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Musculoskeletal

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Answer 50 questions in 15 minutes.
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1. What associations go along with sarcoidosis

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2. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Dermatitis herpetiformis

3. What causes ape hand
Vitiligo - dec number in melanocytes
Osteochondroma - exostosis
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

4. What clinical features in vertebral crush fractures
Adductor policis brevis
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Antibodies around cells of the epidermis in a reticular or netlike pattern
Acute back pain - loss of height - and kyphosis

5. What is a precursor to squamous cell carcinoma
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Nl - thickened dense bones
Actinic keratosis
Obturator - thigh adduction - medial thigh

6. what changes are seen in stratum spinosum and granulosum in psoriasis
Lower trunk of brachial plexus
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Inc spinosum - dec granulosum
Polymyositis - shoulders - perifasicular inflammation

7. What are the subQ rheumatoid nodules made of...
Polyostotic fibrous dysplasia
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Fibrinoid necrosis surrounded by palisading histiocytes
Outer arm

8. Which type of muscle fiber is hypertrophied during weight training
Type 2
Inc spinosum - dec granulosum
Glucocorticoids
Ulnar

9. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Post GI infxn or chlamydia
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Acute back pain - loss of height - and kyphosis
Osteochondroma - exostosis

10. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Fibrinoid necrosis surrounded by palisading histiocytes
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

11. What causes the symptoms of MG to worsen - and What is used to diagnose
Verrucae
Muslce use - nerve stim/compound muscle test
S. aureus - streptococcus
Medially rotates and adducts arm

12. Other than N. gono - what organisms can cause infectious - septic arthritis
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Vesicle
S. aureus - streptococcus
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

13. What do dorsal interosseous muscles do
NSAIDs (indomethacin) colchicine
Making fist with a proximal median nerve lesion
Abduct the fingers
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

14. What are the classic fractures in pts with osteoporosis

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15. What is CREST syndrome and What antibody is it associated with
Thymoma
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Long thoracic nerve
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

16. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

17. What are the signs of ulnar nerve injury

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18. inflammatory disorder affective synovial joints with pannus formation in joints
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Rheumatoid arthritis
Widespread skin involvment - rapid progression - early visceral involvement
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

19. Contraction results in shortening of what bands - and what band remains the same length
Calmodulin - complex activates myosin light chain kinase
Vitiligo - dec number in melanocytes
HI shrinks - A stays same
Abduct the fingers

20. What development failure can results in albinism
Anti Smith
Ulnar nerve
Acanthosis
NC migration

21. What causes golf or tennis elbow
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
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
4th and 5th finger
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

22. Who does osteoporosis type 2 effect
Men and women > 70 - senile osteporosis
Ulnar nerve
S. aureus - streptococcus
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

23. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Squamous cell carcinoma
Erlenmeyer flask bones that flare out - narrowed foramina
Paralysis of abductors
Torn MCL

24. What deformities of the hand are common in RA
Pseudogout
Ulnar nerve - intrinsic muscles of hand
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Boutonniere - swan neck - zthumb

25. large fluid containing blisters seen in bullous pemphigoid
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Polyostotic fibrous dysplasia
Bulla
Nl - thickened dense bones

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

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27. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Biceps
Squamous cell carcinoma
Polymyositis - shoulders - perifasicular inflammation
Median nerve - lunate bone

28. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Age - obesity and joint deformity
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

29. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
McCune - Albright syndrome
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Dec estrogen causes inc bone resorption - postmenopausal
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

30. What does the positive anterior drawer sign test indicate
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Making fist with a proximal median nerve lesion
ANA - sensitive but not specific
Tear of the ACL

31. Where is T2 dermatome
Axilla
Medial 1.5 fingers - hypothenar eminence
Basophilic - rhomboid crystals - weakly birefringent
Ulnar nerve

32. What is the defect in Paget's disease
Polymyositis - shoulders - perifasicular inflammation
Increase in both osteoblast and osteoclast activity
Cervical disk lesion
Supraspinatus - abducts the arm before the deltoid

33. 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+
Torn MCL
Post GI infxn or chlamydia
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

34. What is a positive Nikolsky's sign
Actin
Posterior cord
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

35. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Antibodies around cells of the epidermis in a reticular or netlike pattern
Ulnar nerve
Lung
Viral - maybe paramyxovirus

36. Dermatomyositis places the pt at inc risk For what malignancy in particular
Subclavius
Lung
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
MCP - PIP - no DIP

37. What are defining lab findings for polymyalgia rheumatica and What is the TX
Albinism
Osteogenic carcinoma
Elevated ESR and nl CK - prednisone
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

38. What does MLCK do in smooth muscle contraction
Pemphigus vulgaris
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Dermatitis herpetiformis
Phosphorylates myosin light chain which leads to cross bridge formation

39. What runs the distance of the A band
Myosin
Actin
Large goints (knee)
Impetigo - s aureus - s pyogenes

40. transiet vesicle seen in hives
Ischial spine - relieve pain during delivery
Wheal
Tear of the ACL
MCP - PIP - no DIP

41. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Polyostotic fibrous dysplasia
Antibodies around cells of the epidermis in a reticular or netlike pattern

42. Achondroplasia is a failure of what process which results in which characteristic findings
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Phosphate is liberated from the myosin head
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

43. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Supraspinatus - abducts the arm before the deltoid
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Scleroderma
Spindle shaped cells with multinucleated giant cells

44. thickened - dense bones that are prone to fracture - dz and primary defect
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Deep branch of radial nerve
Anterior interosseous nerve
Osteopetrosis - abnl fxn of osteoclasts

45. What does injury to the distal ulnar nerve cause
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Steroids
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

46. What supplies innervation to the thenar muscles
Widespread skin involvment - rapid progression - early visceral involvement
Seborrheic keratosis
Recurrent branch of the median nerve
Thymoma

47. What other lesion can cause the appearnce of the ulnar claw
Making fist with a proximal median nerve lesion
Obturator - thigh adduction - medial thigh
Carbonic anhydrase II
85% - advanced paternal age - or auto dominant inheritance

48. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Xeropthalmia - xerostomia - arthritis
Female between 14 and 45 - mostly black
Impetigo - s aureus - s pyogenes
Seborrheic keratosis

49. What causes total claw
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Lung
85% - advanced paternal age - or auto dominant inheritance
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

50. What does abnl passive abduction of the knee indicate
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Large goints (knee)
Torn MCL
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

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