Test your basic knowledge |

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 causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Ischial spine - relieve pain during delivery
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

2. What receptor is constitutively activated in achondroplasia and What does it do
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Vitiligo - dec number in melanocytes
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

3. What causes ape hand
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Squamous cell carcinoma
Fibrinoid necrosis surrounded by palisading histiocytes

4. What is CREST syndrome and What antibody is it associated with
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Basophilic - rhomboid crystals - weakly birefringent
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

5. What lesion causes winged scapula
Long thoracic nerve
Renal - pulm - CV - GI - 75% female
Median nerve - same fingers but not on the hand
Osteogenic carcinoma

6. Damage to what 3 structures is common for the unhappy triad
Hairy leukoplakia - HIV population - EBV mediated
Patch
MCL - ACL - lateral meniscus (esp in athletes)
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

7. Where is C5 dermatome
Outer arm
Verrucae
Impetigo - s aureus - s pyogenes
Osteogenic carcinoma

8. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Fibrinoid necrosis surrounded by palisading histiocytes
Strawberry hemangioma
Carbonic anhydrase II
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

9. What causes the symptoms of MG to worsen - and What is used to diagnose
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
MCL - ACL - lateral meniscus (esp in athletes)
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Muslce use - nerve stim/compound muscle test

10. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Medial forearm and arm to just under the axilla
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Adductor policis brevis

11. What causes heart failure in with Paget's disease
Antibodies around cells of the epidermis in a reticular or netlike pattern
Serum ca - phos - PTH are nl alk phos elevated
Flex at the MCP
Inc blood flow from AV shunts can cause high output heart failure

12. Which muscle is the pitching injury and What does it do
Infraspinatus - laterally rotates arm
Torn MCL
Xeropthalmia - xerostomia - arthritis
GC and cGMP and inhibition of MLCK

13. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Crohns and ulcerative colitis
Lichen planus
Osteochondroma - exostosis
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

14. What happens at the gap jxn and what molecules create them
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Actin
NC migration

15. What does lack of ATP cause
Medial finger flexion - wrist flexion
Erythema multiforme - can be macules - papules vesicles - target lesions -
Rigor mortis
Iliac crest

16. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Acanthosis nigcricans
Integrin binds laminin in BM
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Axillary - deltoid - skin over deltoid - flattened deltoid

17. What causes golf or tennis elbow
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Ligand binding leads to muscle depol
Medial 1.5 fingers - hypothenar eminence
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

18. What is the landmark for an LP
Iliac crest
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

19. What are common features of lupus
Inc blood flow from AV shunts can cause high output heart failure
Paralysis of abductors
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

20. What organisms can cause chronic infectious arthritis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
NC migration
Flex the MCP joints and extend both the DIP and PIP joints
TB from dissemination and lyme dz

21. In which gender is gout more common and What does the crystals appear like microscopically
Flex at the MCP
Spindle shaped cells with multinucleated giant cells
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Adductor policis brevis

22. Other than N. gono - what organisms can cause infectious - septic arthritis
Deep branch of radial nerve
Torn MCL
Scleroderma
S. aureus - streptococcus

23. What causes compression of the C7 nerve root
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Cervical disk lesion
Lesioned by midshaft fracture of humerus
Axillary - deltoid - skin over deltoid - flattened deltoid

24. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Medial 1.5 fingers - hypothenar eminence
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Antibodies around cells of the epidermis in a reticular or netlike pattern
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

25. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Median nerve - same fingers but not on the hand
TB from dissemination and lyme dz
Actinic keratosis - risk proportional to epithelial dysplasia

26. Decrease marrow space in osteopetrosis leads to what?
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Anterior interosseous nerve
Papule
Inc spinosum - dec granulosum

27. What causes a lesion in the axillary nerve
Renal - pulm - CV - GI - 75% female
Osteoid osteoma
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Phosphorylates myosin light chain which leads to cross bridge formation

28. What is the precursor to melanom
3rd finger
Dysplastic nevus
Iliac crest
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

29. What is contained within epithelial granulomas of pts with sarcoid
Cherry hemangioma
Type III - RF
Pain in weight bearing joints at the end of the day and improving with rest
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

30. What enzyme is necessary for smooth muscle relaxation after contraction
Basophilic - rhomboid crystals - weakly birefringent
Myosin light chain phosphotase
85% - advanced paternal age - or auto dominant inheritance
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

31. How is diffuse scleroderma characterized
Widespread skin involvment - rapid progression - early visceral involvement
Dermatomyositis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Myosin light chain phosphotase

32. What is the power stroke of muscle contraction
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Myosin releases bound ADP and is displaced on the actin filament
In psoriasis - bleeding spots when scales are scraped off
Tear of the ACL

33. What causes total claw
Condyloma acuminatum - caused by HPV
Acanthosis nigcricans
Subclavius
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

34. What is below the epidermis
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
The dermis
Anti Smith
Phosphate is liberated from the myosin head

35. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Lung

36. What molecule maintatins integrity of basement membrane and What does it bind
TB from dissemination and lyme dz
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Osteoporosis
Integrin binds laminin in BM

37. What kind of bone tumor is associated with FAP and What is the finding
Obturator - thigh adduction - medial thigh
Sarcoidosis - black females - ACE
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Widespread skin involvment - rapid progression - early visceral involvement

38. What does injury to the distal ulnar nerve cause
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
4th and 5th finger
Actin

39. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

40. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Psoriasis
85% - advanced paternal age - or auto dominant inheritance
Phosphate is liberated from the myosin head
Precocious puberty

41. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
B27 - no RF - males
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Albinism
Medial forearm and arm to just under the axilla

42. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Increase in both osteoblast and osteoclast activity
Anterior interosseous nerve
Scleroderma
Parotid enlargement - inc risk of B cell lymphoma - dental caries

43. What are the most common symtpoms of SLE
Rheumatoid arthritis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Anti - CCP - HLA- DR4
NC migration

44. What nerve become injured in the incorrect use of a crutch
Gout
< 2mc found in proximal tibia and femur - men < 25
Exercise and Ca ingestion before age 30
Radial nerve becomes compressed in axilla

45. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Paralysis of lateral rotators
Female between 14 and 45 - mostly black
Parakeratosis

46. What does soft bones result from and What is the dz called in adults and children
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Sites of tibial attachment
S. aureus - streptococcus
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

47. What is the classic traid of sjogrens syndrome
Erythema nodosum
Xeropthalmia - xerostomia - arthritis
Type III - RF
Scleroderma

48. IBS - 2 dz's
Medial finger flexion - wrist flexion
Crohns and ulcerative colitis
Ischial spine - relieve pain during delivery
Osteosarcoma - multiple myeloma

49. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Pemphigus vulgaris
Phosphorylated
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Type 2

50. Macule greater than 1cm
Patch
Ischial spine - relieve pain during delivery
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Supraspinatus - abducts the arm before the deltoid