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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 does the hemidesmosome do and what disease is caused by autoantibodies to it
Connects cells to underlying extracellular - bullous pemphigoid
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Parotid enlargement - inc risk of B cell lymphoma - dental caries

2. What causes a lesion in the axillary nerve
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
In psoriasis - bleeding spots when scales are scraped off
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

3. warts on genitals
Osteoporosis
Inc alk phos - abnl bone architecture
Condyloma acuminatum - caused by HPV
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

4. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Anti - histone
Erythema multiforme - can be macules - papules vesicles - target lesions -
Myosin light chain phosphotase

5. Loss of what muslces in Erbs causes the limb to hang by side
Tear of the ACL
Paralysis of abductors
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Lesioned by midshaft fracture of humerus

6. 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
Medially rotates and adducts arm
Psoriasis
Biceps

7. What lesion causes difficulty flexing elbow with variable sensory loss
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Musculocutaneous
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

8. larger osteoid osteoma found in vertebral column
Type III - RF
Ulnar nerve
Osteoblastoma
Infraspinatus - laterally rotates arm

9. What is TX for osteoporosis
Median nerve
Allopurinaol - uricosurics (probenicid)
Osteochondroma - exostosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

10. What are the lab findings in pagets disease
Gout
Inc alk phos - abnl bone architecture
Cellulitis - s aureus - s pyogenes
Ulnar deviation - subluxation - bakers cysts (behind knee)

11. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Deep branch of radial nerve
Ulnar nerve - intrinsic muscles of hand
Scleroderma
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

12. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Corneum - lucidum - granulosum - spinosum - basalis
AP depol opens voltage gated Ca channels - inducing NT release
Verrucae
Vitiligo - dec number in melanocytes

13. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
GC and cGMP and inhibition of MLCK
Conjunctivitis and anterior uveitis - urethritis and arthritis
Ligand binding leads to muscle depol

14. What is the precursor to melanom
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Myosin light chain phosphotase
Dysplastic nevus
Over deltoid

15. What kind of jxn is the zona occludens andw What is is composed of...
Osteoid osteoma
Axillary - deltoid - skin over deltoid - flattened deltoid
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Basophilic - rhomboid crystals - weakly birefringent

16. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Tear of the ACL
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Vesicle

17. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Bulla
Anti ds DNA - poor prognosis
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

18. What does the positive anterior drawer sign test indicate
Tear of the ACL
Lichen planus
Dec estrogen causes inc bone resorption - postmenopausal
Urticaria

19. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Medial finger flexion - wrist flexion
Gout

20. What is a precursor to squamous cell carcinoma
Pemphigus vulgaris
Median nerve
Actinic keratosis
Antibodies around cells of the epidermis in a reticular or netlike pattern

21. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Antibodies around cells of the epidermis in a reticular or netlike pattern
Calmodulin - complex activates myosin light chain kinase
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
HI shrinks - A stays same

22. What do lumbricals do
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
< 2mc found in proximal tibia and femur - men < 25
Flex the MCP joints and extend both the DIP and PIP joints

23. In which gender is gout more common and What does the crystals appear like microscopically
Dysplastic nevus
Pain in weight bearing joints at the end of the day and improving with rest
Squamous cell carcinoma
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

24. What does injury to the distal median nerve cause

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25. What is the power stroke of muscle contraction
Osteoblastoma
Osteopetrosis - abnl fxn of osteoclasts
Vesicle
Myosin releases bound ADP and is displaced on the actin filament

26. What are the lab findings in osteitis fibrosa cystica
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Post GI infxn or chlamydia
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Xeropthalmia - xerostomia - arthritis

27. knee trauma - nerve - motor and sensory def
Albinism
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

28. What is the classic triad of reactive arthritis
Muslce use - nerve stim/compound muscle test
Medial forearm and arm to just under the axilla
Conjunctivitis and anterior uveitis - urethritis and arthritis
Impetigo - s aureus - s pyogenes

29. What organisms can cause chronic infectious arthritis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
TB from dissemination and lyme dz
Axillary nerve
Exercise and Ca ingestion before age 30

30. hyperpigmentation associated with pregnancy or OCP
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Melasma (chloasma)
Spindle shaped cells with multinucleated giant cells
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

31. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Recurrent branch of the medain nerve
3rd finger
Osteosarcoma - multiple myeloma
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

32. What do anterior and posterior in ACL and PCL refer to...
Calmodulin - complex activates myosin light chain kinase
Keratoacanthoma
Age - obesity and joint deformity
Sites of tibial attachment

33. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Staph scalded skin syndrome
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

34. What does subscapularis do
Median nerve
Medially rotates and adducts arm
Osteochondroma - exostosis
Osteopetrosis - abnl fxn of osteoclasts

35. What is the classic traid of sjogrens syndrome
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Xeropthalmia - xerostomia - arthritis
Adductor policis brevis
Median nerve - same fingers but not on the hand

36. What antibody is less sensitive than RF but more specific and What is the HLA association
Anti - CCP - HLA- DR4
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Tear of the ACL
Squamous cell carcinoma

37. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Psoriasis
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

38. Where does cartilage loss begin in osteoarthritis
Medial aspect
Cherry hemangioma
Seborrheic keratosis
Muslce use - nerve stim/compound muscle test

39. What does I'M DAMN SHARP stand for
Connects cells to underlying extracellular - bullous pemphigoid
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Boutonniere - swan neck - zthumb

40. inflammation of the skin
Dermatitis
Ulnar nerve
Crohns and ulcerative colitis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

41. What lesions causes Erb's palsy
Upper trunk of brachial plexus
Paralysis of lateral rotators
Dermatitis herpetiformis
S. aureus - streptococcus

42. What protects the brachial plexus in clavicle fracture
Large goints (knee)
Axillary nerve
Medially rotates and adducts arm
Subclavius

43. What lesion causes claw hand and What are the muscles involved
Ulnar nerve - intrinsic muscles of hand
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Long thoracic nerve
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

44. Where is T1 dermatome
MCP - PIP - no DIP
Recurrent branch of the medain nerve
Erythema nodosum
Medial forearm and arm to just under the axilla

45. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Lichen planus
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Mesenchymal stem cells in periosteum
Steroids

46. What clinical features in vertebral crush fractures
Ulnar nerve
Acute back pain - loss of height - and kyphosis
TB from dissemination and lyme dz
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

47. In which form is myosin light chain active
Phosphorylated
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Adductor policis brevis
Thymoma

48. What is a very specific test for lupus
Cellulitis - s aureus - s pyogenes
Anti ds DNA - poor prognosis
Anti Scl70 - anti DNA topoisomerase I antibody
Type III - RF

49. What are the motor defs of a proximal ulnar nerve injury
Long thoracic nerve
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Medial finger flexion - wrist flexion

50. What causes heart failure in with Paget's disease
Inc blood flow from AV shunts can cause high output heart failure
Torn MCL
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
In psoriasis - bleeding spots when scales are scraped off