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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 deformities of the hand are common in RA
Boutonniere - swan neck - zthumb
Osteoid osteoma
Myosin releases bound ADP and is displaced on the actin filament
Verrucae

2. What does the positive anterior drawer sign test indicate
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Tear of the ACL
Verrucae vulgaris

3. common mole - benign
Nevocellular nevus
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Patch
Boutonniere - swan neck - zthumb

4. What lesion causes deltoid paralysis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Acute back pain - loss of height - and kyphosis
Basophilic - rhomboid crystals - weakly birefringent
Axillary nerve

5. Deposition of calcium pyrophosphate cyrstals within the joint space
Acantholysis
Glucocorticoids
Rheumatoid arthritis
Pseudogout

6. What is the test for drug induced lupus
Anti - histone
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Impetigo - s aureus - s pyogenes
Glucocorticoids

7. Why does EtOH consumption precipitate gout
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Lichen planus
NC migration
Osteoid osteoma

8. What are the motor defs of a proximal ulnar nerve injury
Medial finger flexion - wrist flexion
Erythema multiforme - can be macules - papules vesicles - target lesions -
Inc spinosum - dec granulosum
MCP - PIP - no DIP

9. What does I'M DAMN SHARP stand for
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
The dermis
Acute back pain - loss of height - and kyphosis
Albinism

10. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Fever - fatigue - pleuritis - pericarditis
Dermatitis herpetiformis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

11. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Osteogenic carcinoma
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

12. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Erythema multiforme - can be macules - papules vesicles - target lesions -
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Vitiligo - dec number in melanocytes
Osteosarcoma - multiple myeloma

13. What is the sensory def of an ulnar nerve injury
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Phosphorylated
Myosin releases bound ADP and is displaced on the actin filament
Medial 1.5 fingers - hypothenar eminence

14. What supplies innervation to the thenar muscles
Recurrent branch of the median nerve
Integrin binds laminin in BM
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
< 2mc found in proximal tibia and femur - men < 25

15. What are the thin lines along the Z line
Ischial spine - relieve pain during delivery
Actin
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Medial finger flexion - wrist flexion

16. What causes hypercalcemia in pts with sarcoid
Osteochondroma - exostosis
Bulla
Ephelis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

17. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Endochondroma
Parakeratosis
Inc blood flow from AV shunts can cause high output heart failure

18. Sarcoid TX
Steroids
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Vitiligo - dec number in melanocytes
Plaque

19. Where is osteosarcoma found in the bone
Metaphysis of long bones - distal femur
Supraspinatus - abducts the arm before the deltoid
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Upper trunk of brachial plexus

20. precipitation of monosodium urate crystals into joints due to hyperuricemia
Outer arm
Bulla
Gout
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

21. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Ligand binding leads to muscle depol

22. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Atopic dermatitis - eczema

23. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Integrin binds laminin in BM
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
< 2mc found in proximal tibia and femur - men < 25
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

24. What do dorsal interosseous muscles do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Abduct the fingers
Anti - histone

25. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Papule
Sarcoidosis - black females - ACE
The dermis
McCune - Albright syndrome

26. What is the defect in Paget's disease
Inc blood flow from AV shunts can cause high output heart failure
MCP - PIP - no DIP
Increase in both osteoblast and osteoclast activity
HI shrinks - A stays same

27. What are the predisposing factors for osteoarthritis
Vesicle
Men and women > 70 - senile osteporosis
Scleroderma
Age - obesity and joint deformity

28. Macule greater than 1cm
Xeropthalmia - xerostomia - arthritis
Patch
Tear of the ACL
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

29. large fluid containing blisters seen in bullous pemphigoid
Myosin releases bound ADP and is displaced on the actin filament
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Bulla
Acute back pain - loss of height - and kyphosis

30. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Inc spinosum - dec granulosum
Plaque
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

31. 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
Medial forearm and arm to just under the axilla
TB from dissemination and lyme dz
3rd finger

32. What are the signs of ulnar nerve injury

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33. What does injury to the distal median nerve cause

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34. What causes total claw
Adductor policis brevis
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Precocious puberty
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

35. What kind of bone tumor is associated with FAP and What is the finding
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Precocious puberty
Papule
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

36. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Acanthosis nigcricans
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Median nerve

37. thickened - dense bones that are prone to fracture - dz and primary defect
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Osteopetrosis - abnl fxn of osteoclasts
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Upper trunk of brachial plexus

38. What are the common perpetrating infections for Reiters syndrome
Ulnar
Post GI infxn or chlamydia
Acanthosis
Intraepidermal bullae involving the skin and oral mucosa

39. What is a very specific test for lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Anti Scl70 - anti DNA topoisomerase I antibody
Anti ds DNA - poor prognosis
85% - advanced paternal age - or auto dominant inheritance

40. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Squamous cell carcinoma
Palisading
Upper trunk of brachial plexus
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

41. What are the systemic symptoms found in RA
Ulnar
Nl - decreased bone mass
Strawberry hemangioma
Fever - fatigue - pleuritis - pericarditis

42. What lesion causes Saturday night wrist drop
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Staph scalded skin syndrome
Patch
Radial nerve

43. epi of SLE
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Pseudogout
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Female between 14 and 45 - mostly black

44. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Ischial spine - relieve pain during delivery
Bulla
Osteochondroma - exostosis

45. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Down T tubule
Sites of tibial attachment
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

46. Where are most osteoid osteoma found and In what population
Supraspinatus - abducts the arm before the deltoid
< 2mc found in proximal tibia and femur - men < 25
Osteoporosis
Steroids

47. In which gender is gout more common and What does the crystals appear like microscopically
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
85% - advanced paternal age - or auto dominant inheritance

48. What do palmar interosseous muscles do
Men and women > 70 - senile osteporosis
Paralysis of lateral rotators
Adduct the fingers
Papule

49. What antibody is less sensitive than RF but more specific and What is the HLA association
Anti - CCP - HLA- DR4
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Post GI infxn or chlamydia
Ischial spine - relieve pain during delivery

50. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Abduct the fingers
Seborrheic keratosis
Conjunctivitis and anterior uveitis - urethritis and arthritis