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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. What do dorsal interosseous muscles do
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Abduct the fingers
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

2. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
McCune - Albright syndrome
Axillary nerve
Osteosarcoma - multiple myeloma

3. What are the subQ rheumatoid nodules made of...
Renal - pulm - CV - GI - 75% female
Fibrinoid necrosis surrounded by palisading histiocytes
Large goints (knee)
Interossei and adductor policis

4. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Atopic dermatitis - eczema
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Fever - fatigue - pleuritis - pericarditis
Albinism

5. What nerve is injured by a superficial laceration of the hand
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Recurrent branch of the medain nerve
Men and women > 70 - senile osteporosis
4th and 5th finger

6. Flat discloration <1cm seen in tinea versicolor
McCune - Albright syndrome
Acantholysis
Serum ca - phos - PTH are nl alk phos elevated
Macule

7. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Age - obesity and joint deformity
Anti - CCP - HLA- DR4
Impetigo - s aureus - s pyogenes
Torn MCL

8. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Renal - pulm - CV - GI - 75% female

9. What lesion causes total claw (klumpke's hand)
Endochondroma
Lower trunk of brachial plexus
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Widespread skin involvment - rapid progression - early visceral involvement

10. What lesion causes deltoid paralysis
Staph scalded skin syndrome
Axillary nerve
Melasma (chloasma)
Anterior interosseous nerve

11. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Lower trunk of brachial plexus
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Ulnar nerve
Strawberry hemangioma

12. What lesion causes Saturday night wrist drop
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Radial nerve
Parakeratosis
Plaque

13. What happens at the gap jxn and what molecules create them
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Dec estrogen causes inc bone resorption - postmenopausal
GC and cGMP and inhibition of MLCK
Over deltoid

14. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Anti - histone
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

15. What is the classic presentation of RA
Axillary - deltoid - skin over deltoid - flattened deltoid
Radial nerve becomes compressed in axilla
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Lichen planus

16. hives - intensely pruritic wheals that form after mast cell degranulation
Impetigo - s aureus - s pyogenes
Integrin binds laminin in BM
Recurrent branch of the median nerve
Urticaria

17. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Medial forearm and arm to just under the axilla
Osteochondroma - exostosis
Papule
Rigor mortis

18. hypothenar eminence - nerve and muscles
Ulnar
Female between 14 and 45 - mostly black
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

19. What does MLCK do in smooth muscle contraction
Anterior interosseous nerve
Osteoarthritis
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Phosphorylates myosin light chain which leads to cross bridge formation

20. What is the power stroke of muscle contraction
MCP - PIP - no DIP
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Myosin releases bound ADP and is displaced on the actin filament
Tear of the ACL

21. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Deep branch of radial nerve
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Anti Scl70 - anti DNA topoisomerase I antibody
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

22. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Steroids
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Median nerve - lunate bone

23. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Axilla
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

24. transiet vesicle seen in hives
Nl - thickened dense bones
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
NSAIDs (indomethacin) colchicine
Wheal

25. papule > 1cm seen psoriasis
Steroids
Nevocellular nevus
Plaque
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign

26. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Subclavius
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

27. What does acantholysis show in pemphigus vulgaris
Muslce use - nerve stim/compound muscle test
Intraepidermal bullae involving the skin and oral mucosa
Female between 14 and 45 - mostly black
Osteoid osteoma

28. what changes are seen in stratum spinosum and granulosum in psoriasis
Osteoid osteoma
Pseudogout
Polyostotic fibrous dysplasia
Inc spinosum - dec granulosum

29. What do anterior and posterior in ACL and PCL refer to...
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Sites of tibial attachment
Ligand binding leads to muscle depol
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

30. When do acute attacks of gout typically occur
Renal - pulm - CV - GI - 75% female
HI shrinks - A stays same
After a large meal or EtOH conspumption
Phosphate is liberated from the myosin head

31. What test if specific for lupus but doesn't indicate prognosis
After a large meal or EtOH conspumption
Iliac crest
Palisading
Anti Smith

32. inc thickness of stratum corneum seen in psoriasis
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Verrucae
Radial nerve becomes compressed in axilla
Hyperkeratosis

33. How is diffuse scleroderma characterized
Men and women > 70 - senile osteporosis
Medially rotates and adducts arm
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Widespread skin involvment - rapid progression - early visceral involvement

34. yellow when perpendicular and blue when parallel
Crust
Pseudogout
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Down T tubule

35. What kind of jxn is the zona occludens andw What is is composed of...
Psoriasis
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Scleroderma
Papule

36. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Lichen planus
Posterior cord

37. What kind of bone tumor is associated with FAP and What is the finding
Lung
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Adductor policis brevis

38. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Hairy leukoplakia - HIV population - EBV mediated
Corneum - lucidum - granulosum - spinosum - basalis
Spindle shaped cells with multinucleated giant cells

39. hyperpigmentation associated with pregnancy or OCP
Melasma (chloasma)
Teres minor
Biceps
Type III - RF

40. What TX prophylax against osteoporisi
Exercise and Ca ingestion before age 30
Making fist with a proximal median nerve lesion
Macule
Lower trunk of brachial plexus

41. What organisms can cause chronic infectious arthritis
In psoriasis - bleeding spots when scales are scraped off
Radial nerve becomes compressed in axilla
TB from dissemination and lyme dz
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

42. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
85% - advanced paternal age - or auto dominant inheritance
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Pityriasis rosea

43. What causes hypercalcemia in pts with sarcoid
Verrucae
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Connects cells to underlying extracellular - bullous pemphigoid

44. What medication is contraindicated in osteoporosis
Pustule
3rd finger
Glucocorticoids
Fever - fatigue - pleuritis - pericarditis

45. What is the clinically important landmark for pubendal nerve block and When is it used
Myosin releases bound ADP and is displaced on the actin filament
Ischial spine - relieve pain during delivery
Recurrent branch of the median nerve
Precocious puberty

46. What are the the common causes of Erb palsy - and What are the associated findings
Cellulitis - s aureus - s pyogenes
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Median nerve - lunate bone

47. What enzyme defect in responsible for osteopetrosis
4th and 5th finger
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Carbonic anhydrase II
Hyperkeratosis

48. What nerve is compressed by supracondylar fracture of humerus
Dermatomyositis
Erlenmeyer flask bones that flare out - narrowed foramina
Fever - fatigue - pleuritis - pericarditis
Median nerve

49. What do the branches of the deep ulnar nerve innervate
ANA - sensitive but not specific
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Antibodies around cells of the epidermis in a reticular or netlike pattern
Interossei and adductor policis

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

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