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 lesion causes dec in thumb fxn 'ape hand'
Median nerve
Albinism
Head - trunk - extremities - common benign neoplasm in older persons
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

2. separation of epidermal cells
NC migration
Acantholysis
Sarcoidosis - black females - ACE
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

3. What lesion causes wrist drop
Muslce use - nerve stim/compound muscle test
Posterior cord
Age - obesity and joint deformity
Strawberry hemangioma

4. What are characteristic findings of gout
Medial forearm and arm to just under the axilla
Albinism
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

5. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
MCP - PIP - no DIP
Corneum - lucidum - granulosum - spinosum - basalis
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Thymoma

6. What do anterior and posterior in ACL and PCL refer to...
Infraspinatus - laterally rotates arm
Keratoacanthoma
Sites of tibial attachment
Osteoarthritis

7. What kind of jxn is the zona occludens andw What is is composed of...
Abduct the fingers
Deep branch of radial nerve
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

8. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Median nerve - same fingers but not on the hand
Squamous cell carcinoma
85% - advanced paternal age - or auto dominant inheritance
Type 2

9. Where is McBurney's point and What is there
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Fever - fatigue - pleuritis - pericarditis
Renal - pulm - CV - GI - 75% female
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

10. elevated skin lesion <1cm seen in acne vulgaris
Papule
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
85% - advanced paternal age - or auto dominant inheritance
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

11. What do lupus pts falsely test positive for syphillis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Radial nerve
Verrucae vulgaris
Radial nerve becomes compressed in axilla

12. 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
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Plaque
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

13. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Acute back pain - loss of height - and kyphosis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Type 2
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

14. Which nerve is compressed in deep forearm
Phosphate is liberated from the myosin head
Anterior interosseous nerve
Torn MCL
Nl - thickened dense bones

15. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
S. aureus - streptococcus
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

16. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Post GI infxn or chlamydia
Widespread skin involvment - rapid progression - early visceral involvement

17. What is the classic triad of reactive arthritis
Osteoid osteoma
After a large meal or EtOH conspumption
Conjunctivitis and anterior uveitis - urethritis and arthritis
Crust

18. hyperpigmentation associated with pregnancy or OCP
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Melasma (chloasma)
Medially rotates and adducts arm
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

19. What does IM reveal in pemphigus vulgaris
Rigor mortis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Albinism

20. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Urticaria
Spindle shaped cells with multinucleated giant cells
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

21. What is the most common NMJ disorder - What causes it and What are common symptoms
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
Acanthosis nigcricans
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Glucocorticoids

22. What is a precursor to squamous cell carcinoma
Melasma (chloasma)
Patch
Actinic keratosis
Macule

23. What does lack of ATP cause
Rigor mortis
Erythema multiforme - can be macules - papules vesicles - target lesions -
Down T tubule
Anti Smith

24. Where is C8 dermatome
4th and 5th finger
85% - advanced paternal age - or auto dominant inheritance
Outer arm
Osteoporosis

25. What are common features of lupus
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Nevocellular nevus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Papule

26. What is the clinically important landmark for pubendal nerve block and When is it used
Ischial spine - relieve pain during delivery
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

27. What are the lab findings in osteopetrosis
GC and cGMP and inhibition of MLCK
Endochondroma
Nl - thickened dense bones
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

28. What deformities of the hand are common in RA
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Boutonniere - swan neck - zthumb
Elevated ESR and nl CK - prednisone

29. Which muscle is the pitching injury and What does it do
Hairy leukoplakia - HIV population - EBV mediated
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Acute back pain - loss of height - and kyphosis
Infraspinatus - laterally rotates arm

30. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Median nerve - same fingers but not on the hand
Ulnar
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Xeropthalmia - xerostomia - arthritis

31. What do the lumbrical muscles do
Flex at the MCP
NSAIDs (indomethacin) colchicine
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Making fist with a proximal median nerve lesion

32. What is the sign of Leser - Trelat
Metaphysis of long bones - distal femur
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Melasma (chloasma)
Lung

33. Where is C5 dermatome
Phosphorylated
Outer arm
Pustule
Osteogenic carcinoma

34. loss of what muscles in Erbs causes the medial rotation
Dermatitis herpetiformis
Median nerve
Paralysis of lateral rotators
Medial finger flexion - wrist flexion

35. What are the the common causes of Erb palsy - and What are the associated findings
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Mesenchymal stem cells in periosteum
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

36. what changes are seen in stratum spinosum and granulosum in psoriasis
Mesenchymal stem cells in periosteum
Pain in weight bearing joints at the end of the day and improving with rest
Inc spinosum - dec granulosum
Osteogenic carcinoma

37. What nerve is compressed by supracondylar fracture of humerus
Obturator - thigh adduction - medial thigh
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Flex at the MCP
Median nerve

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

39. larger osteoid osteoma found in vertebral column
Osteoblastoma
Obturator - thigh adduction - medial thigh
Cellulitis - s aureus - s pyogenes
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

40. Loss of what muscles in Erbs causes the forearm to be pronated
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Plaque
Seborrheic keratosis
Biceps

41. Where does cartilage loss begin in osteoarthritis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Medial aspect
Gout

42. What are the lab findings in osteomalacia/rickets
Corneum - lucidum - granulosum - spinosum - basalis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Teres minor

43. What kind of endocrine abnl are associated with McCune Albright
Long thoracic nerve
3rd finger
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Precocious puberty

44. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Keloid
Osteoporosis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
NSAIDs (indomethacin) colchicine

45. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Recurrent branch of the median nerve
Ulnar deviation - subluxation - bakers cysts (behind knee)
Osteochondroma - exostosis

46. Who does osteoporosis type 2 effect
Type 2
Men and women > 70 - senile osteporosis
Papule
Expansile glistening mass within the medullary cavity

47. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Dec estrogen causes inc bone resorption - postmenopausal
Anti Scl70 - anti DNA topoisomerase I antibody
Type 2

48. Deposition of calcium pyrophosphate cyrstals within the joint space
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Pseudogout
Serum ca - phos - alk phos are NL

49. What are the subQ rheumatoid nodules made of...
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Fibrinoid necrosis surrounded by palisading histiocytes
MCP - PIP - no DIP
Carbonic anhydrase II

50. Decrease marrow space in osteopetrosis leads to what?
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Anti Scl70 - anti DNA topoisomerase I antibody
Acanthosis nigcricans