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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 borders of the superficial branch of the radial nerve dermatone
Crust
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Biceps
Expansile glistening mass within the medullary cavity

2. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Endochondroma
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Acanthosis nigcricans
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

3. What does injury to the distal ulnar nerve cause
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

4. What happens at the postsynaptic motor end plate
Ligand binding leads to muscle depol
Nevocellular nevus
Erythema multiforme - can be macules - papules vesicles - target lesions -
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

5. What nerve is injured by a superficial laceration of the hand
Myosin light chain phosphotase
Recurrent branch of the medain nerve
3rd finger
Gout

6. What are the thin lines along the Z line
Anti - CCP - HLA- DR4
Actin
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Elevated ESR and nl CK - prednisone

7. What is TX for osteoporosis
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Keratoacanthoma
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Actinic keratosis

8. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Condyloma acuminatum - caused by HPV
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Ulnar nerve

9. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Anti Smith
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Wheal
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

10. epidermal hyperplasia (inc spinosum)
Myosin light chain phosphotase
Parakeratosis
Acanthosis
Phosphorylated

11. What is the Auspitz sign
Staph scalded skin syndrome
Gout
In psoriasis - bleeding spots when scales are scraped off
Steroids

12. What is the most common NMJ disorder - What causes it and What are common symptoms
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Teres minor
Patch

13. What are the lab findings and TX in dermatomyositis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Nl - thickened dense bones
Anti ds DNA - poor prognosis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

14. What are characteristic findings of gout
Acanthosis nigcricans
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Iliac crest
Trauma

15. What kind of jxn is in the zona adherens and Where is it - What is it composed of - and what ion does it does it depend on...
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Median nerve
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Radial nerve becomes compressed in axilla

16. What medication is contraindicated in osteoporosis
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Glucocorticoids
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
Melasma (chloasma)

17. In smooth muscle contraction - What does Ca bind and What is the purpose
Median nerve
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Calmodulin - complex activates myosin light chain kinase
Urticaria

18. mechanical wear and tear of joints leading to destruction of articular cartilage
Vitiligo - dec number in melanocytes
Actinic keratosis - risk proportional to epithelial dysplasia
Ulnar nerve - intrinsic muscles of hand
Osteoarthritis

19. What is the classic presentation of RA
After a large meal or EtOH conspumption
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Verrucae
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

20. What molecule maintatins integrity of basement membrane and What does it bind
Phosphorylates myosin light chain which leads to cross bridge formation
Paralysis of lateral rotators
Lung
Integrin binds laminin in BM

21. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Squamous cell carcinoma
In psoriasis - bleeding spots when scales are scraped off
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Ulnar nerve - intrinsic muscles of hand

22. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Osteogenic carcinoma
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Obturator - thigh adduction - medial thigh
Parakeratosis

23. When does membranous ossification occur and What is the difference between membranous and endochondrial
Lung
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Phosphorylated

24. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Scleroderma
Viral - maybe paramyxovirus
Median nerve
Calmodulin - complex activates myosin light chain kinase

25. inflammation of the skin
Dermatitis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
In psoriasis - bleeding spots when scales are scraped off
Deep branch of radial nerve

26. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Paralysis of abductors
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Dermatomyositis
Atopic dermatitis - eczema

27. What is the defect in Paget's disease
Increase in both osteoblast and osteoclast activity
Lichen planus
Urticaria
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

28. What other lesion can cause the appearnce of the ulnar claw
Making fist with a proximal median nerve lesion
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Viral - maybe paramyxovirus

29. When do acute attacks of gout typically occur
Intraepidermal bullae involving the skin and oral mucosa
Basal cell carcinoma - pearly papules - commonly with telangiectasias
After a large meal or EtOH conspumption
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

30. What do dorsal interosseous muscles do
Abduct the fingers
Infraspinatus - laterally rotates arm
Anterior interosseous nerve
Impetigo - s aureus - s pyogenes

31. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Erythema multiforme - can be macules - papules vesicles - target lesions -
Torn MCL
Albinism

32. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Obturator - thigh adduction - medial thigh
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

33. Patients with pagets disease can develop what cancer
Antibodies around cells of the epidermis in a reticular or netlike pattern
Osteogenic carcinoma
Recurrent branch of the median nerve
Axillary - deltoid - skin over deltoid - flattened deltoid

34. What is the classic presentation of osteoarthritis
Cellulitis - s aureus - s pyogenes
Patch
Pain in weight bearing joints at the end of the day and improving with rest
Female between 14 and 45 - mostly black

35. knee trauma - nerve - motor and sensory def
Hyperkeratosis
Expansile glistening mass within the medullary cavity
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

36. Where is C8 dermatome
Polymyositis - shoulders - perifasicular inflammation
4th and 5th finger
Paralysis of lateral rotators
Osteoarthritis

37. transiet vesicle seen in hives
Wheal
Tear of the ACL
MCL - ACL - lateral meniscus (esp in athletes)
Trauma

38. What are the subQ rheumatoid nodules made of...
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Fibrinoid necrosis surrounded by palisading histiocytes
Men and women > 70 - senile osteporosis

39. Where do sebhorrheic keratosis lesions occur and in who
Age - obesity and joint deformity
Serum ca - phos - PTH are nl alk phos elevated
Head - trunk - extremities - common benign neoplasm in older persons
Anti - CCP - HLA- DR4

40. What deformities of the hand are common in RA
Osteoarthritis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Boutonniere - swan neck - zthumb
After a large meal or EtOH conspumption

41. How is chondrosarcoma described
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Expansile glistening mass within the medullary cavity
Anti ds DNA - poor prognosis
Boutonniere - swan neck - zthumb

42. 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
Osteoarthritis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Median nerve - same fingers but not on the hand
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

43. What is the classic traid of sjogrens syndrome
Erythema multiforme - can be macules - papules vesicles - target lesions -
Female between 14 and 45 - mostly black
Atopic dermatitis - eczema
Xeropthalmia - xerostomia - arthritis

44. What kind of bone tumor is associated with FAP and What is the finding
Tear of the ACL
Head - trunk - extremities - common benign neoplasm in older persons
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Pityriasis rosea

45. What is a positive Nikolsky's sign
ANA - sensitive but not specific
Lichen planus
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
< 2mc found in proximal tibia and femur - men < 25

46. What are the possible origins of the paget's disease
Lung
Viral - maybe paramyxovirus
Biceps
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

47. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
NSAIDs (indomethacin) colchicine
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Biceps
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

48. What does IM reveal in pemphigus vulgaris
Antibodies around cells of the epidermis in a reticular or netlike pattern
Erlenmeyer flask bones that flare out - narrowed foramina
Making fist with a proximal median nerve lesion
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

49. What are predisposing factors for osteosarcoma - xray finding

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50. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Xeropthalmia - xerostomia - arthritis