Test your basic knowledge |

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 lack of ATP cause
Anti Scl70 - anti DNA topoisomerase I antibody
Rigor mortis
Biceps
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

2. Which muscle fiber type is slow twitch and why are fibers red
Ligand binding leads to muscle depol
Integrin binds laminin in BM
Adductor policis brevis
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

3. What test if specific for lupus but doesn't indicate prognosis
Over deltoid
Radial nerve becomes compressed in axilla
Anti Smith
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

4. What do palmar interosseous muscles do
Lung
AP depol opens voltage gated Ca channels - inducing NT release
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Adduct the fingers

5. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Osteosarcoma - multiple myeloma
Medial finger flexion - wrist flexion
Scleroderma
Actin

6. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Albinism
Keratoacanthoma
Obturator - thigh adduction - medial thigh
Tear of the ACL

7. Which nerve is compressed in deep forearm
Viral - maybe paramyxovirus
Muslce use - nerve stim/compound muscle test
Anterior interosseous nerve
Fever - fatigue - pleuritis - pericarditis

8. What medication is contraindicated in osteoporosis
Glucocorticoids
Osteoarthritis
Erythema nodosum
< 2mc found in proximal tibia and femur - men < 25

9. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Ulnar
Deep branch of radial nerve
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

10. What are the motor defs of a proximal ulnar nerve injury
Pseudogout
Medial finger flexion - wrist flexion
Nl - decreased bone mass
Phosphorylates myosin light chain which leads to cross bridge formation

11. yellow when parallel and blue when perpendicular
Actinic keratosis - risk proportional to epithelial dysplasia
Gout
Supraspinatus - abducts the arm before the deltoid
Xeropthalmia - xerostomia - arthritis

12. What is a very specific test for lupus
Anti ds DNA - poor prognosis
Integrin binds laminin in BM
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Down T tubule

13. What causes compression of the C7 nerve root
Carbonic anhydrase II
Cervical disk lesion
Osteoporosis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

14. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Pemphigus vulgaris
Urticaria
Hyperkeratosis
Metaphysis of long bones - distal femur

15. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Seborrheic keratosis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Anti - CCP - HLA- DR4

16. What is the primary screening test for lupus
Urticaria
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Polyostotic fibrous dysplasia
ANA - sensitive but not specific

17. What does acantholysis show in pemphigus vulgaris
Intraepidermal bullae involving the skin and oral mucosa
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
TB from dissemination and lyme dz
Gout

18. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Osteoarthritis
The dermis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Actinic keratosis

19. What kind of bone tumor is associated with FAP and What is the finding
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Intraepidermal bullae involving the skin and oral mucosa

20. separation of epidermal cells
Ulnar nerve - intrinsic muscles of hand
Acantholysis
Palisading
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

21. What is the TX for acute gout
Paralysis of abductors
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Muslce use - nerve stim/compound muscle test
NSAIDs (indomethacin) colchicine

22. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Erlenmeyer flask bones that flare out - narrowed foramina
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Cellulitis - s aureus - s pyogenes
MCL - ACL - lateral meniscus (esp in athletes)

23. What do lumbricals do
Flex the MCP joints and extend both the DIP and PIP joints
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Hairy leukoplakia - HIV population - EBV mediated
Crohns and ulcerative colitis

24. Where is C4 dermatome
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Biceps
Actinic keratosis
Over deltoid

25. Which type of muscle fiber is hypertrophied during weight training
Type III - RF
Over deltoid
Pain in weight bearing joints at the end of the day and improving with rest
Type 2

26. How is the lower trunk of the brachia plexus injured and what results from it

27. hives - intensely pruritic wheals that form after mast cell degranulation
Urticaria
Medial aspect
Muslce use - nerve stim/compound muscle test
Verrucae

28. What receptor is constitutively activated in achondroplasia and What does it do
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
HI shrinks - A stays same
Phosphorylated

29. What is the classic presentation of osteoarthritis
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Trauma
Pain in weight bearing joints at the end of the day and improving with rest

30. What lesion causes deltoid paralysis
Axillary nerve
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Polymyositis - shoulders - perifasicular inflammation
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

31. What does ATP do in skeletal muscle contraction
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Carbonic anhydrase II
Ulnar deviation - subluxation - bakers cysts (behind knee)
Crust

32. What is the most common NMJ disorder - What causes it and What are common symptoms
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
McCune - Albright syndrome
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

33. Sarcoid TX
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
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
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

34. papule > 1cm seen psoriasis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Serum ca - phos - alk phos are NL
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Plaque

35. Ca2+ released from the SR binds what structure and What does it cause
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Acanthosis
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

36. What happens at the postsynaptic motor end plate
Ligand binding leads to muscle depol
ANA - sensitive but not specific
Basophilic - rhomboid crystals - weakly birefringent
NSAIDs (indomethacin) colchicine

37. IBS - 2 dz's
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Parakeratosis
Crohns and ulcerative colitis

38. What do dorsal interosseous muscles do
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Abduct the fingers
Seborrheic keratosis
Myosin light chain phosphotase

39. Why does EtOH consumption precipitate gout
Scleroderma
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Pityriasis rosea
Infraspinatus - laterally rotates arm

40. What are the common perpetrating infections for Reiters syndrome
Widespread skin involvment - rapid progression - early visceral involvement
Paralysis of abductors
Post GI infxn or chlamydia
Precocious puberty

41. What causes the symptoms of MG to worsen - and What is used to diagnose
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Muslce use - nerve stim/compound muscle test
Long thoracic nerve
Staph scalded skin syndrome

42. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
In psoriasis - bleeding spots when scales are scraped off
< 2mc found in proximal tibia and femur - men < 25
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

43. What deformities of the hand are common in RA
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Boutonniere - swan neck - zthumb

44. In which joints does pseudogout typically occur
Dysplastic nevus
Large goints (knee)
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Cellulitis - s aureus - s pyogenes

45. What causes total claw
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Parotid enlargement - inc risk of B cell lymphoma - dental caries

46. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Acantholysis
Erythema nodosum
Patch
Anti - histone

47. Where is osteosarcoma found in the bone
Metaphysis of long bones - distal femur
Anti - histone
Macule
Median nerve - same fingers but not on the hand

48. What kind of nuclei do basal cell tumors have
Palisading
Erlenmeyer flask bones that flare out - narrowed foramina
Osteosarcoma - multiple myeloma
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

49. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Sarcoidosis - black females - ACE
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Deep branch of radial nerve

50. What supplies innervation to the thenar muscles
Axilla
Recurrent branch of the median nerve
Medially rotates and adducts arm
Lesioned by midshaft fracture of humerus