Nutritional Deficiencies
What condition presents with bowed legs, craniotabes (soft skull), and rachitic rosary (bead-like costochondral junctions) in a child?
a) osteogenesis imperfecta
b) rickets
c) osteopetrosis
d) scurvy
b) rickets
results from vitamin d deficiency in children, leading to defective mineralization of growth plates and skeletal deformities
What type of crystals are seen in gout, and how do they appear under polarized light?
a) rhomboid; positively birefringent
b) needle-shaped; negatively birefringent
c) plate-shaped; positively birefringent
d) hexagonal; non-birefringent
b) needle-shaped; negatively birefringent
gout shows monosodium urate crystals that appear yellow when aligned with polarized light (negative birefringence)
A child with blue sclerae, multiple fractures, hearing loss and dental problems likely has:
a) rickets
b) osteogenesis imperfecta
c) scurvy
d) osteopetrosis
b) osteogenesis imperfecta
autosomal dominant; caused by defective type I collagen and often mimics signs of child abuse due to frequent fractures
Bones
Ears
Eyes
Teeth
What degenerative joint disease presents with morning stiffness that improves with use and affects DIP joints?
a) RA
b) OA
c) Gout
d) SLE
b) OA
worsens with activity, shows osteophytes, involves DIP (Heberden nodes) and PIP (bouchard nodes), sparing MCPs
What childhood bone tumor shows "onion skin" periosteal reaction and t(11;22) translocation
a) osteosarcoma
b) chondrosarcoma
c) ewing sarcoma
d) osteoid osteoma
c) ewing sarcoma
ewing shows small blue cells on histology, of the dyaphysis of long bones (femur), aggressive but responsive to chemo, with a characteristic codman triangle and sunburst pattern on xray
Neisseria gonorrhea commonly causes osteomyelitis. However, which condition might it also cause, where it presents with no fever and malaise, high WBC, and red hot inflamed painful joints (often knee)?
Septic (infectious) arthritis
Which of the following best describes the "unhappy triad" of knee injury?
a) ACL + LCL + lateral meniscus
b) ACL + MCL + medial meniscus
c) PCL + MCL + medial meniscus
d) ACL + LCL + medial meniscus
b) ACL + MCL + medial meniscus
The unhappy triad occurs due to a lateral blow to the knee, injuring these three structures
A deficiency in vitamin C causes which MSK condition characterized by bleeding gums and corkscrew hairs?
a) scurvy
b) osteopetrosis
c) osteomalacia
d) rickets
a) scurvy
vitamin c is required for collagen synthesis; its deficiency results in bleeding, impaired wound healing, and connective tissue fragility
What condition presents with Gottron's papules (on knuckles), heliotrope rash and may be associated with malignancy?
a) RA
b) dermatomyositis
c) PMR
d) fibromyalgia
b) dermatomyositis
features proximal muscle weakness and skin findings, and may signal an underlying cancer
What genetic disorder with tall stature, lens discoloration, and risk of aortic dissection involves fibrillin-1 mutations?
a) ehlers-danlos syndrome
b) marfan syndrome
c) homocystinuria
d) OI
b) marfan syndrome
autosomal dominant affecting fibrillin (structural protein for elastin) due to FBN1 mutations
A patient with vertebral compression fractures and normal calcium, phosphate and ALP likely has:
a) osteopetrosis
b) osteomalacia
c) osteoporosis
d) paget disease
c) osteoporosis
low bone mass and fragility fractures, with normal labs and low bone density on DEXA scan
Which malignant tumor represents 30% of bone sarcomas, is a tumor of chondrocytes, causes popcorn mineralization on xray (stippled appearance), and has deep dull achy pain?
a) ewing sarcoma
b) chondrosarcoma
c) osteosarcoma
b) chondrosarcoma
middle aged
Which condition is commonly caused by strep progenes (Group A strep), presents with severe pain, crepitus, blood blisters and common after surgery?
Necrotizing fasciitis
Which overuse injury presents with pain at the lateral epicondyle?
a) golfer's elbow
b) tennis elbow
c) biceps tendinitis
d) jumper's knee
b) tennis elbow
overuse of extensor muscles attached to the lateral epicondyle
Which vitamin deficiency leads to myopathy, ataxia and hemolytic anemia?
a) vitamin a
b) vitamin d
c) vitamin e
d) vitamin k
c) vitamin e
it protects against oxidative damage; its deficiency causes neuromuscular symptoms and hemolysis
A patient with shoulder and hip stiffness but normal CK levels most likely has:
a) dermatomyositis
b) polymyalgia rheumatica
c) polymyositis
d) fibromyalgia
b) polymyalgia rheumatica
PMR presents with proximal stiffness and elevated inflammatory markers (ESR, CRP) but normal muscle enzymes. it's associated with giant cell arteritis (GCA)
What muscular dystrophy presents in childhood with calf pseudohypertrophy, pelvic girdle weakness, cardiomyopathy and Gower's sign?
a) Becker muscular dystrophy
b) myotonic dystrophy
c) Duchenne muscular dystrophy
d) Emery-Dreifuss dystrophy
c) Duchenne muscular dystrophy
DMD is x-linked frameshift mutation in dystrophin, leading to early progressive muscle weakness. Increased CK
What boen disease presents with a mosaic pattern of lammelar and woven bone, hearing loss, and increased ALP?
a) Osteoporosis
b) osteopetrosis
c) paget disease of bone
d) hyperparathyroidism
c) paget disease of bone
involves disordered bone remodelling with increased osteoblastic and osteoclastic activity
what is the name of a benign bone tumor commonly seen on the skull and facial bones, from an autosomal dominant inheritance, and associated with GI polyps and epidermoid cysts?
