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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. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Connects cells to underlying extracellular - bullous pemphigoid
< 2mc found in proximal tibia and femur - men < 25
Lung
Actinic keratosis - risk proportional to epithelial dysplasia

2. Loss of what muslces in Erbs causes the limb to hang by side
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Paralysis of abductors
Abduct the fingers
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

3. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Integrin binds laminin in BM

4. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Acanthosis nigcricans
Medial finger flexion - wrist flexion
Xeropthalmia - xerostomia - arthritis

5. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Verrucae vulgaris
Pemphigus vulgaris
Pustule
Widespread skin involvment - rapid progression - early visceral involvement

6. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Plaque
Axillary - deltoid - skin over deltoid - flattened deltoid
MCL - ACL - lateral meniscus (esp in athletes)

7. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Anti ds DNA - poor prognosis
Long thoracic nerve
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

8. What is CREST syndrome and What antibody is it associated with
Acanthosis nigcricans
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Antibodies around cells of the epidermis in a reticular or netlike pattern
Subclavius

9. What nerve and branch are stretche by subluxation of the radius
Ulnar nerve - fracture of hook of hamate
B27 - no RF - males
Deep branch of radial nerve
Osteoporosis

10. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
85% - advanced paternal age - or auto dominant inheritance
Supraspinatus - abducts the arm before the deltoid
Type III - RF

11. What lesion causes wrist drop
Posterior cord
Median nerve
Xeropthalmia - xerostomia - arthritis
Ulnar nerve - intrinsic muscles of hand

12. What are the signs of ulnar nerve injury

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13. How does the radial nerve in the spiral groove become injured
Head - trunk - extremities - common benign neoplasm in older persons
Erythema nodosum
Lesioned by midshaft fracture of humerus
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

14. Which muscle laterally rotates and adducts arm
Fibrinoid necrosis surrounded by palisading histiocytes
Ischial spine - relieve pain during delivery
Teres minor
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

15. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Ulnar nerve
Recurrent branch of the median nerve

16. What kind of bone tumor is associated with FAP and What is the finding
TB from dissemination and lyme dz
Pemphigus vulgaris
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

17. Which muscle is the pitching injury and What does it do
Tear of the ACL
AP depol opens voltage gated Ca channels - inducing NT release
Infraspinatus - laterally rotates arm
Serum ca - phos - alk phos are NL

18. Where is T1 dermatome
Serum ca - phos - alk phos are NL
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Medial forearm and arm to just under the axilla
Lichen planus

19. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Ulnar nerve - intrinsic muscles of hand
Chondrosarcoma
Osteoblastoma
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

20. What is the classic traid of sjogrens syndrome
Medial finger flexion - wrist flexion
Xeropthalmia - xerostomia - arthritis
Median nerve
Abduct the fingers

21. interlacing trabeculae of woven bone surrounded by osteoblasts
Median nerve
Median nerve
Osteoid osteoma
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

22. separation of epidermal cells
Dermatitis herpetiformis
Sarcoidosis - black females - ACE
Macule
Acantholysis

23. What are the causes of inferior trunk plexus compression and What are the findings
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
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

24. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Impetigo - s aureus - s pyogenes
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

25. What does subscapularis do
Medially rotates and adducts arm
Lung
Myosin releases bound ADP and is displaced on the actin filament
Flex at the MCP

26. transiet vesicle seen in hives
Wheal
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
MCL - ACL - lateral meniscus (esp in athletes)
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

27. Which nerve is compressed in deep forearm
Medial 1.5 fingers - hypothenar eminence
Anterior interosseous nerve
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Flex at the MCP

28. What does lack of ATP cause
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Osteoporosis
Outer arm
Rigor mortis

29. What causes golf or tennis elbow
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Actinic keratosis

30. Decrease marrow space in osteopetrosis leads to what?
Type 2
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Acute back pain - loss of height - and kyphosis

31. what changes are seen in stratum spinosum and granulosum in psoriasis
Osteoarthritis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Inc spinosum - dec granulosum
Axilla

32. What associations go along with sarcoidosis

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33. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Polymyositis - shoulders - perifasicular inflammation
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Acanthosis

34. What test if specific for lupus but doesn't indicate prognosis
NC migration
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
Renal - pulm - CV - GI - 75% female
Anti Smith

35. Other than N. gono - what organisms can cause infectious - septic arthritis
Glucocorticoids
Axillary - deltoid - skin over deltoid - flattened deltoid
Psoriasis
S. aureus - streptococcus

36. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Dermatitis herpetiformis
Radial nerve becomes compressed in axilla
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Acanthosis nigcricans

37. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Vesicle
Gout
Inc alk phos - abnl bone architecture

38. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
The dermis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

39. What is the TX for acute gout
Sites of tibial attachment
Osteosarcoma - multiple myeloma
Vitiligo - dec number in melanocytes
NSAIDs (indomethacin) colchicine

40. yellow when perpendicular and blue when parallel
Adduct the fingers
< 2mc found in proximal tibia and femur - men < 25
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Pseudogout

41. What is the Auspitz sign
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Myosin releases bound ADP and is displaced on the actin filament
Axilla
In psoriasis - bleeding spots when scales are scraped off

42. Deposition of calcium pyrophosphate cyrstals within the joint space
Osteoblastoma
Cherry hemangioma
Ischial spine - relieve pain during delivery
Pseudogout

43. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Basophilic - rhomboid crystals - weakly birefringent
Staph scalded skin syndrome
Ulnar deviation - subluxation - bakers cysts (behind knee)
Basal cell carcinoma - pearly papules - commonly with telangiectasias

44. What causes compression of the C7 nerve root
85% - advanced paternal age - or auto dominant inheritance
Cervical disk lesion
The dermis
Phosphorylated

45. What is the precursor to melanom
Macule
Sites of tibial attachment
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Dysplastic nevus

46. What is the landmark for an LP
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Subclavius
Iliac crest
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

47. Where are most osteoid osteoma found and In what population
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
TB from dissemination and lyme dz
Outer arm
< 2mc found in proximal tibia and femur - men < 25

48. What nerve is injured by a superficial laceration of the hand
Inc blood flow from AV shunts can cause high output heart failure
Recurrent branch of the medain nerve
Viral - maybe paramyxovirus
Osteoarthritis

49. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Osteoblastoma
Hairy leukoplakia - HIV population - EBV mediated
Dysplastic nevus
Psoriasis

50. Which type of muscle fiber is hypertrophied during weight training
Type 2
Recurrent branch of the median nerve
Parotid enlargement - inc risk of B cell lymphoma - dental caries
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen