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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. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Metaphysis of long bones - distal femur
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Papule
Ulnar deviation - subluxation - bakers cysts (behind knee)

2. Sarcoid TX
Steroids
Nevocellular nevus
Axilla
Median nerve - lunate bone

3. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
ANA - sensitive but not specific
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

4. What are defining lab findings for polymyalgia rheumatica and What is the TX
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Elevated ESR and nl CK - prednisone
Precocious puberty

5. interlacing trabeculae of woven bone surrounded by osteoblasts
Medially rotates and adducts arm
Osteoid osteoma
Cherry hemangioma
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

6. How is diffuse scleroderma characterized
Widespread skin involvment - rapid progression - early visceral involvement
< 2mc found in proximal tibia and femur - men < 25
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Patch

7. What are the most common symtpoms of SLE
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Bulla
Carbonic anhydrase II

8. Where is C7 dermatome
Intraepidermal bullae involving the skin and oral mucosa
Verrucae
Keratoacanthoma
3rd finger

9. What does subscapularis do
Lichen planus
Anterior interosseous nerve
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Medially rotates and adducts arm

10. 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
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Lung

11. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Median nerve
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Ulnar nerve
Seborrheic keratosis

12. What are the characteristic bone findings in paget's disease
Ulnar
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Vesicle
Anti ds DNA - poor prognosis

13. In which form is myosin light chain active
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Phosphorylated
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Axilla

14. Loss of what muscles in Erbs causes the forearm to be pronated
Renal - pulm - CV - GI - 75% female
Acanthosis
Biceps
Myosin releases bound ADP and is displaced on the actin filament

15. What molecule maintatins integrity of basement membrane and What does it bind
Integrin binds laminin in BM
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Lesioned by midshaft fracture of humerus
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

16. What are the systemic symptoms found in RA
Fever - fatigue - pleuritis - pericarditis
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Torn MCL

17. What supplies innervation to the thenar muscles
Pseudogout
Tear of the ACL
TB from dissemination and lyme dz
Recurrent branch of the median nerve

18. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Acanthosis nigcricans
Head - trunk - extremities - common benign neoplasm in older persons
Radial nerve
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

19. What protects the brachial plexus in clavicle fracture
The dermis
Anti Scl70 - anti DNA topoisomerase I antibody
Subclavius
Interossei and adductor policis

20. What does the positive anterior drawer sign test indicate
After a large meal or EtOH conspumption
Tear of the ACL
Over deltoid
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

21. 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
NC migration
Posterior cord
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

22. What nerve become injured in the incorrect use of a crutch
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Radial nerve becomes compressed in axilla
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Conjunctivitis and anterior uveitis - urethritis and arthritis

23. What does injury to the distal median nerve cause

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24. What lesion causes Saturday night wrist drop
Ulnar deviation - subluxation - bakers cysts (behind knee)
Radial nerve
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Scleroderma

25. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Paralysis of abductors
Psoriasis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

26. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Median nerve - lunate bone
Hairy leukoplakia - HIV population - EBV mediated
Biceps
Ulnar nerve - fracture of hook of hamate

27. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Interossei and adductor policis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Squamous cell carcinoma
Ulnar nerve

28. What medication is contraindicated in osteoporosis
< 2mc found in proximal tibia and femur - men < 25
Erlenmeyer flask bones that flare out - narrowed foramina
Chondrosarcoma
Glucocorticoids

29. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Head - trunk - extremities - common benign neoplasm in older persons
TB from dissemination and lyme dz
Lesioned by midshaft fracture of humerus

30. What does ATP do in skeletal muscle contraction
ANA - sensitive but not specific
Paralysis of abductors
Basophilic - rhomboid crystals - weakly birefringent
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

31. What is CREST syndrome and What antibody is it associated with
Actinic keratosis - risk proportional to epithelial dysplasia
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Gout
Fibrinoid necrosis surrounded by palisading histiocytes

32. What are the common perpetrating infections for Reiters syndrome
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Post GI infxn or chlamydia
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
Pseudogout

33. Deposition of calcium pyrophosphate cyrstals within the joint space
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Squamous cell carcinoma
Pseudogout
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

34. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Median nerve - lunate bone
Anti Scl70 - anti DNA topoisomerase I antibody
Crohns and ulcerative colitis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

35. What lesion causes claw hand and What are the muscles involved
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Medially rotates and adducts arm
Ulnar nerve - intrinsic muscles of hand
Ephelis

36. Where is C6 dermatome
Calmodulin - complex activates myosin light chain kinase
ANA - sensitive but not specific
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

37. Where is McBurney's point and What is there
Infraspinatus - laterally rotates arm
Basal cell carcinoma - pearly papules - commonly with telangiectasias
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Crust

38. What is the classic presentation of RA
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Elevated ESR and nl CK - prednisone
S. aureus - streptococcus
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

39. What causes a lesion in the upper trunk of the brachial plexus
Trauma
Palisading
Ligand binding leads to muscle depol
Crust

40. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Hairy leukoplakia - HIV population - EBV mediated
Radial nerve becomes compressed in axilla
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

41. What lesions causes Erb's palsy
Elevated ESR and nl CK - prednisone
Upper trunk of brachial plexus
Erlenmeyer flask bones that flare out - narrowed foramina
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

42. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Conjunctivitis and anterior uveitis - urethritis and arthritis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Scleroderma

43. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Median nerve - lunate bone
Endochondroma
Type 2

44. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Abduct the fingers
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Elevated ESR and nl CK - prednisone
Dermatitis herpetiformis

45. What are the histo findings in an osteoclastoma
Flex the MCP joints and extend both the DIP and PIP joints
Spindle shaped cells with multinucleated giant cells
Acantholysis
< 2mc found in proximal tibia and femur - men < 25

46. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Expansile glistening mass within the medullary cavity
Myosin releases bound ADP and is displaced on the actin filament
Iliac crest
Keratoacanthoma

47. 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 -
Condyloma acuminatum - caused by HPV
Type 2
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

48. hives - intensely pruritic wheals that form after mast cell degranulation
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Urticaria
Exercise and Ca ingestion before age 30
Gout

49. What is the primary screening test for lupus
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
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
ANA - sensitive but not specific

50. Which type of muscle fiber is hypertrophied during weight training
Spindle shaped cells with multinucleated giant cells
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Type 2