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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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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. blister containing pus
Pustule
Adduct the fingers
Lesioned by midshaft fracture of humerus
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

2. What is the power stroke of muscle contraction
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Osteoarthritis
Myosin releases bound ADP and is displaced on the actin filament
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

3. dried exudates from a vesicle - bulla or pustule seen impetigo
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Crust
Anti Smith
Urticaria

4. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Connects cells to underlying extracellular - bullous pemphigoid
Cervical disk lesion
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Osteosarcoma - multiple myeloma

5. What nerve is injured in a fracutre of the hook of hamate
Ulnar nerve
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Vitiligo - dec number in melanocytes
Femoral - thing flexion and leg extension - anterior thigh and medial leg

6. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Ulnar deviation - subluxation - bakers cysts (behind knee)
Posterior cord
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Verrucae vulgaris

7. What kind of nuclei do basal cell tumors have
Palisading
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Osteoarthritis
Phosphate is liberated from the myosin head

8. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
Pustule
Osteosarcoma - multiple myeloma
Acanthosis nigcricans

9. What are the associations for sjogrens syndrome
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Albinism
Precocious puberty
Urticaria

10. appreas in 30s to 40s - does not regress
Cherry hemangioma
Intraepidermal bullae involving the skin and oral mucosa
Head - trunk - extremities - common benign neoplasm in older persons
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

11. What deformities of the hand are common in RA
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Supraspinatus - abducts the arm before the deltoid
Boutonniere - swan neck - zthumb

12. How is chondrosarcoma described
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Expansile glistening mass within the medullary cavity
Type 2

13. What molecule maintatins integrity of basement membrane and What does it bind
Hyperkeratosis
Integrin binds laminin in BM
Phosphorylates myosin light chain which leads to cross bridge formation
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

14. What development failure can results in albinism
McCune - Albright syndrome
NC migration
Deep branch of radial nerve
Osteogenic carcinoma

15. What does I'M DAMN SHARP stand for
NSAIDs (indomethacin) colchicine
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Recurrent branch of the medain nerve
Connects cells to underlying extracellular - bullous pemphigoid

16. What associations go along with sarcoidosis

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17. What does IM reveal in pemphigus vulgaris
Hairy leukoplakia - HIV population - EBV mediated
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Muslce use - nerve stim/compound muscle test
Antibodies around cells of the epidermis in a reticular or netlike pattern

18. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Lower trunk of brachial plexus
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Radial nerve becomes compressed in axilla
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

19. What are the lab findings and TX in dermatomyositis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Seborrheic keratosis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

20. freckle - normal number of melanocytes - inc melanin pigment
Ephelis
Actinic keratosis - risk proportional to epithelial dysplasia
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Ulnar deviation - subluxation - bakers cysts (behind knee)

21. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Strawberry hemangioma

22. What is a positive Nikolsky's sign
Ulnar deviation - subluxation - bakers cysts (behind knee)
Vitiligo - dec number in melanocytes
Chondrosarcoma
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

23. yellow when perpendicular and blue when parallel
Pseudogout
Metaphysis of long bones - distal femur
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Obturator - thigh adduction - medial thigh

24. What muscles of the shoulder form the rotator cuff
Osteoblastoma
Boutonniere - swan neck - zthumb
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Axilla

25. In which form is myosin light chain active
Impetigo - s aureus - s pyogenes
Obturator - thigh adduction - medial thigh
Phosphorylated
Steroids

26. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Staph scalded skin syndrome
Parakeratosis
Palisading
Anti Smith

27. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Verrucae
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

28. What is below the epidermis
Over deltoid
The dermis
85% - advanced paternal age - or auto dominant inheritance
Anterior interosseous nerve

29. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Lichen planus
Type 2
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

30. When do acute attacks of gout typically occur
Median nerve - same fingers but not on the hand
After a large meal or EtOH conspumption
Nl - thickened dense bones
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

31. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Crohns and ulcerative colitis
Osteochondroma - exostosis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Median nerve - same fingers but not on the hand

32. Sarcoid TX
Steroids
Osteopetrosis - abnl fxn of osteoclasts
Anti ds DNA - poor prognosis
Wheal

33. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Cherry hemangioma
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Widespread skin involvment - rapid progression - early visceral involvement
Axillary - deltoid - skin over deltoid - flattened deltoid

34. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Acantholysis
Serum ca - phos - alk phos are NL
Scleroderma
Chondrosarcoma

35. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Osteoid osteoma
Mesenchymal stem cells in periosteum
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Axillary - deltoid - skin over deltoid - flattened deltoid

36. Where is osteosarcoma found in the bone
Osteopetrosis - abnl fxn of osteoclasts
Metaphysis of long bones - distal femur
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Xeropthalmia - xerostomia - arthritis

37. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Interossei and adductor policis
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

38. What are the lab findings in osteomalacia/rickets
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Flex the MCP joints and extend both the DIP and PIP joints
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
MCP - PIP - no DIP

39. irregular areas of complete depigmentation - condition and cause
Vitiligo - dec number in melanocytes
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
MCL - ACL - lateral meniscus (esp in athletes)
Radial nerve becomes compressed in axilla

40. What does lack of ATP cause
Medial 1.5 fingers - hypothenar eminence
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Cellulitis - s aureus - s pyogenes
Rigor mortis

41. knee trauma - nerve - motor and sensory def
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
4th and 5th finger
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

42. interlacing trabeculae of woven bone surrounded by osteoblasts
Recurrent branch of the medain nerve
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Tear of the ACL
Osteoid osteoma

43. What do pseudogout crystals appear like microscopically
Anti ds DNA - poor prognosis
Dysplastic nevus
Medial aspect
Basophilic - rhomboid crystals - weakly birefringent

44. What are the motor defs of a proximal ulnar nerve injury
Crust
Medial finger flexion - wrist flexion
Trauma
Over deltoid

45. What causes heart failure in with Paget's disease
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Keratoacanthoma
Gout
Inc blood flow from AV shunts can cause high output heart failure

46. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Corneum - lucidum - granulosum - spinosum - basalis
Ulnar
Palisading
Viral - maybe paramyxovirus

47. which muscle type is fast twitch and why are fibers white
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Osteoblastoma
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

48. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Conjunctivitis and anterior uveitis - urethritis and arthritis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Endochondroma

49. What kind of endocrine abnl are associated with McCune Albright
Lower trunk of brachial plexus
Over deltoid
Interossei and adductor policis
Precocious puberty

50. What is a very specific test for lupus
Erythema multiforme - can be macules - papules vesicles - target lesions -
Deep branch of radial nerve
Wheal
Anti ds DNA - poor prognosis