Test your basic knowledge |

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 are the potential causes of gout

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2. What antibodies is diffuse scleroderma associated with
Muslce use - nerve stim/compound muscle test
Renal - pulm - CV - GI - 75% female
Anti Scl70 - anti DNA topoisomerase I antibody
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

3. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Macule
Pityriasis rosea
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

4. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
B27 - no RF - males
Elevated ESR and nl CK - prednisone
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

5. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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6. Dermatomyositis places the pt at inc risk For what malignancy in particular
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Carbonic anhydrase II
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
Lung

7. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Muslce use - nerve stim/compound muscle test
Post GI infxn or chlamydia
Supraspinatus - abducts the arm before the deltoid
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

8. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Erythema multiforme - can be macules - papules vesicles - target lesions -
Down T tubule
Femoral - thing flexion and leg extension - anterior thigh and medial leg

9. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Lichen planus
Medial 1.5 fingers - hypothenar eminence
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

10. What nerve is injured in a fracutre of the hook of hamate
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
S. aureus - streptococcus
Osteoporosis
Ulnar nerve

11. What do anterior and posterior in ACL and PCL refer to...
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Sites of tibial attachment
Anti ds DNA - poor prognosis
Osteoarthritis

12. What is the source of osteoblast cells
Corneum - lucidum - granulosum - spinosum - basalis
Psoriasis
Melasma (chloasma)
Mesenchymal stem cells in periosteum

13. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Over deltoid
Actinic keratosis - risk proportional to epithelial dysplasia
Lichen planus
85% - advanced paternal age - or auto dominant inheritance

14. What is the landmark for an LP
Osteogenic carcinoma
Ewings sarcoma - aggressive with early mets - but responsive to chemo
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Iliac crest

15. Where is C6 dermatome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
The dermis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
In psoriasis - bleeding spots when scales are scraped off

16. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Glucocorticoids
MCP - PIP - no DIP
Pemphigus vulgaris
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

17. knee trauma - nerve - motor and sensory def
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Lower trunk of brachial plexus
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Hairy leukoplakia - HIV population - EBV mediated

18. What is a very specific test for lupus
Anti ds DNA - poor prognosis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Parakeratosis

19. What are the lab findings in osteopetrosis
Rheumatoid arthritis
Paralysis of lateral rotators
Axilla
Nl - thickened dense bones

20. What is the classic traid of sjogrens syndrome
Xeropthalmia - xerostomia - arthritis
Sites of tibial attachment
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Actinic keratosis

21. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
TB from dissemination and lyme dz
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Scleroderma
85% - advanced paternal age - or auto dominant inheritance

22. What nerve become injured in the incorrect use of a crutch
Acute back pain - loss of height - and kyphosis
Radial nerve becomes compressed in axilla
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Verrucae

23. What is the sensory def of an ulnar nerve injury
Xeropthalmia - xerostomia - arthritis
Medial 1.5 fingers - hypothenar eminence
< 2mc found in proximal tibia and femur - men < 25
Vitiligo - dec number in melanocytes

24. 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...
Polyostotic fibrous dysplasia
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Age - obesity and joint deformity
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

25. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Axillary - deltoid - skin over deltoid - flattened deltoid
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Hairy leukoplakia - HIV population - EBV mediated
Bulla

26. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Dec estrogen causes inc bone resorption - postmenopausal
Calmodulin - complex activates myosin light chain kinase
Verrucae
Antibodies around cells of the epidermis in a reticular or netlike pattern

27. What happens at the postsynaptic motor end plate
Ligand binding leads to muscle depol
Antibodies around cells of the epidermis in a reticular or netlike pattern
Anti Smith
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

28. Loss of what muslces in Erbs causes the limb to hang by side
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Paralysis of abductors
MCP - PIP - no DIP
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

29. What are the classic fractures in pts with osteoporosis

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30. Which muscle fiber type is slow twitch and why are fibers red
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Rheumatoid arthritis
Making fist with a proximal median nerve lesion

31. elevated skin lesion <1cm seen in acne vulgaris
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Lichen planus
Papule

32. What antibody is less sensitive than RF but more specific and What is the HLA association
Anti - CCP - HLA- DR4
Axillary nerve
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Medially rotates and adducts arm

33. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Vesicle
Lung
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Sites of tibial attachment

34. What are the histo findings in an osteoclastoma
Dysplastic nevus
Spindle shaped cells with multinucleated giant cells
Type 2
Actinic keratosis

35. Loss of what muscles in Erbs causes the forearm to be pronated
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Medial forearm and arm to just under the axilla
Biceps
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

36. What are the common perpetrating infections for Reiters syndrome
Verrucae
Post GI infxn or chlamydia
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Myosin light chain phosphotase

37. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Type III - RF
Posterior cord
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Age - obesity and joint deformity

38. Which type of muscle fiber is hypertrophied during weight training
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Keloid
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Type 2

39. What does ATP do in skeletal muscle contraction
Obturator - thigh adduction - medial thigh
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Post GI infxn or chlamydia

40. MG is associated with what neoplasm
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
S. aureus - streptococcus
Thymoma
Median nerve

41. How does gonococcal arthritis present
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Fever - fatigue - pleuritis - pericarditis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Medial 1.5 fingers - hypothenar eminence

42. What is the primary screening test for lupus
ANA - sensitive but not specific
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Myosin light chain phosphotase
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

43. precipitation of monosodium urate crystals into joints due to hyperuricemia
Gout
Mesenchymal stem cells in periosteum
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Osteosarcoma - multiple myeloma

44. epi of SLE
Female between 14 and 45 - mostly black
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Hyperkeratosis

45. Where does cartilage loss begin in osteoarthritis
4th and 5th finger
Viral - maybe paramyxovirus
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Medial aspect

46. large fluid containing blisters seen in bullous pemphigoid
Inc spinosum - dec granulosum
Bulla
Pemphigus vulgaris
Medial forearm and arm to just under the axilla

47. What lesions causes Erb's palsy
Actinic keratosis
Sites of tibial attachment
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Upper trunk of brachial plexus

48. In which joints does pseudogout typically occur
Flex the MCP joints and extend both the DIP and PIP joints
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Erythema multiforme - can be macules - papules vesicles - target lesions -
Large goints (knee)

49. What lesion causes winged scapula
Integrin binds laminin in BM
Long thoracic nerve
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Ischial spine - relieve pain during delivery

50. Sarcoid TX
Lesioned by midshaft fracture of humerus
Age - obesity and joint deformity
GC and cGMP and inhibition of MLCK
Steroids