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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 does I'M DAMN SHARP stand for
Ulnar
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Seborrheic keratosis
Men and women > 70 - senile osteporosis

2. Where is C4 dermatome
Over deltoid
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Adductor policis brevis

3. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
< 2mc found in proximal tibia and femur - men < 25
Acantholysis
Osteosarcoma - multiple myeloma
Down T tubule

4. What causes total claw
MCL - ACL - lateral meniscus (esp in athletes)
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Erythema nodosum
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

5. What are the lab findings in osteopetrosis
Nl - thickened dense bones
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Recurrent branch of the medain nerve

6. What is CREST syndrome and What antibody is it associated with
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Cervical disk lesion
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Paralysis of lateral rotators

7. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Widespread skin involvment - rapid progression - early visceral involvement
In psoriasis - bleeding spots when scales are scraped off
Phosphorylated
Keratoacanthoma

8. What are the layers of of the epidermis from surface to base
Making fist with a proximal median nerve lesion
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Corneum - lucidum - granulosum - spinosum - basalis

9. 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...
Axilla
Psoriasis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Seborrheic keratosis

10. What happens in the power stroke of skeletal muscle contraction
Lower trunk of brachial plexus
Psoriasis
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Phosphate is liberated from the myosin head

11. What lesion causes claw hand and What are the muscles involved
Increase in both osteoblast and osteoclast activity
Ulnar nerve - intrinsic muscles of hand
Anti ds DNA - poor prognosis
Dermatitis herpetiformis

12. When does membranous ossification occur and What is the difference between membranous and endochondrial
Female between 14 and 45 - mostly black
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

13. What runs the distance of the A band
Mesenchymal stem cells in periosteum
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Myosin
Obturator - thigh adduction - medial thigh

14. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Osteoid osteoma
Crohns and ulcerative colitis
Staph scalded skin syndrome
3rd finger

15. What are the signs of ulnar nerve injury

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16. What are the lab findings in osteoporosis
Vesicle
Bulla
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Nl - decreased bone mass

17. Where is T1 dermatome
B27 - no RF - males
Parakeratosis
Osteopetrosis - abnl fxn of osteoclasts
Medial forearm and arm to just under the axilla

18. Contraction results in shortening of what bands - and what band remains the same length
Nl - decreased bone mass
HI shrinks - A stays same
Lichen planus
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

19. What is a precursor to squamous cell carcinoma
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Actinic keratosis
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

20. separation of epidermal cells
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Acantholysis
Sites of tibial attachment
Elevated ESR and nl CK - prednisone

21. What organisms can cause chronic infectious arthritis
Erythema nodosum
TB from dissemination and lyme dz
Integrin binds laminin in BM
Medial finger flexion - wrist flexion

22. larger osteoid osteoma found in vertebral column
Corneum - lucidum - granulosum - spinosum - basalis
Osteoblastoma
Type III - RF
Cherry hemangioma

23. What are predisposing factors for osteosarcoma - xray finding

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24. What is the classic presentation of osteoarthritis
Pemphigus vulgaris
Pain in weight bearing joints at the end of the day and improving with rest
Parotid enlargement - inc risk of B cell lymphoma - dental caries
The dermis

25. What medication is contraindicated in osteoporosis
Glucocorticoids
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Xeropthalmia - xerostomia - arthritis

26. Dermatomyositis places the pt at inc risk For what malignancy in particular
Medial forearm and arm to just under the axilla
Lung
Hyperkeratosis
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

27. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Ulnar nerve - intrinsic muscles of hand
Antibodies around cells of the epidermis in a reticular or netlike pattern
Ewings sarcoma - aggressive with early mets - but responsive to chemo

28. What molecule maintatins integrity of basement membrane and What does it bind
Elevated ESR and nl CK - prednisone
Integrin binds laminin in BM
Post GI infxn or chlamydia
Ligand binding leads to muscle depol

29. What lesions causes Erb's palsy
Adductor policis brevis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Inc spinosum - dec granulosum
Upper trunk of brachial plexus

30. Macule greater than 1cm
Gout
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Head - trunk - extremities - common benign neoplasm in older persons
Patch

31. knee trauma - nerve - motor and sensory def
Keloid
Glucocorticoids
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

32. What is the classic traid of sjogrens syndrome
Medial 1.5 fingers - hypothenar eminence
Xeropthalmia - xerostomia - arthritis
Posterior cord
Anti Scl70 - anti DNA topoisomerase I antibody

33. What is the landmark for an LP
Iliac crest
Median nerve
Glucocorticoids
Cherry hemangioma

34. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Lung
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

35. Where do sebhorrheic keratosis lesions occur and in who
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Head - trunk - extremities - common benign neoplasm in older persons
Adduct the fingers
Endochondroma

36. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Vesicle
Hairy leukoplakia - HIV population - EBV mediated
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Muslce use - nerve stim/compound muscle test

37. small fluid containing blister seen in chickenpox
Impetigo - s aureus - s pyogenes
Vesicle
Anti - CCP - HLA- DR4
Verrucae vulgaris

38. What kind of jxn is the zona occludens andw What is is composed of...
Osteopetrosis - abnl fxn of osteoclasts
Ulnar nerve - fracture of hook of hamate
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Head - trunk - extremities - common benign neoplasm in older persons

39. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Xeropthalmia - xerostomia - arthritis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Calmodulin - complex activates myosin light chain kinase

40. What are the characteristic bone findings in paget's disease
Phosphorylated
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Papule
Fever - fatigue - pleuritis - pericarditis

41. transiet vesicle seen in hives
Recurrent branch of the median nerve
Pseudogout
Wheal
Osteosarcoma - multiple myeloma

42. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Parakeratosis
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Keratoacanthoma

43. What do anterior and posterior in ACL and PCL refer to...
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Men and women > 70 - senile osteporosis
Sites of tibial attachment
Down T tubule

44. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Scleroderma
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Acanthosis nigcricans

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

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46. What autoantibodies are formed in sjogrens syndrome
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Supraspinatus - abducts the arm before the deltoid
Abduct the fingers
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

47. What does PED and Tip stand for

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48. Which nerve is compressed in deep forearm
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Axilla
Anterior interosseous nerve
Fibrinoid necrosis surrounded by palisading histiocytes

49. What are the motor defs of a proximal ulnar nerve injury
Actinic keratosis - risk proportional to epithelial dysplasia
Medial finger flexion - wrist flexion
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Femoral - thing flexion and leg extension - anterior thigh and medial leg

50. inflammatory disorder affective synovial joints with pannus formation in joints
Muslce use - nerve stim/compound muscle test
Rheumatoid arthritis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
MCL - ACL - lateral meniscus (esp in athletes)