Osteoma
What is the most common cause of osteomyelitis?
Staph aureus
Which ligament is commonly torn in a non-contact twisting knee injury?
a) LCL
b) PCL
c) ACL
d) patellar retinaculum
c) ACL
it prevents anterior tibial translation and is vulnerable during sudden deceleration and pivoting
In adults, chronic kidney disease along with low sun exposure are risk factors for which vitamin deficiency?
Vitamin D
What triad is seen in reactive arthritis (Reiter syndrome)
a) arthritis, photosensitivity, renal failure
b) urethritis, conjunctivitis, arthritis
c) polyarthritis, rash, fever
d) conjunctivitis, fever, splenomegaly
b) urethritis, conjunctivitis, arthritis
reactive arthritis is post-infectious, and presents with the "can't pee, can't see, can't climb a tree"
Which condition shows delayed muscle relaxation (myotonia), gonadal atrophy, early frontal balding, and cataracts?
a) DMD
b) myotonic dystrophy
c) oculopharyngeal dystrophy
d) becker muscular dystrophy
b) myotonic dystrophy
multisystem symptoms, autosomal dominant, CTG trinucleuotide repeat expansion
Cararacts
Toupee
Gonadal Atrophy
Which condition presents with throbbing pain and results from ischemic necrosis of bone and may affect the femoral head?
a) osteopetrosis
b) osteoporosis
c) avascular necrosis
d) fibrous dysplasia
c) avascular necrosis "osteonecrosis"
causes include steroids, alcoholism, sickle cell, caisson's disease, pancreatitis (ASEPTIC pnemonic)
Osteosarcoma (osteogenic sarcoma) is a malignant tumor of osteoblasts. What bone and what age does it affect?
a) humerus and 60 year olds
b) long bones near knee and under 20 year olds
b) long bones near knee and under 20 year olds
What type of infectious arthritis causes more knee involvement, migratory polyarthralgia, tenosynovitis in hands, and dermatitis pustules on the hands?
Gonococcal arthritis
In disc herniation, patients experience parasthesia, weakness in the affected dermatome/myotome, and radicular pain. If L3/L4 is herniated, which nerve root is affected?
L4 nerve root
What are the names of the two "signs" that are positive in Osteomalacia, indicating hypocalcemic tetany?
Chvostek & Trousseau
Which disease is most associated with pannus formation, morning stiffness improves with use, swan neck deformity, anti0CCP antibodies, symmetric joint involvement?
a) OA
b) RA
c) Gout
d) PMR
b) RA
The most common type of core myopathies are AD and due to RYR1 mutation. When it comes to progressive muscle weakness, how does it differ from myositis?
Myositis also has proximal muscle weakness but it's progressive. Core myopathies are not progressive.
Which condition has defective osteoclasts causing a failure of bone resorption, showing thickened, dense bones prone to fractures. Treated with bone marrow transplant.
a) osteoporosis
b) osteopetrosis
c) osteoarthritis
d) osteonecrosis
b) osteopetrosis
Xray shows diffuse symmetric sclerosis, genetic defect in carbonic anhydrase II - can't create acidic environment needed for bone breakdown
What are the two xray findings in osteosarcoma?
a) bamboo spine and onion skin appearance
b) codman triangle and sunburst pattern
b) codman triangle and sunburst pattern
codman = periosteal elevation
sunburst = tumor grows too fast, causing perpendicular bone formation
Is osteomyelitis more common in children or adults?
Children
best detected on MRI, has high ESR and CRP. hematogenous spread. metaphysis of long bones
Which nerve is affected in both the ulnar claw and median claw formations?
a) distal ulnar nerve
b) proximal median nerve
a) distal ulnar nerve
(can't extend fingers)
when you can't make fist, it's proximal median nerve issue
Which condition would present with osteopenia and looser zones (pseudofractures) on xray?
Osteomalacia (adult vit. d deficiency)
Which autoimmune condition is associated with HLA-B27, complication includes restrictive lung disease and presents with "bamboo spine" (vertebral fusion) on XRay?
Ankylosing Spondylitis
Is Becker Muscular Dystrophy (BMD) milder or more severe than Duchenne Muscular Dystrophy (DMD)?
Milder. It is a non-frameshift mutation in the DMD gene.
What T-score value is diagnostic for osteoporosis?
<-2.5
What is the name of a malignant tumor of skeletal muscle and soft tissue with two types (embryonal and alveolar) which is the 3rd most common extra-CNS solid tumor in children, with primary location in head and neck?
a) rhabdomyosarcoma
b) ewing sarcoma
c) chondrosarcoma
a) rhabdomyosarcoma
typically lacks systemic symptoms
Which condition can be caused by gram positive cocci or gram negative rods, presents with swelling, blistering and necrotic appearance, foul discharge, most common on trunk, perineum and feet?
Wet gangrene
What fracture is common in children and can be a sign of child abuse?
a) metacarpal neck fracture
b) torus buckle fracture
b) torus buckle fracture
force is applied to immature bone
metacarpal neck fracture is boxers fracture and common in metacarpals 4&5