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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. inc thickness of stratum corneum seen in psoriasis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Hyperkeratosis
Verrucae

2. What is the clinically important landmark for pubendal nerve block and When is it used
Obturator - thigh adduction - medial thigh
Ischial spine - relieve pain during delivery
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

3. What lesion causes Saturday night wrist drop
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Radial nerve
Anti Smith
Viral - maybe paramyxovirus

4. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Acanthosis nigcricans
Precocious puberty
Expansile glistening mass within the medullary cavity

5. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Fibrinoid necrosis surrounded by palisading histiocytes
GC and cGMP and inhibition of MLCK
Dermatitis herpetiformis
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

6. epidermal hyperplasia (inc spinosum)
Pseudogout
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Large goints (knee)
Acanthosis

7. What do lumbricals do
Median nerve - lunate bone
Flex the MCP joints and extend both the DIP and PIP joints
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Medial finger flexion - wrist flexion

8. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Squamous cell carcinoma
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Ischial spine - relieve pain during delivery
Lung

9. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Flex at the MCP
Keratoacanthoma

10. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Metaphysis of long bones - distal femur
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Wheal

11. What is the classic presentation of RA
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
GC and cGMP and inhibition of MLCK
McCune - Albright syndrome

12. What is TX for osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Musculocutaneous
Ulnar nerve
Gout

13. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Carbonic anhydrase II
ANA - sensitive but not specific
Medial forearm and arm to just under the axilla

14. What lesion causes wrist drop
Nl - decreased bone mass
Spindle shaped cells with multinucleated giant cells
Posterior cord
Ulnar nerve - intrinsic muscles of hand

15. warts on hands
Verrucae vulgaris
Adduct the fingers
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

16. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Acanthosis
Seborrheic keratosis
Iliac crest
Axilla

17. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Pseudogout
Type III - RF
Osteoarthritis

18. hives - intensely pruritic wheals that form after mast cell degranulation
Lichen planus
Urticaria
Rigor mortis
Plaque

19. What is a very specific test for lupus
Medial 1.5 fingers - hypothenar eminence
Anti ds DNA - poor prognosis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Strawberry hemangioma

20. Other than N. gono - what organisms can cause infectious - septic arthritis
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
S. aureus - streptococcus
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Chondrosarcoma

21. What are the associations for sjogrens syndrome
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Elevated ESR and nl CK - prednisone
Myosin releases bound ADP and is displaced on the actin filament
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

22. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Polyostotic fibrous dysplasia
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Biceps

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

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24. Through what pathway does NO work and What is the downstream effect
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
GC and cGMP and inhibition of MLCK
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Lower trunk of brachial plexus

25. transiet vesicle seen in hives
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Increase in both osteoblast and osteoclast activity
Intraepidermal bullae involving the skin and oral mucosa
Wheal

26. What deformities of the hand are common in RA
Pseudogout
Boutonniere - swan neck - zthumb
Adduct the fingers
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

27. What does IM reveal in pemphigus vulgaris
Type III - RF
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Ulnar nerve
Antibodies around cells of the epidermis in a reticular or netlike pattern

28. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Thymoma
Hyperkeratosis
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Osteosarcoma - multiple myeloma

29. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Deep branch of radial nerve
Down T tubule
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

30. What happens at the gap jxn and what molecules create them
Endochondroma
3rd finger
Flex the MCP joints and extend both the DIP and PIP joints
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

31. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Endochondroma
Anti - histone
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Median nerve - lunate bone

32. What causes ape hand
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Condyloma acuminatum - caused by HPV
Patch
Thymoma

33. Where is C5 dermatome
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Outer arm
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Erythema nodosum

34. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Axillary - deltoid - skin over deltoid - flattened deltoid
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Strawberry hemangioma
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

35. What causes a lesion in the axillary nerve
Radial nerve
Hairy leukoplakia - HIV population - EBV mediated
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Antibodies around cells of the epidermis in a reticular or netlike pattern

36. What are the lab findings and TX in dermatomyositis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Serum ca - phos - PTH are nl alk phos elevated
Medial 1.5 fingers - hypothenar eminence

37. What antibody is less sensitive than RF but more specific and What is the HLA association
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Anti - CCP - HLA- DR4
Keratoacanthoma

38. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Staph scalded skin syndrome
Erlenmeyer flask bones that flare out - narrowed foramina
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Obturator - thigh adduction - medial thigh

39. What are the characterstic joints affected in RA
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
MCP - PIP - no DIP
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Median nerve - same fingers but not on the hand

40. Contraction results in shortening of what bands - and what band remains the same length
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Anti - histone
Xeropthalmia - xerostomia - arthritis
HI shrinks - A stays same

41. What causes golf or tennis elbow
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Erythema nodosum
Long thoracic nerve
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

42. What does abnl passive abduction of the knee indicate
Pseudogout
Corneum - lucidum - granulosum - spinosum - basalis
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Torn MCL

43. What are the lab findings in osteopetrosis
Osteopetrosis - abnl fxn of osteoclasts
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Nl - thickened dense bones

44. What is CREST syndrome and What antibody is it associated with
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Atopic dermatitis - eczema
Expansile glistening mass within the medullary cavity

45. What lesion causes difficulty flexing elbow with variable sensory loss
Abduct the fingers
Flex at the MCP
Musculocutaneous
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

46. Which muscle fiber type is slow twitch and why are fibers red
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Nl - decreased bone mass
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

47. What are the lab findings in pagets disease
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Tear of the ACL
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Inc alk phos - abnl bone architecture

48. What nerve and branch are stretche by subluxation of the radius
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Nl - thickened dense bones
Deep branch of radial nerve

49. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Nevocellular nevus
Axillary - deltoid - skin over deltoid - flattened deltoid
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

50. What do dorsal interosseous muscles do
HI shrinks - A stays same
Lesioned by midshaft fracture of humerus
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Abduct the fingers