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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. What are the histo findings in an osteoclastoma
Boutonniere - swan neck - zthumb
Renal - pulm - CV - GI - 75% female
Spindle shaped cells with multinucleated giant cells
Widespread skin involvment - rapid progression - early visceral involvement

2. warts on genitals
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Vesicle
Condyloma acuminatum - caused by HPV
Parotid enlargement - inc risk of B cell lymphoma - dental caries

3. What test if specific for lupus but doesn't indicate prognosis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Anti Smith
Head - trunk - extremities - common benign neoplasm in older persons
Basal cell carcinoma - pearly papules - commonly with telangiectasias

4. precipitation of monosodium urate crystals into joints due to hyperuricemia
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Gout
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Phosphate is liberated from the myosin head

5. What causes heart failure in with Paget's disease
Cervical disk lesion
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Inc blood flow from AV shunts can cause high output heart failure

6. What are the possible origins of the paget's disease
Scleroderma
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Rheumatoid arthritis
Viral - maybe paramyxovirus

7. What are characteristic findings of gout
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Erythema multiforme - can be macules - papules vesicles - target lesions -
Pityriasis rosea
Muslce use - nerve stim/compound muscle test

8. Where is C7 dermatome
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
3rd finger
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Flex at the MCP

9. What kind of jxn is the zona occludens andw What is is composed of...
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Medial 1.5 fingers - hypothenar eminence
Mesenchymal stem cells in periosteum

10. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Musculocutaneous
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Axillary - deltoid - skin over deltoid - flattened deltoid

11. What is the most common NMJ disorder - What causes it and What are common symptoms
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Hairy leukoplakia - HIV population - EBV mediated
Actinic keratosis - risk proportional to epithelial dysplasia
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

12. What are the common perpetrating infections for Reiters syndrome
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Post GI infxn or chlamydia
Endochondroma
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

13. What enzyme is necessary for smooth muscle relaxation after contraction
Anti - CCP - HLA- DR4
Myosin light chain phosphotase
85% - advanced paternal age - or auto dominant inheritance
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

14. Dermatomyositis places the pt at inc risk For what malignancy in particular
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Antibodies around cells of the epidermis in a reticular or netlike pattern
Vesicle
Lung

15. Ca2+ released from the SR binds what structure and What does it cause
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Verrucae vulgaris
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

16. What do palmar interosseous muscles do
Vesicle
Over deltoid
Large goints (knee)
Adduct the fingers

17. What nerve is injured in a fracutre of the hook of hamate
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Crohns and ulcerative colitis
Musculocutaneous
Ulnar nerve

18. What are the thin lines along the Z line
Actin
Outer arm
Vitiligo - dec number in melanocytes
Crust

19. hyperpigmentation associated with pregnancy or OCP
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Scleroderma
Osteoarthritis
Melasma (chloasma)

20. Thenar eminence - nerve and muscles
Actin
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

21. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Phosphate is liberated from the myosin head
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

22. What are the lab findings and TX in dermatomyositis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Trauma
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Medially rotates and adducts arm

23. interlacing trabeculae of woven bone surrounded by osteoblasts
Hairy leukoplakia - HIV population - EBV mediated
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Osteoid osteoma
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

24. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Integrin binds laminin in BM
Inc alk phos - abnl bone architecture
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Verrucae

25. What are the lab findings in pagets disease
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Head - trunk - extremities - common benign neoplasm in older persons
Inc alk phos - abnl bone architecture
Making fist with a proximal median nerve lesion

26. What is the defect in Paget's disease
Dec estrogen causes inc bone resorption - postmenopausal
Osteoid osteoma
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Increase in both osteoblast and osteoclast activity

27. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Trauma
Osteosarcoma - multiple myeloma

28. What lesion causes winged scapula
Actin
Long thoracic nerve
Urticaria
4th and 5th finger

29. What TX prophylax against osteoporisi
Exercise and Ca ingestion before age 30
Precocious puberty
Infraspinatus - laterally rotates arm
Adduct the fingers

30. What are the characteristic bone findings in paget's disease
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Over deltoid
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Medial aspect

31. What causes golf or tennis elbow
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
3rd finger
Osteoarthritis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

32. papule > 1cm seen psoriasis
Plaque
Seborrheic keratosis
Pustule
Recurrent branch of the median nerve

33. knee trauma - nerve - motor and sensory def
Anti Scl70 - anti DNA topoisomerase I antibody
Mesenchymal stem cells in periosteum
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Gout

34. elevated skin lesion <1cm seen in acne vulgaris
Papule
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
S. aureus - streptococcus
Muslce use - nerve stim/compound muscle test

35. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Increase in both osteoblast and osteoclast activity
Ulnar deviation - subluxation - bakers cysts (behind knee)
Seborrheic keratosis

36. What is the precursor to melanom
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Dysplastic nevus
Infraspinatus - laterally rotates arm
Phosphate is liberated from the myosin head

37. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Integrin binds laminin in BM
TB from dissemination and lyme dz
Mesenchymal stem cells in periosteum
Strawberry hemangioma

38. Who does osteoporosis type 2 effect
Urticaria
Men and women > 70 - senile osteporosis
Verrucae vulgaris
Anti - CCP - HLA- DR4

39. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Dermatomyositis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

40. what changes are seen in stratum spinosum and granulosum in psoriasis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
ANA - sensitive but not specific
Inc spinosum - dec granulosum
Osteoporosis

41. What do xray show in osteopetrosis and What do potential CN abnl result from
Thymoma
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Erlenmeyer flask bones that flare out - narrowed foramina
Axilla

42. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Rigor mortis
Polyostotic fibrous dysplasia
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Inc blood flow from AV shunts can cause high output heart failure

43. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Phosphate is liberated from the myosin head
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Viral - maybe paramyxovirus

44. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Type III - RF
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

45. 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
Phosphorylates myosin light chain which leads to cross bridge formation
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Xeropthalmia - xerostomia - arthritis

46. What is the TX for acute gout
Men and women > 70 - senile osteporosis
Acantholysis
NSAIDs (indomethacin) colchicine
Phosphorylates myosin light chain which leads to cross bridge formation

47. What kind of bone tumor is associated with FAP and What is the finding
Metaphysis of long bones - distal femur
Basophilic - rhomboid crystals - weakly birefringent
Anti - histone
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

48. When does membranous ossification occur and What is the difference between membranous and endochondrial
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Recurrent branch of the median nerve
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

49. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
Verrucae vulgaris
Pityriasis rosea
Anti - CCP - HLA- DR4

50. Where does cartilage loss begin in osteoarthritis
Posterior cord
Medial aspect
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Median nerve