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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. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Parakeratosis
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Wheal
ANA - sensitive but not specific

2. larger osteoid osteoma found in vertebral column
Cherry hemangioma
Adduct the fingers
Actin
Osteoblastoma

3. What are the lab findings in pagets disease
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Ulnar
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Inc alk phos - abnl bone architecture

4. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

5. which muscle type is fast twitch and why are fibers white
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Flex the MCP joints and extend both the DIP and PIP joints
Wheal

6. What are the systemic symptoms found in RA
Medially rotates and adducts arm
Scleroderma
Osteosarcoma - multiple myeloma
Fever - fatigue - pleuritis - pericarditis

7. thickened - dense bones that are prone to fracture - dz and primary defect
MCL - ACL - lateral meniscus (esp in athletes)
Supraspinatus - abducts the arm before the deltoid
Carbonic anhydrase II
Osteopetrosis - abnl fxn of osteoclasts

8. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
McCune - Albright syndrome
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Increase in both osteoblast and osteoclast activity
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

9. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Type 2
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Osteoblastoma

10. Which muscle fiber type is slow twitch and why are fibers red
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Cervical disk lesion
Biceps
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

11. warts on genitals
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Condyloma acuminatum - caused by HPV
Strawberry hemangioma
Paralysis of abductors

12. What are the signs of ulnar nerve injury

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13. What lesion causes claw hand and What are the muscles involved
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Osteoid osteoma
Ulnar nerve - intrinsic muscles of hand
Osteoporosis

14. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Fever - fatigue - pleuritis - pericarditis
Squamous cell carcinoma
Adductor policis brevis
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

15. hypothenar eminence - nerve and muscles
Conjunctivitis and anterior uveitis - urethritis and arthritis
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Osteoarthritis
Viral - maybe paramyxovirus

16. What kind of bone tumor is associated with FAP and What is the finding
Osteoarthritis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Erythema nodosum
Long thoracic nerve

17. What TX prophylax against osteoporisi
Exercise and Ca ingestion before age 30
Deep branch of radial nerve
Obturator - thigh adduction - medial thigh
Corneum - lucidum - granulosum - spinosum - basalis

18. What nerve is injured in a fracutre of the hook of hamate
Ulnar nerve
Median nerve
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Vesicle

19. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
NC migration
Psoriasis
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
AP depol opens voltage gated Ca channels - inducing NT release

20. Where is C7 dermatome
Strawberry hemangioma
B27 - no RF - males
Inc blood flow from AV shunts can cause high output heart failure
3rd finger

21. yellow when perpendicular and blue when parallel
Pseudogout
Axilla
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Ephelis

22. 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
Vitiligo - dec number in melanocytes
Antibodies around cells of the epidermis in a reticular or netlike pattern
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Crust

23. What protects the brachial plexus in clavicle fracture
Subclavius
Albinism
Thymoma
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

24. Where is C4 dermatome
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Over deltoid
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

25. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
TB from dissemination and lyme dz
Pemphigus vulgaris
Medially rotates and adducts arm

26. What do palmar interosseous muscles do
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Adduct the fingers
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Rigor mortis

27. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Lung
NSAIDs (indomethacin) colchicine

28. What do xray show in osteopetrosis and What do potential CN abnl result from
Flex at the MCP
Parakeratosis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Erlenmeyer flask bones that flare out - narrowed foramina

29. Which muscle is the pitching injury and What does it do
MCP - PIP - no DIP
Verrucae
Infraspinatus - laterally rotates arm
Ischial spine - relieve pain during delivery

30. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Verrucae vulgaris
Connects cells to underlying extracellular - bullous pemphigoid
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

31. What is the classic presentation of osteoarthritis
Verrucae vulgaris
Pain in weight bearing joints at the end of the day and improving with rest
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Allopurinaol - uricosurics (probenicid)

32. What is the power stroke of muscle contraction
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Myosin releases bound ADP and is displaced on the actin filament
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Spindle shaped cells with multinucleated giant cells

33. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Polyostotic fibrous dysplasia
Osteosarcoma - multiple myeloma
The dermis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

34. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Erythema multiforme - can be macules - papules vesicles - target lesions -
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

35. What causes total claw
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Spindle shaped cells with multinucleated giant cells
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Fever - fatigue - pleuritis - pericarditis

36. When does membranous ossification occur and What is the difference between membranous and endochondrial
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Recurrent branch of the medain nerve
Psoriasis

37. What are the potential causes of gout

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38. small fluid containing blister seen in chickenpox
Vesicle
Keloid
Teres minor
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

39. What kind of jxn is the zona occludens andw What is is composed of...
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Urticaria
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

40. Dermatomyositis places the pt at inc risk For what malignancy in particular
Lung
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Nevocellular nevus
Paralysis of abductors

41. What are the layers of of the epidermis from surface to base
Antibodies around cells of the epidermis in a reticular or netlike pattern
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Corneum - lucidum - granulosum - spinosum - basalis
Viral - maybe paramyxovirus

42. What supplies innervation to the thenar muscles
MCP - PIP - no DIP
Abduct the fingers
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Recurrent branch of the median nerve

43. Where is C6 dermatome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Type III - RF
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Ephelis

44. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Hairy leukoplakia - HIV population - EBV mediated
Impetigo - s aureus - s pyogenes
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Crohns and ulcerative colitis

45. What deformities of the hand are common in RA
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Macule
Boutonniere - swan neck - zthumb
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

46. inflammatory disorder affective synovial joints with pannus formation in joints
TB from dissemination and lyme dz
Rheumatoid arthritis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Ulnar nerve

47. precipitation of monosodium urate crystals into joints due to hyperuricemia
Gout
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Tear of the ACL
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

48. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Exercise and Ca ingestion before age 30
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Osteoarthritis

49. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Gout
Impetigo - s aureus - s pyogenes
Actin
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

50. What do the branches of the deep ulnar nerve innervate
Interossei and adductor policis
Anti Smith
Rheumatoid arthritis
Elevated ESR and nl CK - prednisone