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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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1. knee trauma - nerve - motor and sensory def
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Widespread skin involvment - rapid progression - early visceral involvement
Median nerve - lunate bone

2. What does acantholysis show in pemphigus vulgaris
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Intraepidermal bullae involving the skin and oral mucosa
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Basal cell carcinoma - pearly papules - commonly with telangiectasias

3. What antibodies is diffuse scleroderma associated with
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Anti Scl70 - anti DNA topoisomerase I antibody
Spindle shaped cells with multinucleated giant cells
Outer arm

4. Which nerve is compressed in deep forearm
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Anterior interosseous nerve
MCP - PIP - no DIP

5. What causes golf or tennis elbow
Ulnar
Precocious puberty
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

6. What are the the common causes of Erb palsy - and What are the associated findings
Down T tubule
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Making fist with a proximal median nerve lesion

7. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Ischial spine - relieve pain during delivery
Spindle shaped cells with multinucleated giant cells
Squamous cell carcinoma

8. What is the classic traid of sjogrens syndrome
Ulnar nerve
Osteoblastoma
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Xeropthalmia - xerostomia - arthritis

9. What are the lab findings in pagets disease
Inc alk phos - abnl bone architecture
Iliac crest
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Corneum - lucidum - granulosum - spinosum - basalis

10. What are the characterstic joints affected in RA
Condyloma acuminatum - caused by HPV
Outer arm
MCP - PIP - no DIP
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

11. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Wheal
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

12. What are the causes of inferior trunk plexus compression and What are the findings
Integrin binds laminin in BM
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
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Palisading

13. What kind of endocrine abnl are associated with McCune Albright
Precocious puberty
Cherry hemangioma
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

14. Dermatomyositis places the pt at inc risk For what malignancy in particular
Vitiligo - dec number in melanocytes
Lung
Osteoid osteoma
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

15. What happens at the postsynaptic motor end plate
Flex at the MCP
Ligand binding leads to muscle depol
Osteoarthritis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

16. loss of what muscles in Erbs causes the medial rotation
Rigor mortis
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Paralysis of lateral rotators
Pseudogout

17. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Obturator - thigh adduction - medial thigh
Spindle shaped cells with multinucleated giant cells
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Carbonic anhydrase II

18. What medication is contraindicated in osteoporosis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Dec estrogen causes inc bone resorption - postmenopausal
Carbonic anhydrase II
Glucocorticoids

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

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20. What other muscle in the thenar eminence adducts the thumb
< 2mc found in proximal tibia and femur - men < 25
TB from dissemination and lyme dz
Adductor policis brevis
Impetigo - s aureus - s pyogenes

21. What are characteristic findings of gout
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Gout
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Widespread skin involvment - rapid progression - early visceral involvement

22. What causes ape hand
Keratoacanthoma
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Erythema nodosum
Dysplastic nevus

23. What is a positive Nikolsky's sign
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Acanthosis nigcricans

24. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Cherry hemangioma
Pustule

25. What is the sign of Leser - Trelat
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
4th and 5th finger
Posterior cord
Ulnar

26. What are the lab findings in osteitis fibrosa cystica
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Cervical disk lesion
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

27. What are the lab findings and TX in dermatomyositis
Acantholysis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Cellulitis - s aureus - s pyogenes

28. What lesion causes deltoid paralysis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Cellulitis - s aureus - s pyogenes
Axillary nerve
Elevated ESR and nl CK - prednisone

29. Thenar eminence - nerve and muscles
Melasma (chloasma)
McCune - Albright syndrome
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

30. Flat discloration <1cm seen in tinea versicolor
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Myosin
Macule
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

31. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Post GI infxn or chlamydia
Pain in weight bearing joints at the end of the day and improving with rest
Axillary - deltoid - skin over deltoid - flattened deltoid

32. What percent of these mutations occur sporadically and what parental feature are they associated with
S. aureus - streptococcus
Post GI infxn or chlamydia
85% - advanced paternal age - or auto dominant inheritance
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

33. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Deep branch of radial nerve
Hairy leukoplakia - HIV population - EBV mediated
Ulnar nerve - fracture of hook of hamate
Dec estrogen causes inc bone resorption - postmenopausal

34. What is the power stroke of muscle contraction
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Tear of the ACL
Myosin releases bound ADP and is displaced on the actin filament

35. What is the TX for acute gout
Pemphigus vulgaris
NSAIDs (indomethacin) colchicine
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

36. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Actinic keratosis - risk proportional to epithelial dysplasia
Cherry hemangioma
Post GI infxn or chlamydia

37. Where is C4 dermatome
Melasma (chloasma)
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Over deltoid
MCL - ACL - lateral meniscus (esp in athletes)

38. small fluid containing blister seen in chickenpox
Dermatitis
Lichen planus
Thymoma
Vesicle

39. inc thickness of stratum corneum seen in psoriasis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Teres minor
Hyperkeratosis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

40. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Crust
Biceps
Lichen planus

41. freckle - normal number of melanocytes - inc melanin pigment
Ephelis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Medial 1.5 fingers - hypothenar eminence

42. Where is osteosarcoma found in the bone
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Gout
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Metaphysis of long bones - distal femur

43. How is diffuse scleroderma characterized
Widespread skin involvment - rapid progression - early visceral involvement
Abduct the fingers
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
Ulnar nerve - fracture of hook of hamate

44. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Metaphysis of long bones - distal femur
Tear of the ACL
Carbonic anhydrase II
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

45. Which type of muscle fiber is hypertrophied during weight training
Type 2
Making fist with a proximal median nerve lesion
Recurrent branch of the median nerve
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

46. What is the classic presentation of RA
ANA - sensitive but not specific
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

47. which muscle type is fast twitch and why are fibers white
Metaphysis of long bones - distal femur
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Osteosarcoma - multiple myeloma
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

48. What is the TX for chronic gout
Gout
Allopurinaol - uricosurics (probenicid)
Infraspinatus - laterally rotates arm
Staph scalded skin syndrome

49. What do anterior and posterior in ACL and PCL refer to...
Sites of tibial attachment
Acanthosis nigcricans
Type 2
Gout

50. What nerve is compressed by supracondylar fracture of humerus
Median nerve
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Nl - thickened dense bones
Ischial spine - relieve pain during delivery