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Musculoskeletal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Inc spinosum - dec granulosum
Ulnar nerve
Elevated ESR and nl CK - prednisone
Anterior interosseous nerve

2. Where is McBurney's point and What is there
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Axilla
Xeropthalmia - xerostomia - arthritis

3. What are the lab findings in osteomalacia/rickets
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
NC migration
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

4. What kind of bone tumor is associated with FAP and What is the finding
Lichen planus
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

5. hypothenar eminence - nerve and muscles
Iliac crest
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Dermatitis

6. thickened - dense bones that are prone to fracture - dz and primary defect
Papule
Over deltoid
Osteoblastoma
Osteopetrosis - abnl fxn of osteoclasts

7. What is the landmark for an LP
Osteopetrosis - abnl fxn of osteoclasts
Musculocutaneous
Type 2
Iliac crest

8. What happens at the gap jxn and what molecules create them
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Bulla
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Type III - RF

9. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Osteosarcoma - multiple myeloma
Erythema nodosum
Keloid
Increase in both osteoblast and osteoclast activity

10. What causes osteoporosis type 1 and When does it typically occur
Dysplastic nevus
Obturator - thigh adduction - medial thigh
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Dec estrogen causes inc bone resorption - postmenopausal

11. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Expansile glistening mass within the medullary cavity
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Serum ca - phos - PTH are nl alk phos elevated
Polyostotic fibrous dysplasia

12. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Embryologic - childbirth defect - cervical rib compression - atrophy of the thenar and hypothenar eminences - atrophy of interosseous muscles - sensory deficits of the medial side of the forearm and hand - disappearance of the radial pulse upon movin
TB from dissemination and lyme dz
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Deep branch of radial nerve

13. common mole - benign
Nevocellular nevus
Ulnar nerve
Palisading
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

14. What enzyme is necessary for smooth muscle relaxation after contraction
Bulla
Osteochondroma - exostosis
Myosin light chain phosphotase
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

15. What test if specific for lupus but doesn't indicate prognosis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Rheumatoid arthritis
Anti Smith

16. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Teres minor
Pemphigus vulgaris
Ulnar
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

17. What are the potential causes of gout

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18. What is the power stroke of muscle contraction
Paralysis of abductors
Osteoporosis
Myosin releases bound ADP and is displaced on the actin filament
Ulnar nerve

19. What is the classic triad of reactive arthritis
Post GI infxn or chlamydia
Keloid
Conjunctivitis and anterior uveitis - urethritis and arthritis
Supraspinatus - abducts the arm before the deltoid

20. What deformities of the hand are common in RA
Vesicle
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Boutonniere - swan neck - zthumb
Expansile glistening mass within the medullary cavity

21. papule > 1cm seen psoriasis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Dysplastic nevus
Conjunctivitis and anterior uveitis - urethritis and arthritis
Plaque

22. What causes hypercalcemia in pts with sarcoid
Hairy leukoplakia - HIV population - EBV mediated
Anti - CCP - HLA- DR4
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

23. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Polyostotic fibrous dysplasia
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Acantholysis

24. What are the bone mineralization lab findings in osteopetrosis
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
GC and cGMP and inhibition of MLCK
Serum ca - phos - alk phos are NL
Acanthosis

25. What does IM reveal in pemphigus vulgaris
Precocious puberty
Dermatitis herpetiformis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Boutonniere - swan neck - zthumb

26. What is the classic traid of sjogrens syndrome
Teres minor
Myosin releases bound ADP and is displaced on the actin filament
Xeropthalmia - xerostomia - arthritis
Large goints (knee)

27. What is CREST syndrome and What antibody is it associated with
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Trauma
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Interossei and adductor policis

28. IBS - 2 dz's
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Crohns and ulcerative colitis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

29. What are the common perpetrating infections for Reiters syndrome
Pustule
Paralysis of lateral rotators
Macule
Post GI infxn or chlamydia

30. What is contained within epithelial granulomas of pts with sarcoid
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

31. What lesion causes Saturday night wrist drop
Papule
Atopic dermatitis - eczema
Radial nerve
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

32. What are the systemic symptoms found in RA
Fever - fatigue - pleuritis - pericarditis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Impetigo - s aureus - s pyogenes
Sarcoidosis - black females - ACE

33. What muscles of the shoulder form the rotator cuff
After a large meal or EtOH conspumption
Urticaria
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Adductor policis brevis

34. What are the layers of of the epidermis from surface to base
Papule
Corneum - lucidum - granulosum - spinosum - basalis
Cervical disk lesion
Acanthosis

35. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Dermatitis herpetiformis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Steroids

36. what changes are seen in stratum spinosum and granulosum in psoriasis
Papule
Calmodulin - complex activates myosin light chain kinase
Inc spinosum - dec granulosum
Dermatitis

37. What is TX for osteoporosis
Keratoacanthoma
Anti - histone
Osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

38. interlacing trabeculae of woven bone surrounded by osteoblasts
Interossei and adductor policis
Osteoid osteoma
Obturator - thigh adduction - medial thigh
Crohns and ulcerative colitis

39. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Osteogenic carcinoma
Supraspinatus - abducts the arm before the deltoid
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Parakeratosis

40. yellow when perpendicular and blue when parallel
Patch
Pseudogout
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

41. Sarcoid TX
McCune - Albright syndrome
Steroids
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

42. Why does EtOH consumption precipitate gout
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Phosphorylates myosin light chain which leads to cross bridge formation
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

43. What do the lumbrical muscles do
Post GI infxn or chlamydia
Parakeratosis
Flex at the MCP
Verrucae vulgaris

44. In smooth muscle contraction - What does Ca bind and What is the purpose
Parakeratosis
Supraspinatus - abducts the arm before the deltoid
Calmodulin - complex activates myosin light chain kinase
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

45. epidermal hyperplasia (inc spinosum)
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Acanthosis
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Palisading

46. What are the lab findings in pagets disease
Biceps
Acute back pain - loss of height - and kyphosis
Sites of tibial attachment
Inc alk phos - abnl bone architecture

47. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Acantholysis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Iliac crest
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

48. What causes total claw
Subclavius
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Rheumatoid arthritis
Keratoacanthoma

49. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Type III - RF
Conjunctivitis and anterior uveitis - urethritis and arthritis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

50. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Ewings sarcoma - aggressive with early mets - but responsive to chemo
ANA - sensitive but not specific
Dermatitis herpetiformis