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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. What does soft bones result from and What is the dz called in adults and children
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Viral - maybe paramyxovirus
Flex the MCP joints and extend both the DIP and PIP joints
Metaphysis of long bones - distal femur

2. What are the common perpetrating infections for Reiters syndrome
Acantholysis
Median nerve - lunate bone
Post GI infxn or chlamydia
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

3. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Pseudogout
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

4. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Pain in weight bearing joints at the end of the day and improving with rest
Sarcoidosis - black females - ACE
Hairy leukoplakia - HIV population - EBV mediated
Musculocutaneous

5. 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
Inc blood flow from AV shunts can cause high output heart failure
The dermis
Long thoracic nerve

6. What lesion causes difficulty flexing elbow with variable sensory loss
Osteogenic carcinoma
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Musculocutaneous
Condyloma acuminatum - caused by HPV

7. What associations go along with sarcoidosis

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8. What test if specific for lupus but doesn't indicate prognosis
Fever - fatigue - pleuritis - pericarditis
Flex the MCP joints and extend both the DIP and PIP joints
Anti Smith
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

9. Which nerve is compressed in deep forearm
Age - obesity and joint deformity
Anterior interosseous nerve
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

10. What is a precursor to squamous cell carcinoma
Actinic keratosis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Axillary - deltoid - skin over deltoid - flattened deltoid
Female between 14 and 45 - mostly black

11. What are the borders of the superficial branch of the radial nerve dermatone
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Strawberry hemangioma

12. Where does cartilage loss begin in osteoarthritis
Pseudogout
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
B27 - no RF - males
Medial aspect

13. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Serum ca - phos - PTH are nl alk phos elevated
Actinic keratosis - risk proportional to epithelial dysplasia
Erythema multiforme - can be macules - papules vesicles - target lesions -
Hyperkeratosis

14. What nerve become injured in the incorrect use of a crutch
Allopurinaol - uricosurics (probenicid)
Radial nerve becomes compressed in axilla
Carbonic anhydrase II
Outer arm

15. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Median nerve - same fingers but not on the hand
Impetigo - s aureus - s pyogenes

16. What are defining lab findings for polymyalgia rheumatica and What is the TX
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Pustule
Verrucae
Elevated ESR and nl CK - prednisone

17. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Nl - decreased bone mass
Type 2
Osteoid osteoma

18. What happens in the power stroke of skeletal muscle contraction
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Polymyositis - shoulders - perifasicular inflammation
Phosphate is liberated from the myosin head

19. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Polymyositis - shoulders - perifasicular inflammation
Rheumatoid arthritis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

20. knee trauma - nerve - motor and sensory def
Median nerve
Increase in both osteoblast and osteoclast activity
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Making fist with a proximal median nerve lesion

21. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Verrucae
Actinic keratosis
Anti Smith

22. What is the TX for chronic gout
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Medially rotates and adducts arm
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Allopurinaol - uricosurics (probenicid)

23. What is the classic triad of reactive arthritis
Osteoarthritis
Xeropthalmia - xerostomia - arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Making fist with a proximal median nerve lesion

24. Damage to what 3 structures is common for the unhappy triad
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Basal cell carcinoma - pearly papules - commonly with telangiectasias
MCL - ACL - lateral meniscus (esp in athletes)
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

25. What are predisposing factors for osteosarcoma - xray finding

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26. What nerve and branch are stretche by subluxation of the radius
Glucocorticoids
Anti - CCP - HLA- DR4
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Deep branch of radial nerve

27. 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
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Verrucae
HI shrinks - A stays same

28. yellow when perpendicular and blue when parallel
Pseudogout
Adduct the fingers
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
McCune - Albright syndrome

29. What is a very specific test for lupus
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Anti ds DNA - poor prognosis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Anti - CCP - HLA- DR4

30. What TX prophylax against osteoporisi
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Exercise and Ca ingestion before age 30
Flex at the MCP
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

31. What is the classic presentation of osteoarthritis
Pain in weight bearing joints at the end of the day and improving with rest
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Paralysis of abductors
Anti - CCP - HLA- DR4

32. What are the signs of ulnar nerve injury

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33. What is the landmark for an LP
Cervical disk lesion
Iliac crest
Outer arm
Type III - RF

34. What protects the brachial plexus in clavicle fracture
Actin
Subclavius
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Pain in weight bearing joints at the end of the day and improving with rest

35. What autoantibodies are formed in sjogrens syndrome
Osteoarthritis
Adduct the fingers
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

36. What causes total claw
Intraepidermal bullae involving the skin and oral mucosa
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Teres minor
Serum ca - phos - PTH are nl alk phos elevated

37. IBS - 2 dz's
Sarcoidosis - black females - ACE
Medial 1.5 fingers - hypothenar eminence
Crohns and ulcerative colitis
Inc alk phos - abnl bone architecture

38. How is diffuse scleroderma characterized
Widespread skin involvment - rapid progression - early visceral involvement
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Pain in weight bearing joints at the end of the day and improving with rest
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

39. 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
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Dec estrogen causes inc bone resorption - postmenopausal

40. Ca2+ released from the SR binds what structure and What does it cause
Axilla
Expansile glistening mass within the medullary cavity
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Allopurinaol - uricosurics (probenicid)

41. What are the lab findings in osteitis fibrosa cystica
HI shrinks - A stays same
Dermatomyositis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Ulnar nerve - fracture of hook of hamate

42. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Musculocutaneous
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Trauma
Making fist with a proximal median nerve lesion

43. epidermal hyperplasia (inc spinosum)
Osteochondroma - exostosis
Inc spinosum - dec granulosum
Acanthosis
Flex at the MCP

44. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Rigor mortis
Recurrent branch of the median nerve
Lichen planus

45. What are the histo findings in an osteoclastoma
Spindle shaped cells with multinucleated giant cells
Subclavius
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Paralysis of abductors

46. What lesion causes dec in thumb fxn 'ape hand'
Trauma
Median nerve
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
Anterior interosseous nerve

47. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Acanthosis
Nevocellular nevus
Dermatomyositis
Metaphysis of long bones - distal femur

48. common mole - benign
Nevocellular nevus
Female between 14 and 45 - mostly black
Upper trunk of brachial plexus
Integrin binds laminin in BM

49. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Osteoporosis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Acute back pain - loss of height - and kyphosis
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

50. What causes compression of the C7 nerve root
Cervical disk lesion
Female between 14 and 45 - mostly black
Myosin light chain phosphotase
Endochondroma