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Musculoskeletal

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Answer 50 questions in 15 minutes.
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1. Where is C6 dermatome
Antibodies around cells of the epidermis in a reticular or netlike pattern
Nl - decreased bone mass
Axilla
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

2. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Pustule
Actinic keratosis - risk proportional to epithelial dysplasia
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

3. interlacing trabeculae of woven bone surrounded by osteoblasts
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Osteoid osteoma
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
B27 - no RF - males

4. What is the TX for acute gout
Axillary - deltoid - skin over deltoid - flattened deltoid
Medial forearm and arm to just under the axilla
NSAIDs (indomethacin) colchicine
Ulnar nerve

5. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Anti - CCP - HLA- DR4
Myosin light chain phosphotase

6. What is the classic triad of reactive arthritis
Acute back pain - loss of height - and kyphosis
Dec estrogen causes inc bone resorption - postmenopausal
Acanthosis
Conjunctivitis and anterior uveitis - urethritis and arthritis

7. What is TX for osteoporosis
Radial nerve
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Fever - fatigue - pleuritis - pericarditis

8. appreas in 30s to 40s - does not regress
Steroids
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Cherry hemangioma

9. hyperpigmentation associated with pregnancy or OCP
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Making fist with a proximal median nerve lesion
Median nerve
Melasma (chloasma)

10. epidermal hyperplasia (inc spinosum)
Myosin
Age - obesity and joint deformity
Acanthosis
Adduct the fingers

11. What percent of these mutations occur sporadically and what parental feature are they associated with
Dermatitis herpetiformis
85% - advanced paternal age - or auto dominant inheritance
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Down T tubule

12. Other than N. gono - what organisms can cause infectious - septic arthritis
Fibrinoid necrosis surrounded by palisading histiocytes
GC and cGMP and inhibition of MLCK
Anti - histone
S. aureus - streptococcus

13. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Cellulitis - s aureus - s pyogenes
Calmodulin - complex activates myosin light chain kinase
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

14. Where is C5 dermatome
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Actin
Outer arm

15. What is the precursor to melanom
Recurrent branch of the median nerve
Dysplastic nevus
Mesenchymal stem cells in periosteum
Flex the MCP joints and extend both the DIP and PIP joints

16. What are the lab findings in osteoporosis
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Crust
Nl - decreased bone mass

17. What are the lab findings in osteopetrosis
Nl - thickened dense bones
Median nerve - same fingers but not on the hand
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Age - obesity and joint deformity

18. What muscles of the shoulder form the rotator cuff
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Cervical disk lesion
Medial 1.5 fingers - hypothenar eminence

19. What enzyme defect in responsible for osteopetrosis
Carbonic anhydrase II
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Lesioned by midshaft fracture of humerus
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

20. What nerve become injured in the incorrect use of a crutch
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Radial nerve becomes compressed in axilla
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

21. What is below the epidermis
The dermis
Erythema nodosum
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Supraspinatus - abducts the arm before the deltoid

22. Where is C4 dermatome
Over deltoid
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Bulla
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

23. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Vesicle
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Keratoacanthoma
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

24. small fluid containing blister seen in chickenpox
Vesicle
Verrucae vulgaris
Trauma
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

25. Through what pathway does NO work and What is the downstream effect
Biceps
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
GC and cGMP and inhibition of MLCK
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

26. What supplies innervation to the thenar muscles
Recurrent branch of the median nerve
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Widespread skin involvment - rapid progression - early visceral involvement
Femoral - thing flexion and leg extension - anterior thigh and medial leg

27. What is the classic presentation of osteoarthritis
Pain in weight bearing joints at the end of the day and improving with rest
TB from dissemination and lyme dz
Sites of tibial attachment
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

28. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
TB from dissemination and lyme dz
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Median nerve
Osteoblastoma

29. What are the systemic symptoms found in RA
Osteoporosis
Fever - fatigue - pleuritis - pericarditis
Paralysis of lateral rotators
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

30. What nerve and branch are stretche by subluxation of the radius
Deep branch of radial nerve
Cellulitis - s aureus - s pyogenes
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Verrucae

31. What does PED and Tip stand for

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32. thickened - dense bones that are prone to fracture - dz and primary defect
Viral - maybe paramyxovirus
Posterior cord
Crust
Osteopetrosis - abnl fxn of osteoclasts

33. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Down T tubule
Erythema multiforme - can be macules - papules vesicles - target lesions -
Osteochondroma - exostosis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

34. What causes hypercalcemia in pts with sarcoid
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Wheal

35. What are the causes of inferior trunk plexus compression and What are the findings
Recurrent branch of the median nerve
In psoriasis - bleeding spots when scales are scraped off
Verrucae vulgaris
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

36. What molecule maintatins integrity of basement membrane and What does it bind
Integrin binds laminin in BM
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
The dermis
Antibodies around cells of the epidermis in a reticular or netlike pattern

37. What lesion causes winged scapula
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Long thoracic nerve
Erlenmeyer flask bones that flare out - narrowed foramina
Axillary nerve

38. irregular areas of complete depigmentation - condition and cause
Ulnar nerve
Glucocorticoids
Crohns and ulcerative colitis
Vitiligo - dec number in melanocytes

39. What are the lab findings in osteomalacia/rickets
Acanthosis nigcricans
Anti Smith
Boutonniere - swan neck - zthumb
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

40. What do anterior and posterior in ACL and PCL refer to...
Pustule
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Sites of tibial attachment
Hairy leukoplakia - HIV population - EBV mediated

41. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Squamous cell carcinoma
Dec estrogen causes inc bone resorption - postmenopausal
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

42. What causes a lesion in the upper trunk of the brachial plexus
Cherry hemangioma
Trauma
Elevated ESR and nl CK - prednisone
Radial nerve becomes compressed in axilla

43. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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44. What is a very specific test for lupus
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Infraspinatus - laterally rotates arm
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Anti ds DNA - poor prognosis

45. What signal initiates a muscle contraction
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
AP depol opens voltage gated Ca channels - inducing NT release
Anterior interosseous nerve
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

46. In which gender is gout more common and What does the crystals appear like microscopically
Keloid
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Polyostotic fibrous dysplasia
Flex at the MCP

47. What lesions causes Erb's palsy
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Paralysis of lateral rotators
Lesioned by midshaft fracture of humerus
Upper trunk of brachial plexus

48. What are the characteristic bone findings in paget's disease
Osteoarthritis
Scleroderma
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

49. hives - intensely pruritic wheals that form after mast cell degranulation
Inc spinosum - dec granulosum
Anti Scl70 - anti DNA topoisomerase I antibody
GC and cGMP and inhibition of MLCK
Urticaria

50. What nerve is injured by a superficial laceration of the hand
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Musculocutaneous
Recurrent branch of the medain nerve

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Musculoskeletal

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