection with paramyxovirus and now is having bone deformity and fracture. What does he have??

Back 36

Pagets

Front 37

if you see a haphazard arrangement of cement lines, creating a “mosaic pattern” of lamellar bone what does the patient have?

Back 37

Pagets

Front 38

Highly elevated serum alkaline phosphatase, Increased levels of urinary hydroxyproline, and xrays that show bone enlargement with lytic and sclerotic areas would be indicative of?

Back 38

Pagets

Front 39

decreased bone mass (osteopenia), resulting in thin, fragile bones that are susceptible to fracture

this defines?

Back 39

Osteoporosis

Front 40

this is the Most common bone disorder in the US that
Most commonly occurs in postmenopausal Caucasian women and the elderly

Back 40

Osteoporosis

Front 41

what are some of the primary causes of Osteoporosis

Back 41

Estrogen deficiency (postmenopausal, Turner’s syndrome)
Genetic factors (low density of original bone)
Lack of exercise
Old age
Nutritional factors

Front 42

benign neoplasm that frequently involves the skull and facial bones is what?

Back 42

osteoma

Front 43

what is commonly associated with Gardners syndrome?

Back 43

osteoma

Front 44

benign, painful growth of the diaphysis of a long bone, often the tibia or femur

Back 44

Osteoid osteoma

Front 45

you have a male age 22 comes in with pain along his femur that is worse at night, but is relieved with aspirin. You see a central radiolucency surrounded by a sclerotic rim on x-ray.

What does the pt have?

Back 45

Osteoid osteoma

Front 46

Most common primary malignant tumor of bone is?

Back 46

Osteosarcoma

Front 47

patients with familial retinoblastoma have a high risk for what?

Back 47

Osteosarcoma

Front 48

if you see Codman’s triangle (periosteal elevation)
“Sunburst” pattern
Bone destruction

on xray, what do you have?

Back 48

Osteosarcoma

Front 49

if you see anaplastic cells producing osteoid and bone

Back 49

Osteosarcoma

Front 50

Malignant neoplasm of undifferentiated cells arising within the marrow cavity is what?

Back 50

Ewing sarcoma

Front 51

What are the genetics associated with Ewing sarcoma?

****** MUST KNOW

Back 51

classic translocation t(11;22), which produces the EWS-FLI1 fusion protein

Heed this: Basketball legend Patrick Ewing was #33, so 11+22=33

Front 52

Sheets of undifferentiated small round blue cells resembling lymphocytes and
Homer Wright pseudorosettes are micro findings indicative of?

Back 52

Ewing Sarcoma

Front 53

there are 5 common sites of metastatic lesions. What are they?

Back 53

Prostate (often osteoblastic)
Breast
Lung
Thyroid
Kidney

Front 54

Mot common soft tissue tumor of adulthood?

Back 54

Lipoma

Front 55

Benign tumors of fat are what?

Back 55

Lipomas

Front 56

where is the characteristic chromosomal abnormality seen in a lipoma?

Back 56

13q

Front 57

where are the majority of lipomas found?

Back 57

subcutaneous

Front 58

you have a middle aged man who comes in with a lump under the skin on the trunk and upper extremity. The lumps are benign. What are they likely?

Back 58

lipomas

Front 59

are lipomas painless?

******

Back 59

yes EXCEPT ANGIOLIPOMAS (on forearm)

Front 60

One of the most common sarcomas of adulthood
Patients  in their 40’s – 60’s
Uncommon in children
Usually arise in deep soft tissues/proximal extremities and retroperitoneum
Often develop into large tumors

this describes?

Back 60

LIPOSARCOMA

Front 61

lipoblasts/cytoplasmic vacuoles --> scallop the nucleus

indicative of?

Back 61

Liposarcoma

Front 62

presence of metaplastic bone is seen in?

*****

Back 62

Myositis ossificans

Front 63

Usually develops in athletic adolescents/young adults
Follows an episode of trauma (<50% of cases)
Typically arises in musculature of proximal extremities

what is this?

Back 63

Myositis ossificans

Front 64

what distinguishes MYOSITIS OSSIFICANS from a neoplasm?

Back 64

Bone matures peripherally
Whereas it is immature/or not formed at all – in the center
Called zonation effect
Indicates a reactive process
A neoplasm has an opposite zonation effect
· most mature tissue is located centrally

Front 65

muscle becoming bone is?

Back 65

MYOSITIS OSSIFICANS

Front 66

Characterized by nodular of poorly defined broad fascicles
Mature-appearing fibroblasts surrounded by abundant dense collagen

seen in the palm, sole, and penis

Back 66

FIBROMATOSIS

Front 67

what is a common feature of FIBROMATOSIS?

Back 67

that it RECURS

Front 68

The most common type of soft tissue sarcoma?

****

Back 68

MALIGNANT FIBROUS HISTIOCYTOMA

Front 69

where does malignant fibrous histiocytoma (MFH) most commonly occur? In what type of patient?

Back 69

Occur in the deep soft tissues of extremities in adults

Peak in the 7th decade (but have been recorded in children)

Front 70

what do most malignant fibrous histiocytomas involve? 2

Back 70

deep fascia or substance of a skeletal muscle

(sarcoma of the soft tissue; most common in adults)

Front 71

do malignant fibrous histiocytomas tend to recur? Do they metastasize?

Back 71

Tumor is prone to local recurrence

Has the capacity to metastasize – esp. to lungs and regional L.N.’s