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Musculoskeletal

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Answer 50 questions in 15 minutes.
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1. What causes total claw
Men and women > 70 - senile osteporosis
Keratoacanthoma
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Vesicle

2. What is the power stroke of muscle contraction
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Serum ca - phos - alk phos are NL
Ulnar nerve - fracture of hook of hamate
Myosin releases bound ADP and is displaced on the actin filament

3. blister containing pus
S. aureus - streptococcus
Pustule
Osteoarthritis
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

4. What happens at the postsynaptic motor end plate
Anti Smith
Ulnar nerve - intrinsic muscles of hand
Ligand binding leads to muscle depol
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

5. 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
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Palisading
Men and women > 70 - senile osteporosis
Osteoblastoma

6. What muscles of the shoulder form the rotator cuff
GC and cGMP and inhibition of MLCK
Post GI infxn or chlamydia
Posterior cord
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

7. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Osteoporosis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Bulla
Anti - histone

8. Where is T1 dermatome
Biceps
Medial forearm and arm to just under the axilla
Serum ca - phos - PTH are nl alk phos elevated
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

9. What lesion causes deltoid paralysis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Axillary nerve
Ulnar nerve
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

10. What causes hypercalcemia in pts with sarcoid
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Staph scalded skin syndrome
Posterior cord
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

11. What is a very specific test for lupus
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Erlenmeyer flask bones that flare out - narrowed foramina
Spindle shaped cells with multinucleated giant cells
Anti ds DNA - poor prognosis

12. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Dysplastic nevus
Dermatomyositis
Gout

13. What does acantholysis show in pemphigus vulgaris
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Scleroderma
Intraepidermal bullae involving the skin and oral mucosa
Dermatitis herpetiformis

14. hypothenar eminence - nerve and muscles
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Trauma
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

15. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Lung
Verrucae

16. inflammation of the skin
Palisading
Erlenmeyer flask bones that flare out - narrowed foramina
Dermatitis
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

17. warts on genitals
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Osteosarcoma - multiple myeloma
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Condyloma acuminatum - caused by HPV

18. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Recurrent branch of the medain nerve
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Glucocorticoids

19. Who does osteoporosis type 2 effect
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Biceps
Men and women > 70 - senile osteporosis
Fever - fatigue - pleuritis - pericarditis

20. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
MCP - PIP - no DIP
Seborrheic keratosis
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

21. What development failure can results in albinism
< 2mc found in proximal tibia and femur - men < 25
NC migration
Post GI infxn or chlamydia
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

22. What are the lab findings and TX in dermatomyositis
Infraspinatus - laterally rotates arm
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Inc alk phos - abnl bone architecture

23. What is the primary screening test for lupus
Seborrheic keratosis
Over deltoid
ANA - sensitive but not specific
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

24. Where is C8 dermatome
Down T tubule
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
4th and 5th finger

25. What does subscapularis do
Medially rotates and adducts arm
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Age - obesity and joint deformity
Large goints (knee)

26. What do the branches of the deep ulnar nerve innervate
GC and cGMP and inhibition of MLCK
Acute back pain - loss of height - and kyphosis
Connects cells to underlying extracellular - bullous pemphigoid
Interossei and adductor policis

27. Deposition of calcium pyrophosphate cyrstals within the joint space
Pseudogout
In psoriasis - bleeding spots when scales are scraped off
Gout
Osteoporosis

28. What are predisposing factors for osteosarcoma - xray finding

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29. What are the lab findings in osteitis fibrosa cystica
Elevated ESR and nl CK - prednisone
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Deep branch of radial nerve
Infraspinatus - laterally rotates arm

30. What are the bone mineralization lab findings in osteopetrosis
Serum ca - phos - alk phos are NL
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Nl - decreased bone mass
Lower trunk of brachial plexus

31. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
4th and 5th finger
Acanthosis nigcricans
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

32. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Keloid
Age - obesity and joint deformity
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Squamous cell carcinoma

33. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Verrucae vulgaris
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Myosin releases bound ADP and is displaced on the actin filament

34. What does MLCK do in smooth muscle contraction
Wheal
Recurrent branch of the median nerve
Phosphorylates myosin light chain which leads to cross bridge formation
Pseudogout

35. Achondroplasia is a failure of what process which results in which characteristic findings
Acantholysis
Age - obesity and joint deformity
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

36. What receptor is constitutively activated in achondroplasia and What does it do
Osteoarthritis
Ligand binding leads to muscle depol
Anterior interosseous nerve
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

37. Which type of muscle fiber is hypertrophied during weight training
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Inc spinosum - dec granulosum
Type 2
Osteoarthritis

38. Where is C7 dermatome
3rd finger
Median nerve - same fingers but not on the hand
Osteoid osteoma
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

39. hyperpigmentation associated with pregnancy or OCP
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Melasma (chloasma)
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
NSAIDs (indomethacin) colchicine

40. What are the characterstic joints affected in RA
Erlenmeyer flask bones that flare out - narrowed foramina
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
MCP - PIP - no DIP
Psoriasis

41. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Gout
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Obturator - thigh adduction - medial thigh
Hairy leukoplakia - HIV population - EBV mediated

42. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Supraspinatus - abducts the arm before the deltoid
Large goints (knee)
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

43. What are the characteristic bone findings in paget's disease
Allopurinaol - uricosurics (probenicid)
Phosphate is liberated from the myosin head
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

44. How is chondrosarcoma described
Sites of tibial attachment
Osteopetrosis - abnl fxn of osteoclasts
Gout
Expansile glistening mass within the medullary cavity

45. transiet vesicle seen in hives
Antibodies around cells of the epidermis in a reticular or netlike pattern
Osteoarthritis
Wheal
Ulnar nerve

46. What are the lab findings in pagets disease
Corneum - lucidum - granulosum - spinosum - basalis
Inc alk phos - abnl bone architecture
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

47. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Albinism
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Femoral - thing flexion and leg extension - anterior thigh and medial leg
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

48. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Pseudogout
Teres minor
Axilla

49. inc thickness of stratum corneum seen in psoriasis
Long thoracic nerve
Teres minor
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Hyperkeratosis

50. What autoantibodies are formed in sjogrens syndrome
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Torn MCL
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

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