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Musculoskeletal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. epidermal hyperplasia (inc spinosum)
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Hairy leukoplakia - HIV population - EBV mediated
Acanthosis
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

2. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Macule
Phosphorylated
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Albinism

3. What does ATP do in skeletal muscle contraction
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Gout
GC and cGMP and inhibition of MLCK
Long thoracic nerve

4. Other than N. gono - what organisms can cause infectious - septic arthritis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Serum ca - phos - PTH are nl alk phos elevated
Acantholysis
S. aureus - streptococcus

5. What muscles of the shoulder form the rotator cuff
The dermis
Pseudogout
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

6. What are the lab findings in osteopetrosis
Glucocorticoids
Erlenmeyer flask bones that flare out - narrowed foramina
Nl - thickened dense bones
Actinic keratosis - risk proportional to epithelial dysplasia

7. warts on hands
Scleroderma
Radial nerve becomes compressed in axilla
Verrucae vulgaris
Patch

8. What do lupus pts falsely test positive for syphillis
Acanthosis
Median nerve
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Head - trunk - extremities - common benign neoplasm in older persons

9. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Erythema nodosum
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Erythema multiforme - can be macules - papules vesicles - target lesions -
Hairy leukoplakia - HIV population - EBV mediated

10. Where are most osteoid osteoma found and In what population
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
In psoriasis - bleeding spots when scales are scraped off
< 2mc found in proximal tibia and femur - men < 25
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

11. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Dermatitis herpetiformis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

12. What other muscle in the thenar eminence adducts the thumb
3rd finger
Axillary nerve
Acanthosis nigcricans
Adductor policis brevis

13. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Type III - RF

14. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Posterior cord
Melasma (chloasma)
Acantholysis
Basal cell carcinoma - pearly papules - commonly with telangiectasias

15. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Spindle shaped cells with multinucleated giant cells
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

16. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Patch
Polyostotic fibrous dysplasia
Seborrheic keratosis
Dysplastic nevus

17. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Pain in weight bearing joints at the end of the day and improving with rest
Large goints (knee)
Hairy leukoplakia - HIV population - EBV mediated
Lichen planus

18. What lesion causes total claw (klumpke's hand)
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Phosphate is liberated from the myosin head
Macule
Lower trunk of brachial plexus

19. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Supraspinatus - abducts the arm before the deltoid
Osteoarthritis
Making fist with a proximal median nerve lesion

20. Where is C8 dermatome
Type III - RF
Ischial spine - relieve pain during delivery
Melasma (chloasma)
4th and 5th finger

21. What are the characteristic bone findings in paget's disease
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Basophilic - rhomboid crystals - weakly birefringent
Expansile glistening mass within the medullary cavity
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

22. Thenar eminence - nerve and muscles
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Dermatitis herpetiformis
Femoral - thing flexion and leg extension - anterior thigh and medial leg

23. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Pseudogout

24. What are the lab findings and TX in dermatomyositis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Patch
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Polyostotic fibrous dysplasia

25. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Polyostotic fibrous dysplasia
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Osteochondroma - exostosis

26. What deformities of the hand are common in RA
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Pustule
Ulnar nerve - intrinsic muscles of hand
Boutonniere - swan neck - zthumb

27. What are characteristic findings of gout
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Widespread skin involvment - rapid progression - early visceral involvement
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

28. interlacing trabeculae of woven bone surrounded by osteoblasts
Osteoid osteoma
Rigor mortis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Dermatomyositis

29. In which gender is gout more common and What does the crystals appear like microscopically
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Pseudogout
Pityriasis rosea
Phosphorylates myosin light chain which leads to cross bridge formation

30. Loss of what muslces in Erbs causes the limb to hang by side
Supraspinatus - abducts the arm before the deltoid
Making fist with a proximal median nerve lesion
Squamous cell carcinoma
Paralysis of abductors

31. What causes a lesion in the axillary nerve
Pseudogout
Widespread skin involvment - rapid progression - early visceral involvement
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Femoral - thing flexion and leg extension - anterior thigh and medial leg

32. What is the sensory def of an ulnar nerve injury
Medial 1.5 fingers - hypothenar eminence
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Corneum - lucidum - granulosum - spinosum - basalis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

33. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Keloid
Head - trunk - extremities - common benign neoplasm in older persons
Osteoblastoma

34. Which muscle laterally rotates and adducts arm
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Posterior cord
Osteoarthritis
Teres minor

35. What are the most common symtpoms of SLE
Gout
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Actinic keratosis
Pseudogout

36. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Ulnar nerve
NC migration
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

37. What medication is contraindicated in osteoporosis
Inc blood flow from AV shunts can cause high output heart failure
Glucocorticoids
Men and women > 70 - senile osteporosis
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

38. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Palisading
Corneum - lucidum - granulosum - spinosum - basalis
Myosin releases bound ADP and is displaced on the actin filament
Type III - RF

39. What does abnl passive abduction of the knee indicate
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Torn MCL
Infraspinatus - laterally rotates arm

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

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41. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Serum ca - phos - alk phos are NL
Osteoarthritis
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

42. What molecule maintatins integrity of basement membrane and What does it bind
Integrin binds laminin in BM
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Medial finger flexion - wrist flexion
Femoral - thing flexion and leg extension - anterior thigh and medial leg

43. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Paralysis of lateral rotators
S. aureus - streptococcus

44. What enzyme is necessary for smooth muscle relaxation after contraction
Integrin binds laminin in BM
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Myosin light chain phosphotase
Radial nerve

45. When do acute attacks of gout typically occur
Paralysis of lateral rotators
After a large meal or EtOH conspumption
Pemphigus vulgaris
Scleroderma

46. What are the subQ rheumatoid nodules made of...
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Fibrinoid necrosis surrounded by palisading histiocytes
Scleroderma
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

47. papule > 1cm seen psoriasis
MCP - PIP - no DIP
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Plaque
Ulnar nerve - fracture of hook of hamate

48. In which joints does pseudogout typically occur
Verrucae
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Large goints (knee)
Paralysis of abductors

49. What are the lab findings in pagets disease
Ulnar nerve
Inc alk phos - abnl bone architecture
Myosin light chain phosphotase
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

50. What lesion causes Saturday night wrist drop
Serum ca - phos - PTH are nl alk phos elevated
Radial nerve
Scleroderma
Spindle shaped cells with multinucleated giant cells