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Musculoskeletal

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Answer 50 questions in 15 minutes.
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1. What does lack of ATP cause
Melasma (chloasma)
Rigor mortis
Flex the MCP joints and extend both the DIP and PIP joints
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

2. 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 -
Axilla
TB from dissemination and lyme dz
Median nerve

3. freckle - normal number of melanocytes - inc melanin pigment
Spindle shaped cells with multinucleated giant cells
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Ephelis
Inc blood flow from AV shunts can cause high output heart failure

4. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Recurrent branch of the medain nerve
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Cervical disk lesion

5. 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
Hyperkeratosis
Metaphysis of long bones - distal femur
Papule

6. What do lumbricals do
Pseudogout
Flex the MCP joints and extend both the DIP and PIP joints
Nevocellular nevus
Dermatomyositis

7. What are characteristic findings of gout
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Anti Smith

8. In smooth muscle contraction - What does Ca bind and What is the purpose
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Myosin light chain phosphotase
Calmodulin - complex activates myosin light chain kinase
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

9. epi of SLE
Female between 14 and 45 - mostly black
Head - trunk - extremities - common benign neoplasm in older persons
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
Gout

10. What is the power stroke of muscle contraction
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Axillary - deltoid - skin over deltoid - flattened deltoid
Myosin releases bound ADP and is displaced on the actin filament
Inc spinosum - dec granulosum

11. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Ulnar nerve - fracture of hook of hamate
Scleroderma
Calmodulin - complex activates myosin light chain kinase

12. IBS - 2 dz's
Large goints (knee)
Urticaria
Crohns and ulcerative colitis
Acute back pain - loss of height - and kyphosis

13. When do acute attacks of gout typically occur
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
HI shrinks - A stays same
After a large meal or EtOH conspumption

14. What is the source of osteoblast cells
Carbonic anhydrase II
Musculocutaneous
Mesenchymal stem cells in periosteum
3rd finger

15. What does abnl passive abduction of the knee indicate
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Ulnar nerve - fracture of hook of hamate
Torn MCL
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

16. Loss of what muslces in Erbs causes the limb to hang by side
Osteopetrosis - abnl fxn of osteoclasts
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Paralysis of abductors

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

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18. 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
Cellulitis - s aureus - s pyogenes
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Papule

19. What is a positive Nikolsky's sign
Vitiligo - dec number in melanocytes
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
TB from dissemination and lyme dz
Thymoma

20. What lesions causes Erb's palsy
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Plaque
Medial aspect
Upper trunk of brachial plexus

21. What nerve is compressed by supracondylar fracture of humerus
Verrucae
After a large meal or EtOH conspumption
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Median nerve

22. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Ligand binding leads to muscle depol
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

23. dried exudates from a vesicle - bulla or pustule seen impetigo
Crust
Post GI infxn or chlamydia
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

24. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Keloid
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

25. What muscles of the shoulder form the rotator cuff
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

26. What are the associations for sjogrens syndrome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Parotid enlargement - inc risk of B cell lymphoma - dental caries
In psoriasis - bleeding spots when scales are scraped off
Post GI infxn or chlamydia

27. What test if specific for lupus but doesn't indicate prognosis
Anti Smith
TB from dissemination and lyme dz
Dermatomyositis
Osteoblastoma

28. What runs the distance of the A band
Myosin
After a large meal or EtOH conspumption
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Biceps

29. What are the systemic symptoms found in RA
Type 2
Medial 1.5 fingers - hypothenar eminence
Fever - fatigue - pleuritis - pericarditis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

30. What is TX for osteoporosis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
AP depol opens voltage gated Ca channels - inducing NT release
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Xeropthalmia - xerostomia - arthritis

31. What does MLCK do in smooth muscle contraction
Sarcoidosis - black females - ACE
Phosphorylates myosin light chain which leads to cross bridge formation
Verrucae
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

32. What does acantholysis show in pemphigus vulgaris
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Intraepidermal bullae involving the skin and oral mucosa
Dec estrogen causes inc bone resorption - postmenopausal

33. Macule greater than 1cm
Musculocutaneous
Patch
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

34. osteochondrosis has rare malignant transformation into what cancer
Chondrosarcoma
Torn MCL
Lesioned by midshaft fracture of humerus
Basophilic - rhomboid crystals - weakly birefringent

35. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Basophilic - rhomboid crystals - weakly birefringent
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

36. What do dorsal interosseous muscles do
Obturator - thigh adduction - medial thigh
Abduct the fingers
Strawberry hemangioma
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

37. What lesion causes difficulty flexing elbow with variable sensory loss
Median nerve - same fingers but not on the hand
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Axillary nerve
Musculocutaneous

38. What causes ape hand
Medial finger flexion - wrist flexion
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Verrucae
Recurrent branch of the median nerve

39. What causes a lesion in the axillary nerve
Boutonniere - swan neck - zthumb
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Pain in weight bearing joints at the end of the day and improving with rest

40. Which muscle is the pitching injury and What does it do
Cherry hemangioma
Infraspinatus - laterally rotates arm
Flex at the MCP
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

41. What other muscle in the thenar eminence adducts the thumb
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
HI shrinks - A stays same
Adductor policis brevis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

42. Why does EtOH consumption precipitate gout
Ligand binding leads to muscle depol
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

43. What are the borders of the superficial branch of the radial nerve dermatone
Bulla
Type III - RF
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Abduct the fingers

44. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
AP depol opens voltage gated Ca channels - inducing NT release
Intraepidermal bullae involving the skin and oral mucosa
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

45. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Verrucae vulgaris
Obturator - thigh adduction - medial thigh
Long thoracic nerve
Keloid

46. What does IM reveal in pemphigus vulgaris
Pseudogout
GC and cGMP and inhibition of MLCK
The dermis
Antibodies around cells of the epidermis in a reticular or netlike pattern

47. What nerve is injured in a fracutre of the hook of hamate
Lower trunk of brachial plexus
Acanthosis
Subclavius
Ulnar nerve

48. What is the clinically important landmark for pubendal nerve block and When is it used
Infraspinatus - laterally rotates arm
Ischial spine - relieve pain during delivery
Over deltoid
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

49. Where is C7 dermatome
Ulnar nerve
3rd finger
Long thoracic nerve
TB from dissemination and lyme dz

50. Patients with pagets disease can develop what cancer
Medial finger flexion - wrist flexion
Axilla
Osteogenic carcinoma
The dermis

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Musculoskeletal

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