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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. Why does EtOH consumption precipitate gout
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

2. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Medial forearm and arm to just under the axilla
Trauma
NSAIDs (indomethacin) colchicine
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

3. Where is C4 dermatome
Verrucae
Inc blood flow from AV shunts can cause high output heart failure
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Over deltoid

4. What is below the epidermis
The dermis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Basophilic - rhomboid crystals - weakly birefringent
Thymoma

5. Where is osteosarcoma found in the bone
Age - obesity and joint deformity
Pseudogout
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Metaphysis of long bones - distal femur

6. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
In psoriasis - bleeding spots when scales are scraped off
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Scleroderma

7. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Pityriasis rosea
Condyloma acuminatum - caused by HPV
Obturator - thigh adduction - medial thigh
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

8. What is the classic triad of reactive arthritis
Ephelis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Conjunctivitis and anterior uveitis - urethritis and arthritis
Hairy leukoplakia - HIV population - EBV mediated

9. What are the lab findings in osteomalacia/rickets
Nevocellular nevus
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Acanthosis nigcricans
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

10. What enzyme defect in responsible for osteopetrosis
Acute back pain - loss of height - and kyphosis
Carbonic anhydrase II
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Pustule

11. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Teres minor
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Lower trunk of brachial plexus
Abduct the fingers

12. What are the motor defs of a proximal ulnar nerve injury
Medial finger flexion - wrist flexion
Intraepidermal bullae involving the skin and oral mucosa
Head - trunk - extremities - common benign neoplasm in older persons
Erythema nodosum

13. What is the primary screening test for lupus
Fibrinoid necrosis surrounded by palisading histiocytes
ANA - sensitive but not specific
Biceps
Pseudogout

14. What protects the brachial plexus in clavicle fracture
Subclavius
Steroids
GC and cGMP and inhibition of MLCK
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

15. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Crohns and ulcerative colitis
Osteochondroma - exostosis
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Antibodies around cells of the epidermis in a reticular or netlike pattern

16. What nerve is injured in a fracutre of the hook of hamate
Inc spinosum - dec granulosum
Ulnar nerve
Strawberry hemangioma
Inc blood flow from AV shunts can cause high output heart failure

17. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

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18. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Crust
Medial aspect
Bulla

19. common mole - benign
Age - obesity and joint deformity
Dermatomyositis
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Nevocellular nevus

20. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Median nerve
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Dermatomyositis

21. Through what pathway does NO work and What is the downstream effect
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
The dermis
GC and cGMP and inhibition of MLCK
Albinism

22. larger osteoid osteoma found in vertebral column
Osteoblastoma
Teres minor
Osteoarthritis
Long thoracic nerve

23. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Strawberry hemangioma
Median nerve - lunate bone
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
NC migration

24. Loss of what muscles in Erbs causes the forearm to be pronated
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Musculocutaneous
Biceps

25. What are the associations for sjogrens syndrome
Sarcoidosis - black females - ACE
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Acute back pain - loss of height - and kyphosis
Strawberry hemangioma

26. What does soft bones result from and What is the dz called in adults and children
Pemphigus vulgaris
85% - advanced paternal age - or auto dominant inheritance
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Allopurinaol - uricosurics (probenicid)

27. What are the histo findings in an osteoclastoma
Spindle shaped cells with multinucleated giant cells
Strawberry hemangioma
Muslce use - nerve stim/compound muscle test
Patch

28. What are the bone mineral lab findings in paget's disease
In psoriasis - bleeding spots when scales are scraped off
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Serum ca - phos - PTH are nl alk phos elevated
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

29. What autoantibodies are formed in sjogrens syndrome
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Ulnar nerve
Integrin binds laminin in BM
Medial 1.5 fingers - hypothenar eminence

30. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Acute back pain - loss of height - and kyphosis
Lesioned by midshaft fracture of humerus

31. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Glucocorticoids
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

32. What is the precursor to melanom
Patch
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Dysplastic nevus
Basal cell carcinoma - pearly papules - commonly with telangiectasias

33. What is the classic traid of sjogrens syndrome
Head - trunk - extremities - common benign neoplasm in older persons
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Steroids
Xeropthalmia - xerostomia - arthritis

34. transiet vesicle seen in hives
Axillary nerve
Wheal
Erlenmeyer flask bones that flare out - narrowed foramina
Adductor policis brevis

35. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Flex the MCP joints and extend both the DIP and PIP joints
Median nerve - same fingers but not on the hand
Anti Smith
B27 - no RF - males

36. Deposition of calcium pyrophosphate cyrstals within the joint space
Pseudogout
Osteoblastoma
Dermatomyositis
NC migration

37. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Deep branch of radial nerve
Axilla
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

38. What are the lab findings in osteoporosis
Trauma
Nl - decreased bone mass
Posterior cord
TB from dissemination and lyme dz

39. What causes ape hand
Urticaria
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Ligand binding leads to muscle depol
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

40. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Myosin
Lung
Ulnar

41. knee trauma - nerve - motor and sensory def
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Carbonic anhydrase II
Paralysis of abductors
Anterior interosseous nerve

42. What are the subQ rheumatoid nodules made of...
Fibrinoid necrosis surrounded by palisading histiocytes
Condyloma acuminatum - caused by HPV
Glucocorticoids
Vitiligo - dec number in melanocytes

43. What medication is contraindicated in osteoporosis
Glucocorticoids
Calmodulin - complex activates myosin light chain kinase
Polyostotic fibrous dysplasia
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

44. Other than N. gono - what organisms can cause infectious - septic arthritis
Acanthosis nigcricans
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Macule
S. aureus - streptococcus

45. inc thickness of stratum corneum seen in psoriasis
Post GI infxn or chlamydia
Lower trunk of brachial plexus
Hyperkeratosis
AP depol opens voltage gated Ca channels - inducing NT release

46. What is the TX for acute gout
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Chondrosarcoma
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
NSAIDs (indomethacin) colchicine

47. What are the the common causes of Erb palsy - and What are the associated findings
Axillary nerve
4th and 5th finger
Xeropthalmia - xerostomia - arthritis
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

48. What deformities of the hand are common in RA
Type III - RF
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Vesicle
Boutonniere - swan neck - zthumb

49. What nerve is compressed by supracondylar fracture of humerus
Median nerve
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Gout
Supraspinatus - abducts the arm before the deltoid

50. What are predisposing factors for osteosarcoma - xray finding

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