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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. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
The dermis

2. What are the associations for sjogrens syndrome
AP depol opens voltage gated Ca channels - inducing NT release
Keratoacanthoma
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Lesioned by midshaft fracture of humerus

3. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Paralysis of abductors
AP depol opens voltage gated Ca channels - inducing NT release
Verrucae vulgaris

4. Achondroplasia is a failure of what process which results in which characteristic findings
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
ANA - sensitive but not specific
Upper trunk of brachial plexus
Gout

5. What is the sign of Leser - Trelat
Antibodies around cells of the epidermis in a reticular or netlike pattern
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

6. Who does osteoporosis type 2 effect
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Men and women > 70 - senile osteporosis
Dysplastic nevus
Dec estrogen causes inc bone resorption - postmenopausal

7. What happens at the postsynaptic motor end plate
Tear of the ACL
Lung
Acantholysis
Ligand binding leads to muscle depol

8. What are the common perpetrating infections for Reiters syndrome
Post GI infxn or chlamydia
Large goints (knee)
Exercise and Ca ingestion before age 30
Sarcoidosis - black females - ACE

9. epi of SLE
Viral - maybe paramyxovirus
Osteoid osteoma
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Female between 14 and 45 - mostly black

10. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Macule
Type 2
Myosin light chain phosphotase
Strawberry hemangioma

11. Where is C7 dermatome
3rd finger
Head - trunk - extremities - common benign neoplasm in older persons
Anti - histone
Osteochondroma - exostosis

12. separation of epidermal cells
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Erythema multiforme - can be macules - papules vesicles - target lesions -
Dec estrogen causes inc bone resorption - postmenopausal
Acantholysis

13. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Upper trunk of brachial plexus
Acanthosis nigcricans
B27 - no RF - males
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

14. What causes ape hand
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Increase in both osteoblast and osteoclast activity
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Dermatitis herpetiformis

15. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
Ulnar
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Basal cell carcinoma - pearly papules - commonly with telangiectasias

16. What are the lab findings in osteitis fibrosa cystica
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

17. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Myosin releases bound ADP and is displaced on the actin filament
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Recurrent branch of the median nerve

18. What does the positive anterior drawer sign test indicate
Tear of the ACL
In psoriasis - bleeding spots when scales are scraped off
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Ischial spine - relieve pain during delivery

19. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Ewings sarcoma - aggressive with early mets - but responsive to chemo
85% - advanced paternal age - or auto dominant inheritance
Ulnar nerve - intrinsic muscles of hand

20. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
B27 - no RF - males
Osteosarcoma - multiple myeloma
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Ulnar deviation - subluxation - bakers cysts (behind knee)

21. What are the bone mineral lab findings in paget's disease
Trauma
Serum ca - phos - PTH are nl alk phos elevated
Ulnar nerve
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

22. Which muscle fiber type is slow twitch and why are fibers red
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Hairy leukoplakia - HIV population - EBV mediated
Biceps
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

23. How is diffuse scleroderma characterized
Musculocutaneous
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Widespread skin involvment - rapid progression - early visceral involvement
Over deltoid

24. 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 -
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Keratoacanthoma
Inc spinosum - dec granulosum

25. What are the signs of ulnar nerve injury

26. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Boutonniere - swan neck - zthumb
Renal - pulm - CV - GI - 75% female
Gout

27. What nerve is compressed by supracondylar fracture of humerus
Antibodies around cells of the epidermis in a reticular or netlike pattern
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Median nerve
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

28. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
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
Radial nerve becomes compressed in axilla

29. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Acanthosis nigcricans
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Myosin releases bound ADP and is displaced on the actin filament

30. What nerve is injured in a fracutre of the hook of hamate
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Ulnar nerve
Myosin
Inc blood flow from AV shunts can cause high output heart failure

31. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

32. What antibodies is diffuse scleroderma associated with
Anti Scl70 - anti DNA topoisomerase I antibody
3rd finger
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Median nerve - same fingers but not on the hand

33. What lesion causes wrist drop
AP depol opens voltage gated Ca channels - inducing NT release
In psoriasis - bleeding spots when scales are scraped off
Ligand binding leads to muscle depol
Posterior cord

34. What are the most common symtpoms of SLE
Medial forearm and arm to just under the axilla
Acantholysis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Anti ds DNA - poor prognosis

35. What are the lab findings in osteoporosis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Papule
Plaque
Nl - decreased bone mass

36. What causes osteoporosis type 1 and When does it typically occur
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Post GI infxn or chlamydia
Serum ca - phos - PTH are nl alk phos elevated
Dec estrogen causes inc bone resorption - postmenopausal

37. What are the lab findings in osteomalacia/rickets
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Axilla
Dec estrogen causes inc bone resorption - postmenopausal
Ulnar nerve - intrinsic muscles of hand

38. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Teres minor
Strawberry hemangioma
Interossei and adductor policis

39. What are the characteristic bone findings in paget's disease
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Axillary nerve
Paralysis of abductors
Basal cell carcinoma - pearly papules - commonly with telangiectasias

40. freckle - normal number of melanocytes - inc melanin pigment
Osteoblastoma
Ephelis
Head - trunk - extremities - common benign neoplasm in older persons
Melasma (chloasma)

41. Macule greater than 1cm
Patch
Strawberry hemangioma
Fever - fatigue - pleuritis - pericarditis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

42. What does IM reveal in pemphigus vulgaris
Post GI infxn or chlamydia
Albinism
Actinic keratosis - risk proportional to epithelial dysplasia
Antibodies around cells of the epidermis in a reticular or netlike pattern

43. What is the classic traid of sjogrens syndrome
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Xeropthalmia - xerostomia - arthritis
Serum ca - phos - alk phos are NL
Integrin binds laminin in BM

44. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Viral - maybe paramyxovirus
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Upper trunk of brachial plexus

45. When do acute attacks of gout typically occur
After a large meal or EtOH conspumption
Lichen planus
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Inc spinosum - dec granulosum

46. What nerve is injured by a superficial laceration of the hand
Recurrent branch of the medain nerve
Over deltoid
Acanthosis
Ulnar nerve - intrinsic muscles of hand

47. What are the causes of inferior trunk plexus compression and What are the findings
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
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Sarcoidosis - black females - ACE
Gout

48. warts on genitals
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Condyloma acuminatum - caused by HPV
Serum ca - phos - alk phos are NL
Hairy leukoplakia - HIV population - EBV mediated

49. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Erythema nodosum
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

50. What lesion causes deltoid paralysis
Axillary nerve
3rd finger
Elevated ESR and nl CK - prednisone
Increase in both osteoblast and osteoclast activity