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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 are the lab findings in osteomalacia/rickets
Increase in both osteoblast and osteoclast activity
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Large goints (knee)
Adductor policis brevis

2. Who does osteoporosis type 2 effect
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Men and women > 70 - senile osteporosis

3. What are characteristic findings of gout
Ulnar nerve - intrinsic muscles of hand
Serum ca - phos - PTH are nl alk phos elevated
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
After a large meal or EtOH conspumption

4. which muscle type is fast twitch and why are fibers white
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Fever - fatigue - pleuritis - pericarditis
Making fist with a proximal median nerve lesion
Adduct the fingers

5. What are the lab findings in osteitis fibrosa cystica
Elevated ESR and nl CK - prednisone
Parakeratosis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

6. What causes ape hand
Recurrent branch of the medain nerve
Inc blood flow from AV shunts can cause high output heart failure
Posterior cord
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

7. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Serum ca - phos - alk phos are NL
Palisading
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Thymoma

8. What causes osteoporosis type 1 and When does it typically occur
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Dec estrogen causes inc bone resorption - postmenopausal
Ischial spine - relieve pain during delivery
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

9. What are the predisposing factors for osteoarthritis
Myosin
Urticaria
Precocious puberty
Age - obesity and joint deformity

10. What nerve is compressed by supracondylar fracture of humerus
Biceps
Osteogenic carcinoma
Median nerve
Psoriasis

11. What do anterior and posterior in ACL and PCL refer to...
Radial nerve becomes compressed in axilla
Sites of tibial attachment
Erythema nodosum
Wheal

12. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Spindle shaped cells with multinucleated giant cells
Basophilic - rhomboid crystals - weakly birefringent
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

13. what changes are seen in stratum spinosum and granulosum in psoriasis
Lung
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Inc spinosum - dec granulosum
Verrucae

14. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Osteochondroma - exostosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Phosphorylates myosin light chain which leads to cross bridge formation
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

15. What are the possible origins of the paget's disease
Bulla
Dermatomyositis
Viral - maybe paramyxovirus
Posterior cord

16. What autoantibodies are formed in sjogrens syndrome
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Ulnar nerve - intrinsic muscles of hand

17. What are the lab findings in pagets disease
Cherry hemangioma
Long thoracic nerve
Elevated ESR and nl CK - prednisone
Inc alk phos - abnl bone architecture

18. What is the classic presentation of RA
Rheumatoid arthritis
Subclavius
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Outer arm

19. 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
Erythema multiforme - can be macules - papules vesicles - target lesions -
Deep branch of radial nerve
Recurrent branch of the medain nerve

20. Sarcoid TX
Steroids
Pseudogout
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

21. What are the systemic symptoms found in RA
Lower trunk of brachial plexus
Fever - fatigue - pleuritis - pericarditis
Interossei and adductor policis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

22. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Large goints (knee)
Age - obesity and joint deformity

23. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Pustule
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

24. What do the branches of the deep ulnar nerve innervate
Rigor mortis
Osteoblastoma
Interossei and adductor policis
Plaque

25. In which joints does pseudogout typically occur
Medial aspect
Osteopetrosis - abnl fxn of osteoclasts
Serum ca - phos - alk phos are NL
Large goints (knee)

26. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

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27. Where do sebhorrheic keratosis lesions occur and in who
TB from dissemination and lyme dz
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Head - trunk - extremities - common benign neoplasm in older persons
Medial 1.5 fingers - hypothenar eminence

28. What are the bone mineralization lab findings in osteopetrosis
Serum ca - phos - alk phos are NL
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Dec estrogen causes inc bone resorption - postmenopausal

29. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Anti - CCP - HLA- DR4
Making fist with a proximal median nerve lesion
Myosin
Parakeratosis

30. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Rheumatoid arthritis
McCune - Albright syndrome
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

31. 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
Axillary - deltoid - skin over deltoid - flattened deltoid
Osteosarcoma - multiple myeloma
S. aureus - streptococcus
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

32. What TX prophylax against osteoporisi
Osteoarthritis
Exercise and Ca ingestion before age 30
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Men and women > 70 - senile osteporosis

33. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Anti - CCP - HLA- DR4
Lesioned by midshaft fracture of humerus
Actin
Osteoarthritis

34. What protects the brachial plexus in clavicle fracture
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Subclavius
Lichen planus
Medial aspect

35. How is diffuse scleroderma characterized
Acanthosis
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Widespread skin involvment - rapid progression - early visceral involvement
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

36. 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
Sites of tibial attachment
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

37. What causes a lesion in the upper trunk of the brachial plexus
Trauma
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Increase in both osteoblast and osteoclast activity
Lower trunk of brachial plexus

38. What are the potential causes of gout

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39. What causes the symptoms of MG to worsen - and What is used to diagnose
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
MCP - PIP - no DIP
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Muslce use - nerve stim/compound muscle test

40. What causes golf or tennis elbow
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Sarcoidosis - black females - ACE
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

41. elevated skin lesion <1cm seen in acne vulgaris
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Anti Scl70 - anti DNA topoisomerase I antibody
Osteoid osteoma
Papule

42. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Allopurinaol - uricosurics (probenicid)
< 2mc found in proximal tibia and femur - men < 25
Ulnar
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

43. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Bulla
Chondrosarcoma
Erythema nodosum

44. What do dorsal interosseous muscles do
Abduct the fingers
Myosin
Subclavius
GC and cGMP and inhibition of MLCK

45. What is TX for osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Ligand binding leads to muscle depol
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

46. Dermatomyositis places the pt at inc risk For what malignancy in particular
Embryologic - childbirth defect - cervical rib compression - atrophy of the thenar and hypothenar eminences - atrophy of interosseous muscles - sensory deficits of the medial side of the forearm and hand - disappearance of the radial pulse upon movin
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Lung
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

47. What is the primary screening test for lupus
Musculocutaneous
Tear of the ACL
Increase in both osteoblast and osteoclast activity
ANA - sensitive but not specific

48. What are the motor defs of a proximal ulnar nerve injury
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Medial finger flexion - wrist flexion
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Recurrent branch of the medain nerve

49. freckle - normal number of melanocytes - inc melanin pigment
Tear of the ACL
Men and women > 70 - senile osteporosis
NC migration
Ephelis

50. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Recurrent branch of the median nerve
Macule