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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 does subscapularis do
Medially rotates and adducts arm
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Cherry hemangioma

2. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Female between 14 and 45 - mostly black
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Sarcoidosis - black females - ACE

3. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Parakeratosis
Erythema nodosum
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Pseudogout

4. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Staph scalded skin syndrome
Large goints (knee)
Interossei and adductor policis
Inc blood flow from AV shunts can cause high output heart failure

5. Where is T2 dermatome
Axilla
Expansile glistening mass within the medullary cavity
TB from dissemination and lyme dz
Endochondroma

6. What is the classic traid of sjogrens syndrome
Lesioned by midshaft fracture of humerus
Recurrent branch of the medain nerve
ANA - sensitive but not specific
Xeropthalmia - xerostomia - arthritis

7. Where is McBurney's point and What is there
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Chondrosarcoma
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

8. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
MCP - PIP - no DIP
Staph scalded skin syndrome
Spindle shaped cells with multinucleated giant cells
Actinic keratosis - risk proportional to epithelial dysplasia

9. Thenar eminence - nerve and muscles
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Nevocellular nevus
Patch
Renal - pulm - CV - GI - 75% female

10. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Fever - fatigue - pleuritis - pericarditis
Dermatitis herpetiformis

11. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Psoriasis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Polyostotic fibrous dysplasia
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

12. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Cervical disk lesion
Outer arm

13. What kind of endocrine abnl are associated with McCune Albright
Pseudogout
Exercise and Ca ingestion before age 30
Precocious puberty
Anti Smith

14. What is contained within epithelial granulomas of pts with sarcoid
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

15. hypothenar eminence - nerve and muscles
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Actin
Allopurinaol - uricosurics (probenicid)
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

16. What causes total claw
Elevated ESR and nl CK - prednisone
Hyperkeratosis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Atopic dermatitis - eczema

17. What is the classic triad of reactive arthritis
Paralysis of abductors
Urticaria
Age - obesity and joint deformity
Conjunctivitis and anterior uveitis - urethritis and arthritis

18. What is the landmark for an LP
Iliac crest
< 2mc found in proximal tibia and femur - men < 25
Recurrent branch of the medain nerve
Medial forearm and arm to just under the axilla

19. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Outer arm
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

20. What is the most common NMJ disorder - What causes it and What are common symptoms
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Hyperkeratosis
Cellulitis - s aureus - s pyogenes
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

21. What causes ape hand
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Intraepidermal bullae involving the skin and oral mucosa
Ligand binding leads to muscle depol
Squamous cell carcinoma

22. What does lack of ATP cause
Rigor mortis
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Muslce use - nerve stim/compound muscle test
Papule

23. What does acantholysis show in pemphigus vulgaris
Intraepidermal bullae involving the skin and oral mucosa
Posterior cord
Antibodies around cells of the epidermis in a reticular or netlike pattern
Albinism

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

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25. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Making fist with a proximal median nerve lesion
Osteoporosis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

26. What TX prophylax against osteoporisi
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Exercise and Ca ingestion before age 30
Wheal
Expansile glistening mass within the medullary cavity

27. What is the classic presentation of RA
Xeropthalmia - xerostomia - arthritis
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Medial finger flexion - wrist flexion
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

28. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Erythema multiforme - can be macules - papules vesicles - target lesions -
Pain in weight bearing joints at the end of the day and improving with rest
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

29. knee trauma - nerve - motor and sensory def
Lichen planus
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Ulnar deviation - subluxation - bakers cysts (behind knee)
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

30. What are defining lab findings for polymyalgia rheumatica and What is the TX
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Dec estrogen causes inc bone resorption - postmenopausal
Elevated ESR and nl CK - prednisone
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

31. What do dorsal interosseous muscles do
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Age - obesity and joint deformity
Abduct the fingers
Urticaria

32. What does the positive anterior drawer sign test indicate
Lung
Radial nerve becomes compressed in axilla
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Tear of the ACL

33. When does membranous ossification occur and What is the difference between membranous and endochondrial
Recurrent branch of the medain nerve
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Flex at the MCP

34. What does injury to the distal ulnar nerve cause
Parakeratosis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Serum ca - phos - PTH are nl alk phos elevated
Flex at the MCP

35. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Polyostotic fibrous dysplasia
McCune - Albright syndrome
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

36. What are the predisposing factors for osteoarthritis
Serum ca - phos - alk phos are NL
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Age - obesity and joint deformity
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

37. Where is T1 dermatome
NC migration
AP depol opens voltage gated Ca channels - inducing NT release
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Medial forearm and arm to just under the axilla

38. What does IM reveal in pemphigus vulgaris
Viral - maybe paramyxovirus
Ischial spine - relieve pain during delivery
Myosin releases bound ADP and is displaced on the actin filament
Antibodies around cells of the epidermis in a reticular or netlike pattern

39. common mole - benign
Nevocellular nevus
Palisading
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

40. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Gout
Parakeratosis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

41. What is the primary screening test for lupus
ANA - sensitive but not specific
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Pseudogout
Anti Smith

42. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Papule
Anti - histone
Atopic dermatitis - eczema
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

43. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Medial 1.5 fingers - hypothenar eminence
Osteoarthritis
Cervical disk lesion
Dec estrogen causes inc bone resorption - postmenopausal

44. 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
Sites of tibial attachment
Type III - RF
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Median nerve - same fingers but not on the hand

45. Which nerve is compressed in deep forearm
Medial forearm and arm to just under the axilla
Erythema nodosum
Staph scalded skin syndrome
Anterior interosseous nerve

46. What does PED and Tip stand for

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47. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Recurrent branch of the median nerve
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Lower trunk of brachial plexus

48. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Vesicle
Median nerve - lunate bone
Osteoblastoma
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

49. What is a very specific test for lupus
Anti ds DNA - poor prognosis
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

50. What is the Auspitz sign
Ulnar nerve
In psoriasis - bleeding spots when scales are scraped off
Long thoracic nerve
Age - obesity and joint deformity