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 is a precursor to squamous cell carcinoma
Osteogenic carcinoma
Actinic keratosis
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Basal cell carcinoma - pearly papules - commonly with telangiectasias

2. What are the associations for sjogrens syndrome
S. aureus - streptococcus
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Squamous cell carcinoma
< 2mc found in proximal tibia and femur - men < 25

3. Loss of what muslces in Erbs causes the limb to hang by side
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Paralysis of abductors
Type III - RF
Flex the MCP joints and extend both the DIP and PIP joints

4. hyperpigmentation associated with pregnancy or OCP
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Osteoporosis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Melasma (chloasma)

5. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Vesicle
Medial forearm and arm to just under the axilla

6. 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
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Phosphorylated
Exercise and Ca ingestion before age 30

7. Who does osteoporosis type 2 effect
Down T tubule
Teres minor
Men and women > 70 - senile osteporosis
Fever - fatigue - pleuritis - pericarditis

8. Where is osteosarcoma found in the bone
Posterior cord
Basal cell carcinoma - pearly papules - commonly with telangiectasias
< 2mc found in proximal tibia and femur - men < 25
Metaphysis of long bones - distal femur

9. What are the bone mineral lab findings in paget's disease
Adductor policis brevis
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Serum ca - phos - PTH are nl alk phos elevated
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

10. What are the common perpetrating infections for Reiters syndrome
McCune - Albright syndrome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Post GI infxn or chlamydia
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

11. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Age - obesity and joint deformity
Ulnar nerve - fracture of hook of hamate

12. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Erythema multiforme - can be macules - papules vesicles - target lesions -
Subclavius
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Femoral - thing flexion and leg extension - anterior thigh and medial leg

13. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Actin

14. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Osteogenic carcinoma
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Nevocellular nevus
Long thoracic nerve

15. What is the source of osteoblast cells
Musculocutaneous
Anti - CCP - HLA- DR4
Mesenchymal stem cells in periosteum
Anti ds DNA - poor prognosis

16. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Pustule
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Type III - RF
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

17. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Corneum - lucidum - granulosum - spinosum - basalis
Intraepidermal bullae involving the skin and oral mucosa
Psoriasis
Vitiligo - dec number in melanocytes

18. What does the positive anterior drawer sign test indicate
Tear of the ACL
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

19. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Torn MCL
McCune - Albright syndrome
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Median nerve - lunate bone

20. yellow when perpendicular and blue when parallel
Supraspinatus - abducts the arm before the deltoid
Pseudogout
Ulnar nerve - intrinsic muscles of hand
Dermatitis herpetiformis

21. What are the lab findings in osteomalacia/rickets
Bulla
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Polyostotic fibrous dysplasia

22. hypothenar eminence - nerve and muscles
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Verrucae
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

23. What is the Sicca syndrome
Papule
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Dec estrogen causes inc bone resorption - postmenopausal
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

24. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Ulnar
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
B27 - no RF - males
Supraspinatus - abducts the arm before the deltoid

25. What do xray show in osteopetrosis and What do potential CN abnl result from
Actinic keratosis - risk proportional to epithelial dysplasia
Erlenmeyer flask bones that flare out - narrowed foramina
Axillary nerve
Medial 1.5 fingers - hypothenar eminence

26. 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
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Ulnar
Inc alk phos - abnl bone architecture

27. What are the subQ rheumatoid nodules made of...
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
S. aureus - streptococcus
MCP - PIP - no DIP
Fibrinoid necrosis surrounded by palisading histiocytes

28. Where is McBurney's point and What is there
Squamous cell carcinoma
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Elevated ESR and nl CK - prednisone

29. Where is C6 dermatome
Condyloma acuminatum - caused by HPV
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Female between 14 and 45 - mostly black
Subclavius

30. Sarcoid TX
Dysplastic nevus
Allopurinaol - uricosurics (probenicid)
Steroids
Long thoracic nerve

31. What are characteristic findings of gout
Medial forearm and arm to just under the axilla
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Axillary - deltoid - skin over deltoid - flattened deltoid
Carbonic anhydrase II

32. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Acanthosis nigcricans
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Viral - maybe paramyxovirus

33. What nerve is injured in a fracutre of the hook of hamate
Making fist with a proximal median nerve lesion
Osteopetrosis - abnl fxn of osteoclasts
Ulnar nerve
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

34. What do lumbricals do
Torn MCL
Vesicle
McCune - Albright syndrome
Flex the MCP joints and extend both the DIP and PIP joints

35. What do pseudogout crystals appear like microscopically
Myosin releases bound ADP and is displaced on the actin filament
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Basophilic - rhomboid crystals - weakly birefringent
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

36. What are defining lab findings for polymyalgia rheumatica and What is the TX
Elevated ESR and nl CK - prednisone
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
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
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

37. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Axillary - deltoid - skin over deltoid - flattened deltoid
Corneum - lucidum - granulosum - spinosum - basalis
Elevated ESR and nl CK - prednisone
Sarcoidosis - black females - ACE

38. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Verrucae vulgaris
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Thymoma

39. Where are most osteoid osteoma found and In what population
Radial nerve becomes compressed in axilla
< 2mc found in proximal tibia and femur - men < 25
Acantholysis
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

40. What does subscapularis do
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Pseudogout
Rigor mortis
Medially rotates and adducts arm

41. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Psoriasis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Pain in weight bearing joints at the end of the day and improving with rest

42. Damage to what 3 structures is common for the unhappy triad
Trauma
MCL - ACL - lateral meniscus (esp in athletes)
Dermatitis
Seborrheic keratosis

43. What does injury to the distal ulnar nerve cause
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Plaque
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

44. What percent of these mutations occur sporadically and what parental feature are they associated with
Pseudogout
Renal - pulm - CV - GI - 75% female
Dermatomyositis
85% - advanced paternal age - or auto dominant inheritance

45. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Bulla
Vesicle
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Erythema nodosum

46. Ca2+ released from the SR binds what structure and What does it cause
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Upper trunk of brachial plexus
Phosphorylates myosin light chain which leads to cross bridge formation
Acute back pain - loss of height - and kyphosis

47. What medication is contraindicated in osteoporosis
Glucocorticoids
Elevated ESR and nl CK - prednisone
Osteogenic carcinoma
Keloid

48. What organisms can cause chronic infectious arthritis
3rd finger
Dec estrogen causes inc bone resorption - postmenopausal
Polyostotic fibrous dysplasia
TB from dissemination and lyme dz

49. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Polyostotic fibrous dysplasia
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Crohns and ulcerative colitis
Boutonniere - swan neck - zthumb

50. What does acantholysis show in pemphigus vulgaris
Median nerve - same fingers but not on the hand
Gout
Keloid
Intraepidermal bullae involving the skin and oral mucosa