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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. Where do sebhorrheic keratosis lesions occur and in who
Ulnar nerve - fracture of hook of hamate
Head - trunk - extremities - common benign neoplasm in older persons
Flex at the MCP
Intraepidermal bullae involving the skin and oral mucosa

2. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
After a large meal or EtOH conspumption
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Lichen planus
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

3. Where is C6 dermatome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Expansile glistening mass within the medullary cavity
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Condyloma acuminatum - caused by HPV

4. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Keloid
Anterior interosseous nerve
AP depol opens voltage gated Ca channels - inducing NT release

5. Flat discloration <1cm seen in tinea versicolor
Anti - histone
Strawberry hemangioma
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Macule

6. What autoantibodies are formed in sjogrens syndrome
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Anti Scl70 - anti DNA topoisomerase I antibody
Osteopetrosis - abnl fxn of osteoclasts

7. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Ulnar nerve - fracture of hook of hamate
Patch
Renal - pulm - CV - GI - 75% female
Long thoracic nerve

8. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Flex at the MCP
Impetigo - s aureus - s pyogenes

9. How is chondrosarcoma described
Lesioned by midshaft fracture of humerus
Axillary - deltoid - skin over deltoid - flattened deltoid
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Expansile glistening mass within the medullary cavity

10. IBS - 2 dz's
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Crohns and ulcerative colitis

11. How does the radial nerve in the spiral groove become injured
Cherry hemangioma
Female between 14 and 45 - mostly black
Lesioned by midshaft fracture of humerus
Psoriasis

12. Deposition of calcium pyrophosphate cyrstals within the joint space
Serum ca - phos - PTH are nl alk phos elevated
Age - obesity and joint deformity
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Pseudogout

13. Damage to what 3 structures is common for the unhappy triad
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
MCL - ACL - lateral meniscus (esp in athletes)
Ischial spine - relieve pain during delivery
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

14. What protects the brachial plexus in clavicle fracture
Subclavius
Steroids
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Tear of the ACL

15. What are the most common symtpoms of SLE
Polyostotic fibrous dysplasia
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Posterior cord
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

16. What are predisposing factors for osteosarcoma - xray finding

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17. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Torn MCL
Exercise and Ca ingestion before age 30
Acanthosis

18. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Papule
Hairy leukoplakia - HIV population - EBV mediated
Ulnar nerve - intrinsic muscles of hand
Macule

19. What is the sensory def of an ulnar nerve injury
Melasma (chloasma)
Endochondroma
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Medial 1.5 fingers - hypothenar eminence

20. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Boutonniere - swan neck - zthumb
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Ischial spine - relieve pain during delivery

21. What does abnl passive abduction of the knee indicate
Glucocorticoids
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Increase in both osteoblast and osteoclast activity
Torn MCL

22. What is the TX for acute gout
Renal - pulm - CV - GI - 75% female
NSAIDs (indomethacin) colchicine
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Men and women > 70 - senile osteporosis

23. Thenar eminence - nerve and muscles
Polymyositis - shoulders - perifasicular inflammation
Female between 14 and 45 - mostly black
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Ewings sarcoma - aggressive with early mets - but responsive to chemo

24. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Squamous cell carcinoma
Carbonic anhydrase II

25. What are the causes of inferior trunk plexus compression and What are the findings
Serum ca - phos - PTH are nl alk phos elevated
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
3rd finger
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

26. hives - intensely pruritic wheals that form after mast cell degranulation
Basophilic - rhomboid crystals - weakly birefringent
Urticaria
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Phosphorylates myosin light chain which leads to cross bridge formation

27. What are the characterstic joints affected in RA
Osteoporosis
MCP - PIP - no DIP
Recurrent branch of the medain nerve
Scleroderma

28. What other lesion can cause the appearnce of the ulnar claw
Making fist with a proximal median nerve lesion
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Lower trunk of brachial plexus
Elevated ESR and nl CK - prednisone

29. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Abduct the fingers
Axillary nerve
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

30. What are the potential causes of gout

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31. common mole - benign
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Anti - CCP - HLA- DR4
Osteoarthritis
Nevocellular nevus

32. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Phosphorylates myosin light chain which leads to cross bridge formation
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Ischial spine - relieve pain during delivery
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

33. What lesion causes Saturday night wrist drop
Radial nerve
Musculocutaneous
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

34. What lesions causes Erb's palsy
NSAIDs (indomethacin) colchicine
4th and 5th finger
Upper trunk of brachial plexus
Dermatitis

35. Which type of muscle fiber is hypertrophied during weight training
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Type 2
Anti Scl70 - anti DNA topoisomerase I antibody
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

36. What TX prophylax against osteoporisi
Actinic keratosis
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Inc alk phos - abnl bone architecture
Exercise and Ca ingestion before age 30

37. What lesion causes deltoid paralysis
Axillary nerve
Calmodulin - complex activates myosin light chain kinase
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Ischial spine - relieve pain during delivery

38. What is a very specific test for lupus
Paralysis of lateral rotators
Anti ds DNA - poor prognosis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Viral - maybe paramyxovirus

39. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Ephelis
Ulnar deviation - subluxation - bakers cysts (behind knee)
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

40. freckle - normal number of melanocytes - inc melanin pigment
Mesenchymal stem cells in periosteum
Median nerve - lunate bone
Anti Smith
Ephelis

41. Which muscle laterally rotates and adducts arm
Teres minor
Anti Scl70 - anti DNA topoisomerase I antibody
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Connects cells to underlying extracellular - bullous pemphigoid

42. loss of what muscles in Erbs causes the medial rotation
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Paralysis of lateral rotators
Precocious puberty
Ligand binding leads to muscle depol

43. What do the lumbrical muscles do
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Mesenchymal stem cells in periosteum
Flex at the MCP

44. What kind of endocrine abnl are associated with McCune Albright
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Precocious puberty
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

45. What are the histo findings in an osteoclastoma
Spindle shaped cells with multinucleated giant cells
Xeropthalmia - xerostomia - arthritis
Muslce use - nerve stim/compound muscle test
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

46. inc thickness of stratum corneum seen in psoriasis
Over deltoid
Cervical disk lesion
Hyperkeratosis
Boutonniere - swan neck - zthumb

47. What are the bone mineralization lab findings in osteopetrosis
Serum ca - phos - alk phos are NL
Age - obesity and joint deformity
Dermatitis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

48. What does the positive anterior drawer sign test indicate
AP depol opens voltage gated Ca channels - inducing NT release
Tear of the ACL
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Nl - decreased bone mass

49. What kind of bone tumor is associated with FAP and What is the finding
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Dermatitis herpetiformis

50. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Keloid
Median nerve - same fingers but not on the hand
ANA - sensitive but not specific