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 claw hand and What are the muscles involved
Elevated ESR and nl CK - prednisone
Ulnar nerve - intrinsic muscles of hand
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Axilla

2. What deformities of the hand are common in RA
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Boutonniere - swan neck - zthumb
Seborrheic keratosis
Strawberry hemangioma

3. What is the TX for chronic gout
Type III - RF
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Allopurinaol - uricosurics (probenicid)

4. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Osteoarthritis
Myosin releases bound ADP and is displaced on the actin filament
Actinic keratosis - risk proportional to epithelial dysplasia
Ligand binding leads to muscle depol

5. What enzyme defect in responsible for osteopetrosis
Carbonic anhydrase II
Lichen planus
Melasma (chloasma)
Bulla

6. hives - intensely pruritic wheals that form after mast cell degranulation
Urticaria
Widespread skin involvment - rapid progression - early visceral involvement
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Cellulitis - s aureus - s pyogenes

7. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Fever - fatigue - pleuritis - pericarditis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Pityriasis rosea

8. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Hairy leukoplakia - HIV population - EBV mediated
Pityriasis rosea
Intraepidermal bullae involving the skin and oral mucosa
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

9. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Staph scalded skin syndrome
Ulnar
Phosphorylated
Ligand binding leads to muscle depol

10. IBS - 2 dz's
Dermatitis
Trauma
Large goints (knee)
Crohns and ulcerative colitis

11. Which muscle fiber type is slow twitch and why are fibers red
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Nl - thickened dense bones
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

12. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Seborrheic keratosis
Phosphorylated
Polyostotic fibrous dysplasia
Expansile glistening mass within the medullary cavity

13. What kind of endocrine abnl are associated with McCune Albright
Precocious puberty
Axillary nerve
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Squamous cell carcinoma

14. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Nl - decreased bone mass
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Sarcoidosis - black females - ACE
Polyostotic fibrous dysplasia

15. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Connects cells to underlying extracellular - bullous pemphigoid
Crust
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Lichen planus

16. What do the branches of the deep ulnar nerve innervate
Interossei and adductor policis
Female between 14 and 45 - mostly black
Long thoracic nerve
Gout

17. What is the source of osteoblast cells
Mesenchymal stem cells in periosteum
Viral - maybe paramyxovirus
Ulnar nerve - fracture of hook of hamate
Nl - thickened dense bones

18. what changes are seen in stratum spinosum and granulosum in psoriasis
Carbonic anhydrase II
Serum ca - phos - alk phos are NL
Inc spinosum - dec granulosum
Actinic keratosis - risk proportional to epithelial dysplasia

19. What are the systemic symptoms found in RA
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Impetigo - s aureus - s pyogenes
Fever - fatigue - pleuritis - pericarditis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

20. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Psoriasis
Endochondroma
Musculocutaneous
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

21. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Conjunctivitis and anterior uveitis - urethritis and arthritis
Anti - CCP - HLA- DR4
Pemphigus vulgaris
Ulnar nerve - fracture of hook of hamate

22. What are the thin lines along the Z line
Actin
Gout
Flex the MCP joints and extend both the DIP and PIP joints
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

23. What is the precursor to melanom
Dysplastic nevus
Upper trunk of brachial plexus
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Dec estrogen causes inc bone resorption - postmenopausal

24. In which joints does pseudogout typically occur
Boutonniere - swan neck - zthumb
Macule
Large goints (knee)
Nl - decreased bone mass

25. What are the lab findings in pagets disease
S. aureus - streptococcus
HI shrinks - A stays same
Inc alk phos - abnl bone architecture
Fibrinoid necrosis surrounded by palisading histiocytes

26. What is the classic presentation of osteoarthritis
Squamous cell carcinoma
Pain in weight bearing joints at the end of the day and improving with rest
Osteoblastoma
Outer arm

27. What is the sensory def of an ulnar nerve injury
Calmodulin - complex activates myosin light chain kinase
Medial 1.5 fingers - hypothenar eminence
Acantholysis
Down T tubule

28. epi of SLE
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Axillary nerve
Female between 14 and 45 - mostly black
Large goints (knee)

29. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Down T tubule
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Osteoporosis

30. What organisms can cause chronic infectious arthritis
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Carbonic anhydrase II
TB from dissemination and lyme dz
Medial finger flexion - wrist flexion

31. Where is C8 dermatome
Ulnar nerve
Macule
Tear of the ACL
4th and 5th finger

32. What are defining lab findings for polymyalgia rheumatica and What is the TX
Papule
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Metaphysis of long bones - distal femur
Elevated ESR and nl CK - prednisone

33. What are the common perpetrating infections for Reiters syndrome
Polyostotic fibrous dysplasia
Post GI infxn or chlamydia
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Osteoid osteoma

34. What are the lab findings in osteoporosis
Recurrent branch of the medain nerve
Nl - decreased bone mass
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Gout

35. How is diffuse scleroderma characterized
MCP - PIP - no DIP
Post GI infxn or chlamydia
Melasma (chloasma)
Widespread skin involvment - rapid progression - early visceral involvement

36. Deposition of calcium pyrophosphate cyrstals within the joint space
Pseudogout
Median nerve - same fingers but not on the hand
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

37. What lesion causes dec in thumb fxn 'ape hand'
Pityriasis rosea
Osteoarthritis
Median nerve
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

38. What causes heart failure in with Paget's disease
Plaque
Serum ca - phos - alk phos are NL
Acute back pain - loss of height - and kyphosis
Inc blood flow from AV shunts can cause high output heart failure

39. What TX prophylax against osteoporisi
Serum ca - phos - alk phos are NL
Exercise and Ca ingestion before age 30
Erlenmeyer flask bones that flare out - narrowed foramina
Pityriasis rosea

40. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Anti Scl70 - anti DNA topoisomerase I antibody
Albinism
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Melasma (chloasma)

41. Flat discloration <1cm seen in tinea versicolor
Macule
Albinism
Impetigo - s aureus - s pyogenes
Torn MCL

42. What is TX for osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Osteoblastoma
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

43. What are the most common symtpoms of SLE
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Flex the MCP joints and extend both the DIP and PIP joints
Integrin binds laminin in BM
Dermatitis herpetiformis

44. Decrease marrow space in osteopetrosis leads to what?
Allopurinaol - uricosurics (probenicid)
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Making fist with a proximal median nerve lesion
Type III - RF

45. What lesions causes Erb's palsy
Papule
Xeropthalmia - xerostomia - arthritis
Pain in weight bearing joints at the end of the day and improving with rest
Upper trunk of brachial plexus

46. thickened - dense bones that are prone to fracture - dz and primary defect
Metaphysis of long bones - distal femur
Outer arm
Pemphigus vulgaris
Osteopetrosis - abnl fxn of osteoclasts

47. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Osteosarcoma - multiple myeloma
Keloid
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

48. interlacing trabeculae of woven bone surrounded by osteoblasts
Paralysis of abductors
Osteoid osteoma
Strawberry hemangioma
Adductor policis brevis

49. What clinical features in vertebral crush fractures
Acute back pain - loss of height - and kyphosis
Pain in weight bearing joints at the end of the day and improving with rest
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Osteoarthritis

50. inc thickness of stratum corneum seen in psoriasis
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Iliac crest
Hyperkeratosis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar