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Musculoskeletal

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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. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Osteopetrosis - abnl fxn of osteoclasts
Albinism
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Papule

2. What causes osteoporosis type 1 and When does it typically occur
Myosin light chain phosphotase
In psoriasis - bleeding spots when scales are scraped off
Osteochondroma - exostosis
Dec estrogen causes inc bone resorption - postmenopausal

3. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Calmodulin - complex activates myosin light chain kinase
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Polyostotic fibrous dysplasia

4. Where does the muscle contraction travel after leaving the motor end plate
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Corneum - lucidum - granulosum - spinosum - basalis
Down T tubule
Lower trunk of brachial plexus

5. What does lack of ATP cause
Rigor mortis
Thymoma
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Lower trunk of brachial plexus

6. What organisms can cause chronic infectious arthritis
Anterior interosseous nerve
Adductor policis brevis
TB from dissemination and lyme dz
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

7. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Dermatomyositis
Verrucae vulgaris
Abduct the fingers
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

8. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Down T tubule
AP depol opens voltage gated Ca channels - inducing NT release

9. papule > 1cm seen psoriasis
Medial aspect
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
NC migration
Plaque

10. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
MCP - PIP - no DIP
Ulnar
Erythema multiforme - can be macules - papules vesicles - target lesions -
Fever - fatigue - pleuritis - pericarditis

11. Loss of what muscles in Erbs causes the forearm to be pronated
Osteochondroma - exostosis
Connects cells to underlying extracellular - bullous pemphigoid
Lichen planus
Biceps

12. What enzyme defect in responsible for osteopetrosis
Carbonic anhydrase II
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Lung

13. What is the landmark for an LP
Iliac crest
Pityriasis rosea
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

14. What kind of endocrine abnl are associated with McCune Albright
Precocious puberty
McCune - Albright syndrome
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Intraepidermal bullae involving the skin and oral mucosa

15. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Plaque
HI shrinks - A stays same
Medially rotates and adducts arm

16. transiet vesicle seen in hives
Wheal
Head - trunk - extremities - common benign neoplasm in older persons
Large goints (knee)
Exercise and Ca ingestion before age 30

17. warts on genitals
Supraspinatus - abducts the arm before the deltoid
Acanthosis
Muslce use - nerve stim/compound muscle test
Condyloma acuminatum - caused by HPV

18. What are the classic fractures in pts with osteoporosis

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19. What does subscapularis do
Xeropthalmia - xerostomia - arthritis
Medially rotates and adducts arm
Dysplastic nevus
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

20. What is the classic triad of reactive arthritis
AP depol opens voltage gated Ca channels - inducing NT release
Conjunctivitis and anterior uveitis - urethritis and arthritis
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

21. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Hairy leukoplakia - HIV population - EBV mediated
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Fever - fatigue - pleuritis - pericarditis
Elevated ESR and nl CK - prednisone

22. What antibodies is diffuse scleroderma associated with
Anti Scl70 - anti DNA topoisomerase I antibody
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
< 2mc found in proximal tibia and femur - men < 25
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

23. What is a precursor to squamous cell carcinoma
Actinic keratosis
Teres minor
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Basal cell carcinoma - pearly papules - commonly with telangiectasias

24. What is TX for osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Precocious puberty
Cherry hemangioma
Ulnar

25. What does injury to the distal ulnar nerve cause
Head - trunk - extremities - common benign neoplasm in older persons
Precocious puberty
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Gout

26. common mole - benign
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Nevocellular nevus
Crust
Viral - maybe paramyxovirus

27. what changes are seen in stratum spinosum and granulosum in psoriasis
Integrin binds laminin in BM
Osteoporosis
Inc spinosum - dec granulosum
Ephelis

28. What is the test for drug induced lupus
Anti - histone
Acantholysis
In psoriasis - bleeding spots when scales are scraped off
Dermatitis herpetiformis

29. What do pseudogout crystals appear like microscopically
NC migration
Osteoblastoma
Serum ca - phos - alk phos are NL
Basophilic - rhomboid crystals - weakly birefringent

30. What are the histo findings in an osteoclastoma
85% - advanced paternal age - or auto dominant inheritance
Precocious puberty
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)

31. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Actinic keratosis
Erythema nodosum
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

32. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Phosphorylates myosin light chain which leads to cross bridge formation
Elevated ESR and nl CK - prednisone
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

33. What are the lab findings in pagets disease
Hyperkeratosis
Embryologic - childbirth defect - cervical rib compression - atrophy of the thenar and hypothenar eminences - atrophy of interosseous muscles - sensory deficits of the medial side of the forearm and hand - disappearance of the radial pulse upon movin
Inc alk phos - abnl bone architecture
3rd finger

34. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Endochondroma
Lower trunk of brachial plexus
Hyperkeratosis
Actinic keratosis

35. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Anti - CCP - HLA- DR4
Glucocorticoids
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

36. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Dysplastic nevus
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Basal cell carcinoma - pearly papules - commonly with telangiectasias

37. What lesion causes dec in thumb fxn 'ape hand'
Intraepidermal bullae involving the skin and oral mucosa
Median nerve
Anti - histone
Xeropthalmia - xerostomia - arthritis

38. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Lung

39. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Connects cells to underlying extracellular - bullous pemphigoid

40. What development failure can results in albinism
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Parakeratosis
Medial finger flexion - wrist flexion
NC migration

41. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Paralysis of abductors
Calmodulin - complex activates myosin light chain kinase
Making fist with a proximal median nerve lesion

42. What is the defect in Paget's disease
Over deltoid
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Increase in both osteoblast and osteoclast activity
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

43. What causes hypercalcemia in pts with sarcoid
Ulnar
Medial forearm and arm to just under the axilla
Acute back pain - loss of height - and kyphosis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

44. What does soft bones result from and What is the dz called in adults and children
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
4th and 5th finger
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

45. What nerve become injured in the incorrect use of a crutch
Radial nerve becomes compressed in axilla
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Recurrent branch of the median nerve
Ephelis

46. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Psoriasis
Ulnar deviation - subluxation - bakers cysts (behind knee)
Glucocorticoids

47. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Cellulitis - s aureus - s pyogenes
Medial 1.5 fingers - hypothenar eminence
Torn MCL

48. Contraction results in shortening of what bands - and what band remains the same length
HI shrinks - A stays same
Pustule
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

49. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Median nerve - lunate bone
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Plaque
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

50. How does the radial nerve in the spiral groove become injured
NSAIDs (indomethacin) colchicine
Lesioned by midshaft fracture of humerus
Squamous cell carcinoma
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids