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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 is the power stroke of muscle contraction
Myosin releases bound ADP and is displaced on the actin filament
Supraspinatus - abducts the arm before the deltoid
HI shrinks - A stays same
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

2. How is diffuse scleroderma characterized
Cherry hemangioma
B27 - no RF - males
Widespread skin involvment - rapid progression - early visceral involvement
3rd finger

3. What are the subQ rheumatoid nodules made of...
Medial forearm and arm to just under the axilla
Pseudogout
Fibrinoid necrosis surrounded by palisading histiocytes
S. aureus - streptococcus

4. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Serum ca - phos - alk phos are NL
AP depol opens voltage gated Ca channels - inducing NT release
Flex the MCP joints and extend both the DIP and PIP joints
Median nerve - lunate bone

5. How does the radial nerve in the spiral groove become injured
Lesioned by midshaft fracture of humerus
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
S. aureus - streptococcus

6. Where does the muscle contraction travel after leaving the motor end plate
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Anti - CCP - HLA- DR4
Rigor mortis
Down T tubule

7. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Medially rotates and adducts arm
Post GI infxn or chlamydia
Iliac crest
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

8. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Abduct the fingers

9. What clinical features in vertebral crush fractures
Acute back pain - loss of height - and kyphosis
Phosphorylates myosin light chain which leads to cross bridge formation
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Chondrosarcoma

10. small fluid containing blister seen in chickenpox
Vesicle
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Ligand binding leads to muscle depol
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

11. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Anti Scl70 - anti DNA topoisomerase I antibody
Ulnar deviation - subluxation - bakers cysts (behind knee)
Seborrheic keratosis
Pemphigus vulgaris

12. What do pseudogout crystals appear like microscopically
Anterior interosseous nerve
Basophilic - rhomboid crystals - weakly birefringent
Atopic dermatitis - eczema
Osteoarthritis

13. What causes a lesion in the axillary nerve
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Condyloma acuminatum - caused by HPV
Post GI infxn or chlamydia

14. What organisms can cause chronic infectious arthritis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
MCP - PIP - no DIP
Medially rotates and adducts arm
TB from dissemination and lyme dz

15. Ca2+ released from the SR binds what structure and What does it cause
Trauma
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Gout
Anterior interosseous nerve

16. separation of epidermal cells
Erythema multiforme - can be macules - papules vesicles - target lesions -
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
HI shrinks - A stays same
Acantholysis

17. What does injury to the distal median nerve cause

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18. What is a very specific test for lupus
Recurrent branch of the median nerve
Rigor mortis
Anti ds DNA - poor prognosis
Osteochondroma - exostosis

19. What does lack of ATP cause
Strawberry hemangioma
Rigor mortis
< 2mc found in proximal tibia and femur - men < 25
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

20. dried exudates from a vesicle - bulla or pustule seen impetigo
Post GI infxn or chlamydia
Crust
Radial nerve becomes compressed in axilla
Acanthosis

21. How is chondrosarcoma described
Fibrinoid necrosis surrounded by palisading histiocytes
Myosin releases bound ADP and is displaced on the actin filament
Over deltoid
Expansile glistening mass within the medullary cavity

22. Which muscle is the pitching injury and What does it do
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Crust
Infraspinatus - laterally rotates arm
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

23. 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
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Adduct the fingers
Phosphorylated

24. What molecule maintatins integrity of basement membrane and What does it bind
Integrin binds laminin in BM
Medial 1.5 fingers - hypothenar eminence
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Long thoracic nerve

25. Why does EtOH consumption precipitate gout
Adductor policis brevis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Over deltoid
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

26. What lesion causes claw hand and What are the muscles involved
Glucocorticoids
Upper trunk of brachial plexus
Long thoracic nerve
Ulnar nerve - intrinsic muscles of hand

27. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Osteogenic carcinoma
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Axillary nerve

28. What percent of these mutations occur sporadically and what parental feature are they associated with
85% - advanced paternal age - or auto dominant inheritance
Gout
Sites of tibial attachment
Boutonniere - swan neck - zthumb

29. What are the the common causes of Erb palsy - and What are the associated findings
Ischial spine - relieve pain during delivery
Vitiligo - dec number in melanocytes
Ulnar nerve - fracture of hook of hamate
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

30. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Spindle shaped cells with multinucleated giant cells
Lesioned by midshaft fracture of humerus
Cellulitis - s aureus - s pyogenes

31. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

32. What does IM reveal in pemphigus vulgaris
Anti ds DNA - poor prognosis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Sites of tibial attachment
Antibodies around cells of the epidermis in a reticular or netlike pattern

33. When do acute attacks of gout typically occur
After a large meal or EtOH conspumption
HI shrinks - A stays same
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
Acanthosis nigcricans

34. What do xray show in osteopetrosis and What do potential CN abnl result from
Serum ca - phos - alk phos are NL
MCP - PIP - no DIP
Erlenmeyer flask bones that flare out - narrowed foramina
Flex at the MCP

35. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Osteoarthritis
Flex the MCP joints and extend both the DIP and PIP joints
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

36. warts on hands
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Abduct the fingers
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Verrucae vulgaris

37. Where is C8 dermatome
4th and 5th finger
Axillary - deltoid - skin over deltoid - flattened deltoid
Exercise and Ca ingestion before age 30
Outer arm

38. Loss of what muscles in Erbs causes the forearm to be pronated
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Posterior cord
Biceps
Dermatomyositis

39. What muscles of the shoulder form the rotator cuff
Osteopetrosis - abnl fxn of osteoclasts
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Medially rotates and adducts arm
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

40. What deformities of the hand are common in RA
Conjunctivitis and anterior uveitis - urethritis and arthritis
Boutonniere - swan neck - zthumb
Pityriasis rosea
Actinic keratosis - risk proportional to epithelial dysplasia

41. hives - intensely pruritic wheals that form after mast cell degranulation
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Urticaria
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

42. What are common features of lupus
MCL - ACL - lateral meniscus (esp in athletes)
Glucocorticoids
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

43. Where is C5 dermatome
Outer arm
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

44. What does MLCK do in smooth muscle contraction
Phosphorylates myosin light chain which leads to cross bridge formation
Dec estrogen causes inc bone resorption - postmenopausal
In psoriasis - bleeding spots when scales are scraped off
Upper trunk of brachial plexus

45. What is the TX for acute gout
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
NSAIDs (indomethacin) colchicine
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
MCL - ACL - lateral meniscus (esp in athletes)

46. What are characteristic findings of gout
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
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
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Median nerve

47. What nerve is injured by a superficial laceration of the hand
Recurrent branch of the medain nerve
The dermis
Female between 14 and 45 - mostly black
Crohns and ulcerative colitis

48. larger osteoid osteoma found in vertebral column
Osteoblastoma
Nevocellular nevus
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Glucocorticoids

49. What are the lab findings in osteomalacia/rickets
Infraspinatus - laterally rotates arm
Pemphigus vulgaris
Median nerve - same fingers but not on the hand
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

50. What lesions causes Erb's palsy
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Rigor mortis
Upper trunk of brachial plexus