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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. What is the TX for chronic gout
Allopurinaol - uricosurics (probenicid)
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
In psoriasis - bleeding spots when scales are scraped off
Verrucae

2. How does the radial nerve in the spiral groove become injured
Lesioned by midshaft fracture of humerus
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Xeropthalmia - xerostomia - arthritis
Precocious puberty

3. What causes ape hand
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Ulnar nerve - fracture of hook of hamate

4. hyperpigmentation associated with pregnancy or OCP
Pustule
Paralysis of abductors
Melasma (chloasma)
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

5. Where is C5 dermatome
Hairy leukoplakia - HIV population - EBV mediated
Ulnar nerve - fracture of hook of hamate
Outer arm
Radial nerve

6. warts on hands
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Verrucae vulgaris
Pustule
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

7. What are the classic fractures in pts with osteoporosis

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8. What do palmar interosseous muscles do
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Ligand binding leads to muscle depol
Adduct the fingers

9. What are the lab findings in pagets disease
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Paralysis of lateral rotators
Inc alk phos - abnl bone architecture

10. What do lupus pts falsely test positive for syphillis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Osteoarthritis
Lichen planus

11. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
McCune - Albright syndrome
TB from dissemination and lyme dz
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

12. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Wheal
Hairy leukoplakia - HIV population - EBV mediated
Actinic keratosis

13. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Pseudogout
Actin
Rheumatoid arthritis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

14. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Anti Smith
Crohns and ulcerative colitis
Subclavius

15. When does membranous ossification occur and What is the difference between membranous and endochondrial
Obturator - thigh adduction - medial thigh
Viral - maybe paramyxovirus
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

16. What runs the distance of the A band
Myosin
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Vitiligo - dec number in melanocytes

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

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18. In which form is myosin light chain active
Impetigo - s aureus - s pyogenes
Phosphorylated
Basophilic - rhomboid crystals - weakly birefringent
Osteoarthritis

19. MG is associated with what neoplasm
Axillary nerve
Ischial spine - relieve pain during delivery
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Thymoma

20. What are the characterstic joints affected in RA
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Cherry hemangioma
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
MCP - PIP - no DIP

21. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Pemphigus vulgaris
Cervical disk lesion
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Iliac crest

22. What is the source of osteoblast cells
Parakeratosis
The dermis
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Mesenchymal stem cells in periosteum

23. What causes the symptoms of MG to worsen - and What is used to diagnose
Muslce use - nerve stim/compound muscle test
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Biceps
Endochondroma

24. Which nerve is compressed in deep forearm
Medial aspect
Anterior interosseous nerve
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
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

25. What are common features of lupus
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Bulla
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Crust

26. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Erythema nodosum
Dermatitis herpetiformis
Verrucae vulgaris
Ewings sarcoma - aggressive with early mets - but responsive to chemo

27. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Polyostotic fibrous dysplasia
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

28. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Strawberry hemangioma
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Ulnar nerve - fracture of hook of hamate

29. What associations go along with sarcoidosis

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30. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Albinism
Inc spinosum - dec granulosum
Medial finger flexion - wrist flexion
Steroids

31. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Polyostotic fibrous dysplasia
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Pseudogout
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

32. What do pseudogout crystals appear like microscopically
Cellulitis - s aureus - s pyogenes
Impetigo - s aureus - s pyogenes
Basophilic - rhomboid crystals - weakly birefringent
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

33. What does MLCK do in smooth muscle contraction
Teres minor
Phosphorylates myosin light chain which leads to cross bridge formation
Psoriasis
Mesenchymal stem cells in periosteum

34. What causes heart failure in with Paget's disease
Precocious puberty
Increase in both osteoblast and osteoclast activity
Inc blood flow from AV shunts can cause high output heart failure
Ulnar nerve

35. hives - intensely pruritic wheals that form after mast cell degranulation
Patch
Corneum - lucidum - granulosum - spinosum - basalis
Urticaria
Radial nerve becomes compressed in axilla

36. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Ulnar
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Connects cells to underlying extracellular - bullous pemphigoid
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

37. Macule greater than 1cm
Patch
Tear of the ACL
Ulnar nerve
Boutonniere - swan neck - zthumb

38. Which muscle fiber type is slow twitch and why are fibers red
Pseudogout
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Down T tubule
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

39. What are the motor defs of a proximal ulnar nerve injury
Conjunctivitis and anterior uveitis - urethritis and arthritis
Hyperkeratosis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Medial finger flexion - wrist flexion

40. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Serum ca - phos - PTH are nl alk phos elevated
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

41. What is the classic traid of sjogrens syndrome
Anterior interosseous nerve
Axillary - deltoid - skin over deltoid - flattened deltoid
Xeropthalmia - xerostomia - arthritis
Down T tubule

42. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Type 2

43. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Dysplastic nevus
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Lower trunk of brachial plexus
Verrucae

44. dried exudates from a vesicle - bulla or pustule seen impetigo
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Rheumatoid arthritis
Crust

45. What test if specific for lupus but doesn't indicate prognosis
Actinic keratosis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Anti Smith
Dermatomyositis

46. Where is C8 dermatome
Verrucae vulgaris
Inc blood flow from AV shunts can cause high output heart failure
4th and 5th finger
Dysplastic nevus

47. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Lichen planus
Upper trunk of brachial plexus
Erythema multiforme - can be macules - papules vesicles - target lesions -
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

48. Through what pathway does NO work and What is the downstream effect
Osteoblastoma
Over deltoid
Osteoporosis
GC and cGMP and inhibition of MLCK

49. Where is C4 dermatome
Widespread skin involvment - rapid progression - early visceral involvement
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Over deltoid

50. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Flex at the MCP
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Pustule
Actinic keratosis - risk proportional to epithelial dysplasia