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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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1. What nerve is injured in a fracutre of the hook of hamate
Ulnar nerve
Bulla
Medial forearm and arm to just under the axilla
Acute back pain - loss of height - and kyphosis

2. What happens in the power stroke of skeletal muscle contraction
Age - obesity and joint deformity
In psoriasis - bleeding spots when scales are scraped off
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Phosphate is liberated from the myosin head

3. What test if specific for lupus but doesn't indicate prognosis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Making fist with a proximal median nerve lesion
Boutonniere - swan neck - zthumb
Anti Smith

4. What nerve is compressed by supracondylar fracture of humerus
Anti - histone
Median nerve
Myosin
Radial nerve becomes compressed in axilla

5. What are defining lab findings for polymyalgia rheumatica and What is the TX
Pseudogout
Ulnar nerve
Median nerve
Elevated ESR and nl CK - prednisone

6. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Sarcoidosis - black females - ACE
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

7. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Dysplastic nevus
Verrucae
4th and 5th finger
Lower trunk of brachial plexus

8. What are the systemic symptoms found in RA
Fever - fatigue - pleuritis - pericarditis
Osteoblastoma
Erythema multiforme - can be macules - papules vesicles - target lesions -
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

9. Where is C4 dermatome
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Over deltoid
Iliac crest
Median nerve - lunate bone

10. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Palisading
Glucocorticoids
Anti ds DNA - poor prognosis
Seborrheic keratosis

11. What nerve and branch are stretche by subluxation of the radius
Biceps
Gout
Seborrheic keratosis
Deep branch of radial nerve

12. knee trauma - nerve - motor and sensory def
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Medial forearm and arm to just under the axilla
Acanthosis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

13. What lesions causes Erb's palsy
Upper trunk of brachial plexus
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
< 2mc found in proximal tibia and femur - men < 25
Paralysis of abductors

14. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Thymoma
Metaphysis of long bones - distal femur

15. What is the power stroke of muscle contraction
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
3rd finger
Chondrosarcoma
Myosin releases bound ADP and is displaced on the actin filament

16. What kind of nuclei do basal cell tumors have
NC migration
Dermatomyositis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Palisading

17. Thenar eminence - nerve and muscles
3rd finger
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Nl - thickened dense bones
Osteoarthritis

18. How does gonococcal arthritis present
Atopic dermatitis - eczema
Renal - pulm - CV - GI - 75% female
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

19. What is the source of osteoblast cells
Acantholysis
Mesenchymal stem cells in periosteum
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Flex at the MCP

20. What does injury to the distal ulnar nerve cause
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
4th and 5th finger
Intraepidermal bullae involving the skin and oral mucosa
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

21. hyperpigmentation associated with pregnancy or OCP
Pustule
McCune - Albright syndrome
Axillary nerve
Melasma (chloasma)

22. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Dermatomyositis
Thymoma
Medial forearm and arm to just under the axilla
Outer arm

23. What is the sensory def of an ulnar nerve injury
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
HI shrinks - A stays same
Medial 1.5 fingers - hypothenar eminence
Adductor policis brevis

24. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Dysplastic nevus
Palisading
Myosin

25. Loss of what muslces in Erbs causes the limb to hang by side
Actinic keratosis - risk proportional to epithelial dysplasia
Paralysis of abductors
ANA - sensitive but not specific
Flex at the MCP

26. elevated skin lesion <1cm seen in acne vulgaris
Urticaria
Impetigo - s aureus - s pyogenes
Pemphigus vulgaris
Papule

27. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Lesioned by midshaft fracture of humerus
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

28. What TX prophylax against osteoporisi
Dysplastic nevus
Long thoracic nerve
Exercise and Ca ingestion before age 30
Glucocorticoids

29. What do palmar interosseous muscles do
Ulnar nerve - intrinsic muscles of hand
Calmodulin - complex activates myosin light chain kinase
Sarcoidosis - black females - ACE
Adduct the fingers

30. 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
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Osteogenic carcinoma

31. What are the common perpetrating infections for Reiters syndrome
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Post GI infxn or chlamydia
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

32. What lesion causes total claw (klumpke's hand)
Lower trunk of brachial plexus
Osteoblastoma
Inc blood flow from AV shunts can cause high output heart failure
3rd finger

33. What is a very specific test for lupus
Anti ds DNA - poor prognosis
4th and 5th finger
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Lichen planus

34. What enzyme is necessary for smooth muscle relaxation after contraction
Dermatomyositis
Large goints (knee)
Myosin light chain phosphotase
Xeropthalmia - xerostomia - arthritis

35. What are the layers of of the epidermis from surface to base
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Osteochondroma - exostosis
Corneum - lucidum - granulosum - spinosum - basalis
Median nerve - same fingers but not on the hand

36. What is the classic presentation of osteoarthritis
Pain in weight bearing joints at the end of the day and improving with rest
Allopurinaol - uricosurics (probenicid)
Inc spinosum - dec granulosum
In psoriasis - bleeding spots when scales are scraped off

37. Where is C5 dermatome
Outer arm
Parakeratosis
Hyperkeratosis
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

38. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
MCL - ACL - lateral meniscus (esp in athletes)
Acanthosis
Seborrheic keratosis

39. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Osteosarcoma - multiple myeloma

40. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Osteoblastoma
Biceps
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

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

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42. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Ulnar nerve
Endochondroma
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Axillary - deltoid - skin over deltoid - flattened deltoid

43. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Endochondroma
B27 - no RF - males
Lung
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

44. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Dermatitis herpetiformis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

45. What is the defect in Paget's disease
Over deltoid
Staph scalded skin syndrome
Increase in both osteoblast and osteoclast activity
Carbonic anhydrase II

46. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Paralysis of lateral rotators
Making fist with a proximal median nerve lesion
Strawberry hemangioma

47. What causes total claw
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Crohns and ulcerative colitis
Integrin binds laminin in BM

48. What associations go along with sarcoidosis

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49. What are the motor defs of a proximal ulnar nerve injury
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Osteoporosis
Medial finger flexion - wrist flexion
Pustule

50. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Cervical disk lesion
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

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Musculoskeletal

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