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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. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Ischial spine - relieve pain during delivery
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Phosphate is liberated from the myosin head

2. mechanical wear and tear of joints leading to destruction of articular cartilage
Rigor mortis
Xeropthalmia - xerostomia - arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Osteoarthritis

3. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ulnar nerve
Dec estrogen causes inc bone resorption - postmenopausal

4. Dermatomyositis places the pt at inc risk For what malignancy in particular
Lung
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Actinic keratosis - risk proportional to epithelial dysplasia
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

5. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Integrin binds laminin in BM
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

6. What is the sign of Leser - Trelat
MCL - ACL - lateral meniscus (esp in athletes)
Actin
Crust
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

7. warts on hands
Verrucae vulgaris
Axillary nerve
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

8. What are the the common causes of Erb palsy - and What are the associated findings
Pityriasis rosea
Infraspinatus - laterally rotates arm
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Albinism

9. What is the TX for acute gout
Teres minor
Medially rotates and adducts arm
Elevated ESR and nl CK - prednisone
NSAIDs (indomethacin) colchicine

10. What is the clinically important landmark for pubendal nerve block and When is it used
Phosphorylated
Ischial spine - relieve pain during delivery
Medially rotates and adducts arm
Papule

11. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Obturator - thigh adduction - medial thigh
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

12. Where is C7 dermatome
3rd finger
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
85% - advanced paternal age - or auto dominant inheritance
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

13. What kind of jxn is in the zona adherens and Where is it - What is it composed of - and what ion does it does it depend on...
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Recurrent branch of the median nerve
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
4th and 5th finger

14. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Inc alk phos - abnl bone architecture
Chondrosarcoma

15. What lesion causes Saturday night wrist drop
Radial nerve
Pityriasis rosea
Ulnar nerve - intrinsic muscles of hand
Scleroderma

16. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Infraspinatus - laterally rotates arm
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
MCP - PIP - no DIP
Actinic keratosis - risk proportional to epithelial dysplasia

17. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Over deltoid
Making fist with a proximal median nerve lesion
Median nerve - same fingers but not on the hand
Musculocutaneous

18. inflammatory disorder affective synovial joints with pannus formation in joints
Axilla
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Rheumatoid arthritis

19. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Sarcoidosis - black females - ACE
Wheal
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Palisading

20. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Polyostotic fibrous dysplasia
Osteoid osteoma

21. What kind of nuclei do basal cell tumors have
Sarcoidosis - black females - ACE
Palisading
Acantholysis
Condyloma acuminatum - caused by HPV

22. What kind of bone tumor is associated with FAP and What is the finding
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Ligand binding leads to muscle depol
Dermatitis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

23. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
Recurrent branch of the median nerve
Radial nerve
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

24. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Connects cells to underlying extracellular - bullous pemphigoid
Ulnar nerve - fracture of hook of hamate
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

25. hives - intensely pruritic wheals that form after mast cell degranulation
Type 2
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Urticaria
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

26. What are the possible origins of the paget's disease
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Precocious puberty
Sarcoidosis - black females - ACE
Viral - maybe paramyxovirus

27. What enzyme is necessary for smooth muscle relaxation after contraction
Myosin light chain phosphotase
Trauma
Ulnar nerve
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

28. What nerve become injured in the incorrect use of a crutch
Supraspinatus - abducts the arm before the deltoid
Radial nerve becomes compressed in axilla
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Gout

29. What antibody is less sensitive than RF but more specific and What is the HLA association
Anti - CCP - HLA- DR4
Conjunctivitis and anterior uveitis - urethritis and arthritis
Radial nerve
Flex the MCP joints and extend both the DIP and PIP joints

30. What is a precursor to squamous cell carcinoma
Corneum - lucidum - granulosum - spinosum - basalis
Bulla
Anti ds DNA - poor prognosis
Actinic keratosis

31. How is the lower trunk of the brachia plexus injured and what results from it

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

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33. What does lack of ATP cause
Rigor mortis
Gout
Palisading
Squamous cell carcinoma

34. transiet vesicle seen in hives
Wheal
Hyperkeratosis
Dec estrogen causes inc bone resorption - postmenopausal
Median nerve - same fingers but not on the hand

35. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Ulnar nerve
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

36. What happens at the gap jxn and what molecules create them
Age - obesity and joint deformity
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Radial nerve becomes compressed in axilla
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

37. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Widespread skin involvment - rapid progression - early visceral involvement
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Staph scalded skin syndrome

38. What causes heart failure in with Paget's disease
Condyloma acuminatum - caused by HPV
Osteochondroma - exostosis
Inc blood flow from AV shunts can cause high output heart failure
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

39. Where does cartilage loss begin in osteoarthritis
Muslce use - nerve stim/compound muscle test
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Mesenchymal stem cells in periosteum
Medial aspect

40. What are the causes of inferior trunk plexus compression and What are the findings
Type III - RF
Ewings sarcoma - aggressive with early mets - but responsive to chemo
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
Allopurinaol - uricosurics (probenicid)

41. What nerve is compressed by supracondylar fracture of humerus
Keratoacanthoma
Median nerve
Anti ds DNA - poor prognosis
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

42. What TX prophylax against osteoporisi
Calmodulin - complex activates myosin light chain kinase
Exercise and Ca ingestion before age 30
Endochondroma
Sarcoidosis - black females - ACE

43. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Ulnar nerve
Conjunctivitis and anterior uveitis - urethritis and arthritis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Teres minor

44. freckle - normal number of melanocytes - inc melanin pigment
MCL - ACL - lateral meniscus (esp in athletes)
Over deltoid
Ephelis
Torn MCL

45. What protects the brachial plexus in clavicle fracture
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Strawberry hemangioma
Subclavius
Vitiligo - dec number in melanocytes

46. Loss of what muscles in Erbs causes the forearm to be pronated
Pemphigus vulgaris
Erythema nodosum
Biceps
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

47. What is the sensory def of an ulnar nerve injury
Medial 1.5 fingers - hypothenar eminence
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Ulnar
Cellulitis - s aureus - s pyogenes

48. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Interossei and adductor policis
McCune - Albright syndrome
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

49. What other muscle in the thenar eminence adducts the thumb
Adductor policis brevis
Ephelis
Osteopetrosis - abnl fxn of osteoclasts
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

50. What is TX for osteoporosis
Actinic keratosis
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Serum ca - phos - alk phos are NL