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. Where does cartilage loss begin in osteoarthritis
MCL - ACL - lateral meniscus (esp in athletes)
Verrucae
Gout
Medial aspect

2. What are the borders of the superficial branch of the radial nerve dermatone
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Large goints (knee)

3. What antibody is less sensitive than RF but more specific and What is the HLA association
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Xeropthalmia - xerostomia - arthritis
Anti - CCP - HLA- DR4
Rigor mortis

4. Ca2+ released from the SR binds what structure and What does it cause
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Acanthosis
Median nerve - same fingers but not on the hand
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

5. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Musculocutaneous
Metaphysis of long bones - distal femur

6. What is the classic presentation of RA
Scleroderma
Ulnar nerve - intrinsic muscles of hand
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Polymyositis - shoulders - perifasicular inflammation

7. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
AP depol opens voltage gated Ca channels - inducing NT release

8. What is the Sicca syndrome
Myosin releases bound ADP and is displaced on the actin filament
Subclavius
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Psoriasis

9. What are the histo findings in an osteoclastoma
Pseudogout
Spindle shaped cells with multinucleated giant cells
Recurrent branch of the median nerve
4th and 5th finger

10. What kind of bone tumor is associated with FAP and What is the finding
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
< 2mc found in proximal tibia and femur - men < 25
Condyloma acuminatum - caused by HPV
Phosphate is liberated from the myosin head

11. transiet vesicle seen in hives
Torn MCL
Wheal
Interossei and adductor policis
Mesenchymal stem cells in periosteum

12. What are the systemic symptoms found in RA
Vesicle
S. aureus - streptococcus
Fever - fatigue - pleuritis - pericarditis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

13. What is below the epidermis
Erythema nodosum
Keratoacanthoma
3rd finger
The dermis

14. What is the precursor to melanom
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Ulnar nerve - intrinsic muscles of hand
Dysplastic nevus
Boutonniere - swan neck - zthumb

15. What do lumbricals do
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Gout
Flex the MCP joints and extend both the DIP and PIP joints

16. What do palmar interosseous muscles do
Teres minor
Pustule
Adduct the fingers
Osteoporosis

17. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
< 2mc found in proximal tibia and femur - men < 25
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign

18. What is the sensory def of an ulnar nerve injury
Medial 1.5 fingers - hypothenar eminence
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
ANA - sensitive but not specific

19. What lesion causes dec in thumb fxn 'ape hand'
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Dermatomyositis
Median nerve
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

20. What percent of these mutations occur sporadically and what parental feature are they associated with
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Teres minor
85% - advanced paternal age - or auto dominant inheritance

21. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Osteoporosis
Dermatitis herpetiformis
Teres minor
Verrucae vulgaris

22. What molecule maintatins integrity of basement membrane and What does it bind
After a large meal or EtOH conspumption
Integrin binds laminin in BM
Median nerve - lunate bone
Medial aspect

23. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Pemphigus vulgaris
Connects cells to underlying extracellular - bullous pemphigoid
Adduct the fingers
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

24. What are the characterstic joints affected in RA
Medially rotates and adducts arm
MCP - PIP - no DIP
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

25. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Psoriasis
McCune - Albright syndrome
Trauma

26. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Cellulitis - s aureus - s pyogenes
Dermatitis herpetiformis
Keratoacanthoma

27. What are the classic fractures in pts with osteoporosis

28. What receptor is constitutively activated in achondroplasia and What does it do
Gout
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Ligand binding leads to muscle depol
Femoral - thing flexion and leg extension - anterior thigh and medial leg

29. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Wheal
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

30. Which muscle laterally rotates and adducts arm
Paralysis of lateral rotators
Staph scalded skin syndrome
Teres minor
Verrucae

31. What antibodies is diffuse scleroderma associated with
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Anti Scl70 - anti DNA topoisomerase I antibody
Serum ca - phos - alk phos are NL

32. What autoantibodies are formed in sjogrens syndrome
Deep branch of radial nerve
Carbonic anhydrase II
Crust
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

33. What are the potential causes of gout

34. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
B27 - no RF - males
Macule
McCune - Albright syndrome
Hyperkeratosis

35. warts on genitals
Widespread skin involvment - rapid progression - early visceral involvement
Endochondroma
Median nerve - same fingers but not on the hand
Condyloma acuminatum - caused by HPV

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

37. yellow when perpendicular and blue when parallel
Anti - histone
Pseudogout
TB from dissemination and lyme dz
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

38. Achondroplasia is a failure of what process which results in which characteristic findings
Interossei and adductor policis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Myosin light chain phosphotase

39. What do lupus pts falsely test positive for syphillis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Inc alk phos - abnl bone architecture
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Corneum - lucidum - granulosum - spinosum - basalis

40. What is a precursor to squamous cell carcinoma
Post GI infxn or chlamydia
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Actinic keratosis
Basal cell carcinoma - pearly papules - commonly with telangiectasias

41. What are the motor - sensory deficits and sign of carpal tunnel syndrome
85% - advanced paternal age - or auto dominant inheritance
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

42. What do dorsal interosseous muscles do
Medial 1.5 fingers - hypothenar eminence
Medial forearm and arm to just under the axilla
Abduct the fingers
Musculocutaneous

43. Where are most osteoid osteoma found and In what population
< 2mc found in proximal tibia and femur - men < 25
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Actin
Subclavius

44. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Plaque
Myosin releases bound ADP and is displaced on the actin filament
Median nerve

45. What causes osteoporosis type 1 and When does it typically occur
Intraepidermal bullae involving the skin and oral mucosa
Ischial spine - relieve pain during delivery
Dec estrogen causes inc bone resorption - postmenopausal
Connects cells to underlying extracellular - bullous pemphigoid

46. What are the common perpetrating infections for Reiters syndrome
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Ulnar
Post GI infxn or chlamydia
Median nerve - same fingers but not on the hand

47. What deformities of the hand are common in RA
S. aureus - streptococcus
Ulnar deviation - subluxation - bakers cysts (behind knee)
Boutonniere - swan neck - zthumb
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

48. 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
Recurrent branch of the median nerve
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Pseudogout
Plaque

49. What enzyme defect in responsible for osteopetrosis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Acanthosis
Carbonic anhydrase II
Phosphorylates myosin light chain which leads to cross bridge formation

50. Where is C6 dermatome
Anti ds DNA - poor prognosis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Atopic dermatitis - eczema
Phosphorylated