Test your basic knowledge |

Musculoskeletal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 is the primary screening test for lupus
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Biceps
ANA - sensitive but not specific
Nevocellular nevus

2. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Sarcoidosis - black females - ACE
Osteopetrosis - abnl fxn of osteoclasts
Posterior cord
Renal - pulm - CV - GI - 75% female

3. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Inc spinosum - dec granulosum
Osteoarthritis
Widespread skin involvment - rapid progression - early visceral involvement
Acanthosis nigcricans

4. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Ulnar nerve
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Steroids

5. What causes a lesion in the axillary nerve
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Polyostotic fibrous dysplasia
Median nerve

6. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Seborrheic keratosis
Nevocellular nevus
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

7. What muscles of the shoulder form the rotator cuff
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Ulnar nerve
Crust

8. MG is associated with what neoplasm
Thymoma
Boutonniere - swan neck - zthumb
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Dermatomyositis

9. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Rigor mortis
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Medial 1.5 fingers - hypothenar eminence

10. What is the classic presentation of osteoarthritis
Renal - pulm - CV - GI - 75% female
TB from dissemination and lyme dz
Dysplastic nevus
Pain in weight bearing joints at the end of the day and improving with rest

11. What are the layers of of the epidermis from surface to base
Actin
Corneum - lucidum - granulosum - spinosum - basalis
85% - advanced paternal age - or auto dominant inheritance
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

12. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Flex at the MCP
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Post GI infxn or chlamydia

13. Flat discloration <1cm seen in tinea versicolor
Dec estrogen causes inc bone resorption - postmenopausal
Anterior interosseous nerve
Radial nerve
Macule

14. What development failure can results in albinism
NC migration
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Recurrent branch of the medain nerve
Median nerve

15. What enzyme is necessary for smooth muscle relaxation after contraction
Fibrinoid necrosis surrounded by palisading histiocytes
Myosin light chain phosphotase
Infraspinatus - laterally rotates arm
Ulnar deviation - subluxation - bakers cysts (behind knee)

16. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Conjunctivitis and anterior uveitis - urethritis and arthritis
Erythema multiforme - can be macules - papules vesicles - target lesions -
Phosphate is liberated from the myosin head
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

17. What happens in the power stroke of skeletal muscle contraction
Acute back pain - loss of height - and kyphosis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Outer arm
Phosphate is liberated from the myosin head

18. What are the lab findings in pagets disease
Inc alk phos - abnl bone architecture
MCP - PIP - no DIP
Crohns and ulcerative colitis
Type III - RF

19. What are the associations for sjogrens syndrome
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Parakeratosis
Phosphate is liberated from the myosin head

20. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Lesioned by midshaft fracture of humerus
4th and 5th finger
Acanthosis
Endochondroma

21. small fluid containing blister seen in chickenpox
Cherry hemangioma
Condyloma acuminatum - caused by HPV
Vesicle
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

22. papule > 1cm seen psoriasis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Plaque
Axillary nerve
Muslce use - nerve stim/compound muscle test

23. In which gender is gout more common and What does the crystals appear like microscopically
Xeropthalmia - xerostomia - arthritis
Ulnar nerve - intrinsic muscles of hand
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Gout

24. What are the potential causes of gout

25. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Intraepidermal bullae involving the skin and oral mucosa
Urticaria
Ulnar

26. What are the bone mineral lab findings in paget's disease
Serum ca - phos - PTH are nl alk phos elevated
Acantholysis
Albinism
Keloid

27. What TX prophylax against osteoporisi
Mesenchymal stem cells in periosteum
Female between 14 and 45 - mostly black
Exercise and Ca ingestion before age 30
MCL - ACL - lateral meniscus (esp in athletes)

28. How is diffuse scleroderma characterized
Paralysis of lateral rotators
Medial forearm and arm to just under the axilla
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Widespread skin involvment - rapid progression - early visceral involvement

29. What lesion causes Saturday night wrist drop
Thymoma
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Radial nerve

30. precipitation of monosodium urate crystals into joints due to hyperuricemia
Post GI infxn or chlamydia
Boutonniere - swan neck - zthumb
Subclavius
Gout

31. What causes ape hand
Median nerve
Myosin
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Chondrosarcoma

32. What nerve and branch are stretche by subluxation of the radius
Osteoid osteoma
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Deep branch of radial nerve

33. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Anti Smith
Polyostotic fibrous dysplasia
Nl - decreased bone mass
Femoral - thing flexion and leg extension - anterior thigh and medial leg

34. transiet vesicle seen in hives
Metaphysis of long bones - distal femur
Wheal
Head - trunk - extremities - common benign neoplasm in older persons
Hairy leukoplakia - HIV population - EBV mediated

35. hyperpigmentation associated with pregnancy or OCP
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Carbonic anhydrase II
Increase in both osteoblast and osteoclast activity
Melasma (chloasma)

36. What does IM reveal in pemphigus vulgaris
Osteopetrosis - abnl fxn of osteoclasts
GC and cGMP and inhibition of MLCK
Antibodies around cells of the epidermis in a reticular or netlike pattern
Median nerve - lunate bone

37. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Deep branch of radial nerve
Polyostotic fibrous dysplasia
Actinic keratosis - risk proportional to epithelial dysplasia

38. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Endochondroma
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Vitiligo - dec number in melanocytes

39. What other lesion can cause the appearnce of the ulnar claw
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Making fist with a proximal median nerve lesion
Widespread skin involvment - rapid progression - early visceral involvement
Crust

40. What lesions causes Erb's palsy
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Upper trunk of brachial plexus
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Widespread skin involvment - rapid progression - early visceral involvement

41. What are characteristic findings of gout
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Axillary nerve
Osteoid osteoma
Phosphate is liberated from the myosin head

42. Sarcoid TX
ANA - sensitive but not specific
Steroids
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Paralysis of lateral rotators

43. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Plaque
Gout
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

44. What causes osteoporosis type 1 and When does it typically occur
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Cervical disk lesion
Dec estrogen causes inc bone resorption - postmenopausal
Chondrosarcoma

45. What is the Auspitz sign
Interossei and adductor policis
Acute back pain - loss of height - and kyphosis
Dermatitis
In psoriasis - bleeding spots when scales are scraped off

46. What are the motor defs of a proximal ulnar nerve injury
Condyloma acuminatum - caused by HPV
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Recurrent branch of the medain nerve
Medial finger flexion - wrist flexion

47. What do xray show in osteopetrosis and What do potential CN abnl result from
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Erlenmeyer flask bones that flare out - narrowed foramina
B27 - no RF - males
Teres minor

48. What causes heart failure in with Paget's disease
Hyperkeratosis
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Type 2
Inc blood flow from AV shunts can cause high output heart failure

49. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Fibrinoid necrosis surrounded by palisading histiocytes
Intraepidermal bullae involving the skin and oral mucosa
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

50. What is the sign of Leser - Trelat
Lesioned by midshaft fracture of humerus
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Intraepidermal bullae involving the skin and oral mucosa