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Musculoskeletal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What are the classic fractures in pts with osteoporosis

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2. What is the sensory def of an ulnar nerve injury
Nevocellular nevus
Anti Smith
Medial 1.5 fingers - hypothenar eminence
Erythema multiforme - can be macules - papules vesicles - target lesions -

3. What are the possible origins of the paget's disease
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Ulnar
Viral - maybe paramyxovirus
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

4. What receptor is constitutively activated in achondroplasia and What does it do
Ulnar nerve
Osteoblastoma
Bulla
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

5. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Anti - CCP - HLA- DR4
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Dermatomyositis

6. What is TX for osteoporosis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Increase in both osteoblast and osteoclast activity
Hairy leukoplakia - HIV population - EBV mediated
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

7. What do the branches of the deep ulnar nerve innervate
Osteoid osteoma
Interossei and adductor policis
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

8. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Dysplastic nevus
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Boutonniere - swan neck - zthumb
Pityriasis rosea

9. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Ulnar nerve - fracture of hook of hamate
Fibrinoid necrosis surrounded by palisading histiocytes
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

10. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Sites of tibial attachment
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Osteosarcoma - multiple myeloma

11. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Post GI infxn or chlamydia
Lichen planus
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

12. What development failure can results in albinism
Hairy leukoplakia - HIV population - EBV mediated
Keloid
NC migration
Supraspinatus - abducts the arm before the deltoid

13. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Age - obesity and joint deformity
MCL - ACL - lateral meniscus (esp in athletes)
Ulnar
Urticaria

14. What nerve is compressed by supracondylar fracture of humerus
Medial forearm and arm to just under the axilla
Median nerve
Phosphate is liberated from the myosin head
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

15. loss of what muscles in Erbs causes the medial rotation
Osteoid osteoma
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Ephelis
Paralysis of lateral rotators

16. What does IM reveal in pemphigus vulgaris
Crust
Antibodies around cells of the epidermis in a reticular or netlike pattern
Musculocutaneous
Acanthosis

17. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
S. aureus - streptococcus
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Myosin light chain phosphotase
Type III - RF

18. What is the TX for acute gout
NSAIDs (indomethacin) colchicine
Ulnar deviation - subluxation - bakers cysts (behind knee)
Antibodies around cells of the epidermis in a reticular or netlike pattern
Lichen planus

19. What deformities of the hand are common in RA
GC and cGMP and inhibition of MLCK
Boutonniere - swan neck - zthumb
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

20. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Head - trunk - extremities - common benign neoplasm in older persons
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Adductor policis brevis

21. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Fibrinoid necrosis surrounded by palisading histiocytes
Condyloma acuminatum - caused by HPV
Pemphigus vulgaris
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

22. How does gonococcal arthritis present
Osteosarcoma - multiple myeloma
Integrin binds laminin in BM
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

23. What do xray show in osteopetrosis and What do potential CN abnl result from
Interossei and adductor policis
Erlenmeyer flask bones that flare out - narrowed foramina
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Pityriasis rosea

24. What are the characterstic joints affected in RA
Parakeratosis
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
MCP - PIP - no DIP
Deep branch of radial nerve

25. What is the classic presentation of RA
Seborrheic keratosis
Ephelis
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

26. What happens at the gap jxn and what molecules create them
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Intraepidermal bullae involving the skin and oral mucosa
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Rheumatoid arthritis

27. small fluid containing blister seen in chickenpox
Serum ca - phos - PTH are nl alk phos elevated
S. aureus - streptococcus
Dec estrogen causes inc bone resorption - postmenopausal
Vesicle

28. Loss of what muscles in Erbs causes the forearm to be pronated
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Adduct the fingers
Ulnar nerve
Biceps

29. What does abnl passive abduction of the knee indicate
Phosphorylated
Vitiligo - dec number in melanocytes
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Torn MCL

30. What do the lumbrical muscles do
Flex at the MCP
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

31. What is the clinically important landmark for pubendal nerve block and When is it used
Cervical disk lesion
Verrucae
Ischial spine - relieve pain during delivery
Exercise and Ca ingestion before age 30

32. What is below the epidermis
The dermis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Chondrosarcoma
Torn MCL

33. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

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34. What are the bone mineral lab findings in paget's disease
AP depol opens voltage gated Ca channels - inducing NT release
Osteoblastoma
Serum ca - phos - PTH are nl alk phos elevated
Ulnar

35. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Medially rotates and adducts arm
Serum ca - phos - PTH are nl alk phos elevated
Erythema nodosum
Anti - histone

36. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Sarcoidosis - black females - ACE
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

37. hypothenar eminence - nerve and muscles
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Large goints (knee)
Basal cell carcinoma - pearly papules - commonly with telangiectasias

38. large fluid containing blisters seen in bullous pemphigoid
Bulla
Median nerve - same fingers but not on the hand
Actinic keratosis - risk proportional to epithelial dysplasia
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

39. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Osteochondroma - exostosis
Squamous cell carcinoma
Rheumatoid arthritis

40. Where do sebhorrheic keratosis lesions occur and in who
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Head - trunk - extremities - common benign neoplasm in older persons
Crohns and ulcerative colitis

41. What do dorsal interosseous muscles do
Dec estrogen causes inc bone resorption - postmenopausal
Ulnar nerve
Anti - histone
Abduct the fingers

42. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Axillary - deltoid - skin over deltoid - flattened deltoid
Psoriasis
Atopic dermatitis - eczema
NC migration

43. Which muscle is the pitching injury and What does it do
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Spindle shaped cells with multinucleated giant cells
Infraspinatus - laterally rotates arm
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

44. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Serum ca - phos - alk phos are NL
Medial 1.5 fingers - hypothenar eminence
MCP - PIP - no DIP
Axillary - deltoid - skin over deltoid - flattened deltoid

45. knee trauma - nerve - motor and sensory def
Chondrosarcoma
Ulnar nerve
Scleroderma
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

46. What are common features of lupus
Widespread skin involvment - rapid progression - early visceral involvement
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Crohns and ulcerative colitis

47. Where is C7 dermatome
Lung
Sites of tibial attachment
Paralysis of lateral rotators
3rd finger

48. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Psoriasis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

49. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Lichen planus
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Basophilic - rhomboid crystals - weakly birefringent
Verrucae

50. Thenar eminence - nerve and muscles
Median nerve
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
The dermis