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

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2. What do the lumbrical muscles do
Serum ca - phos - PTH are nl alk phos elevated
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Flex at the MCP
Crohns and ulcerative colitis

3. Who does osteoporosis type 2 effect
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Anterior interosseous nerve
Fibrinoid necrosis surrounded by palisading histiocytes
Men and women > 70 - senile osteporosis

4. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Ligand binding leads to muscle depol
Anti Smith
Erythema nodosum
Adductor policis brevis

5. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Infraspinatus - laterally rotates arm
Deep branch of radial nerve
Polymyositis - shoulders - perifasicular inflammation

6. Where are most osteoid osteoma found and In what population
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
< 2mc found in proximal tibia and femur - men < 25
Tear of the ACL
Ulnar nerve

7. In which joints does pseudogout typically occur
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Large goints (knee)
Radial nerve

8. separation of epidermal cells
Melasma (chloasma)
Condyloma acuminatum - caused by HPV
Outer arm
Acantholysis

9. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Osteogenic carcinoma
Squamous cell carcinoma
Tear of the ACL
Dermatitis

10. What TX prophylax against osteoporisi
Exercise and Ca ingestion before age 30
Iliac crest
Supraspinatus - abducts the arm before the deltoid
Teres minor

11. Where is C7 dermatome
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Calmodulin - complex activates myosin light chain kinase
3rd finger

12. What are the characteristic bone findings in paget's disease
Keloid
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Fibrinoid necrosis surrounded by palisading histiocytes
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

13. What does the positive anterior drawer sign test indicate
Tear of the ACL
GC and cGMP and inhibition of MLCK
Staph scalded skin syndrome
Boutonniere - swan neck - zthumb

14. epidermal hyperplasia (inc spinosum)
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
85% - advanced paternal age - or auto dominant inheritance
Osteoporosis
Acanthosis

15. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Medial forearm and arm to just under the axilla
Endochondroma
Median nerve

16. Where is C8 dermatome
Polymyositis - shoulders - perifasicular inflammation
4th and 5th finger
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Glucocorticoids

17. Where is McBurney's point and What is there
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Connects cells to underlying extracellular - bullous pemphigoid
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Myosin releases bound ADP and is displaced on the actin filament

18. Macule greater than 1cm
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Age - obesity and joint deformity
Patch
Muslce use - nerve stim/compound muscle test

19. What are defining lab findings for polymyalgia rheumatica and What is the TX
Sites of tibial attachment
Elevated ESR and nl CK - prednisone
Lichen planus
NSAIDs (indomethacin) colchicine

20. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Xeropthalmia - xerostomia - arthritis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Rigor mortis

21. Which type of muscle fiber is hypertrophied during weight training
Boutonniere - swan neck - zthumb
Osteoblastoma
Vesicle
Type 2

22. What lesion causes deltoid paralysis
Axillary nerve
Myosin releases bound ADP and is displaced on the actin filament
Female between 14 and 45 - mostly black
Psoriasis

23. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Ulnar nerve
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Staph scalded skin syndrome

24. What does acantholysis show in pemphigus vulgaris
Intraepidermal bullae involving the skin and oral mucosa
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Increase in both osteoblast and osteoclast activity

25. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Ulnar nerve
Acantholysis
Head - trunk - extremities - common benign neoplasm in older persons
Actinic keratosis - risk proportional to epithelial dysplasia

26. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Subclavius
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Corneum - lucidum - granulosum - spinosum - basalis
Bulla

27. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Type 2
Anti - histone
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Pemphigus vulgaris

28. What is the precursor to melanom
Dysplastic nevus
Median nerve
Lichen planus
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

29. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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30. knee trauma - nerve - motor and sensory def
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Paralysis of abductors

31. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Fibrinoid necrosis surrounded by palisading histiocytes
Muslce use - nerve stim/compound muscle test

32. What autoantibodies are formed in sjogrens syndrome
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Osteoblastoma

33. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Impetigo - s aureus - s pyogenes
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Pemphigus vulgaris
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

34. Where is T1 dermatome
Medial forearm and arm to just under the axilla
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Phosphate is liberated from the myosin head

35. What lesion causes claw hand and What are the muscles involved
Crust
Ulnar nerve - intrinsic muscles of hand
Glucocorticoids
Rheumatoid arthritis

36. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Myosin light chain phosphotase
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Keratoacanthoma
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

37. What are common features of lupus
Acantholysis
Mesenchymal stem cells in periosteum
Crohns and ulcerative colitis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

38. hives - intensely pruritic wheals that form after mast cell degranulation
Obturator - thigh adduction - medial thigh
Urticaria
Melasma (chloasma)
Bulla

39. What protects the brachial plexus in clavicle fracture
Psoriasis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Subclavius

40. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Erythema nodosum
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Medial aspect

41. What are the layers of of the epidermis from surface to base
Corneum - lucidum - granulosum - spinosum - basalis
Allopurinaol - uricosurics (probenicid)
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Albinism

42. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Deep branch of radial nerve
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Phosphate is liberated from the myosin head
Osteogenic carcinoma

43. larger osteoid osteoma found in vertebral column
B27 - no RF - males
Osteoblastoma
Increase in both osteoblast and osteoclast activity
Basal cell carcinoma - pearly papules - commonly with telangiectasias

44. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Palisading
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

45. inflammation of the skin
Dermatitis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Basophilic - rhomboid crystals - weakly birefringent
Anti Scl70 - anti DNA topoisomerase I antibody

46. What kind of jxn is the zona occludens andw What is is composed of...
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Medial 1.5 fingers - hypothenar eminence
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

47. appreas in 30s to 40s - does not regress
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Medial 1.5 fingers - hypothenar eminence
Cherry hemangioma
Median nerve

48. What are the lab findings in osteoporosis
Staph scalded skin syndrome
Nl - decreased bone mass
Post GI infxn or chlamydia
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

49. What do palmar interosseous muscles do
Renal - pulm - CV - GI - 75% female
Medial finger flexion - wrist flexion
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Adduct the fingers

50. What associations go along with sarcoidosis

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