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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 a very specific test for lupus
Thymoma
Squamous cell carcinoma
Adductor policis brevis
Anti ds DNA - poor prognosis

2. What are the predisposing factors for osteoarthritis
Vesicle
Rheumatoid arthritis
Age - obesity and joint deformity
GC and cGMP and inhibition of MLCK

3. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Gout
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Carbonic anhydrase II
Dermatomyositis

4. What is the sensory def of an ulnar nerve injury
Erythema nodosum
Medial 1.5 fingers - hypothenar eminence
Ligand binding leads to muscle depol
Post GI infxn or chlamydia

5. Decrease marrow space in osteopetrosis leads to what?
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Ulnar
Down T tubule

6. common mole - benign
Lichen planus
Nevocellular nevus
Spindle shaped cells with multinucleated giant cells
Intraepidermal bullae involving the skin and oral mucosa

7. What is the defect in Paget's disease
Carbonic anhydrase II
Conjunctivitis and anterior uveitis - urethritis and arthritis
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Increase in both osteoblast and osteoclast activity

8. hyperpigmentation associated with pregnancy or OCP
Melasma (chloasma)
Increase in both osteoblast and osteoclast activity
Torn MCL
Precocious puberty

9. Where does the muscle contraction travel after leaving the motor end plate
Erythema nodosum
Gout
Down T tubule
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

10. What are the lab findings in osteopetrosis
Papule
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Median nerve - lunate bone
Nl - thickened dense bones

11. inflammatory disorder affective synovial joints with pannus formation in joints
Endochondroma
Rheumatoid arthritis
Ischial spine - relieve pain during delivery
Lichen planus

12. What are the lab findings in pagets disease
Inc alk phos - abnl bone architecture
Inc spinosum - dec granulosum
Acanthosis nigcricans
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

13. What does MLCK do in smooth muscle contraction
Phosphorylates myosin light chain which leads to cross bridge formation
Papule
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Acanthosis nigcricans

14. inflammation of the skin
Dermatitis
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Cellulitis - s aureus - s pyogenes
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

15. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Strawberry hemangioma
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Erythema nodosum
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

16. What do lumbricals do
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Flex the MCP joints and extend both the DIP and PIP joints
Trauma
Erythema nodosum

17. knee trauma - nerve - motor and sensory def
Boutonniere - swan neck - zthumb
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

18. What are defining lab findings for polymyalgia rheumatica and What is the TX
Steroids
Elevated ESR and nl CK - prednisone
Basophilic - rhomboid crystals - weakly birefringent
Upper trunk of brachial plexus

19. warts on hands
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Parakeratosis
Verrucae vulgaris
Median nerve - same fingers but not on the hand

20. What supplies innervation to the thenar muscles
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Down T tubule
Osteoid osteoma
Recurrent branch of the median nerve

21. What is the classic presentation of RA
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Median nerve - same fingers but not on the hand
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

22. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Median nerve
Ulnar
Recurrent branch of the median nerve

23. irregular areas of complete depigmentation - condition and cause
Paralysis of lateral rotators
Vitiligo - dec number in melanocytes
Elevated ESR and nl CK - prednisone
Radial nerve

24. Where does cartilage loss begin in osteoarthritis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Ulnar
Medial aspect

25. Macule greater than 1cm
Cellulitis - s aureus - s pyogenes
Ligand binding leads to muscle depol
Patch
Large goints (knee)

26. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Palisading
Cherry hemangioma
Antibodies around cells of the epidermis in a reticular or netlike pattern
Squamous cell carcinoma

27. What is the sign of Leser - Trelat
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Osteopetrosis - abnl fxn of osteoclasts
Dermatomyositis
Osteoarthritis

28. What are the borders of the superficial branch of the radial nerve dermatone
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Steroids
Keratoacanthoma
GC and cGMP and inhibition of MLCK

29. What causes the symptoms of MG to worsen - and What is used to diagnose
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Muslce use - nerve stim/compound muscle test
3rd finger
Actin

30. What medication is contraindicated in osteoporosis
Cherry hemangioma
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Glucocorticoids

31. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
Inc spinosum - dec granulosum
Rigor mortis
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

32. What causes hypercalcemia in pts with sarcoid
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Crust
< 2mc found in proximal tibia and femur - men < 25
Polymyositis - shoulders - perifasicular inflammation

33. Where are most osteoid osteoma found and In what population
< 2mc found in proximal tibia and femur - men < 25
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Muslce use - nerve stim/compound muscle test

34. How is chondrosarcoma described
Glucocorticoids
Anti - histone
Expansile glistening mass within the medullary cavity
Palisading

35. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Ligand binding leads to muscle depol
Hyperkeratosis
Medial forearm and arm to just under the axilla
Cellulitis - s aureus - s pyogenes

36. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Type III - RF
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Acantholysis

37. What does subscapularis do
Paralysis of abductors
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
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Medially rotates and adducts arm

38. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Endochondroma
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Tear of the ACL

39. What development failure can results in albinism
Dec estrogen causes inc bone resorption - postmenopausal
McCune - Albright syndrome
NC migration
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

40. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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41. Where is osteosarcoma found in the bone
Metaphysis of long bones - distal femur
Head - trunk - extremities - common benign neoplasm in older persons
Vesicle
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

42. What enzyme defect in responsible for osteopetrosis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Crust
Carbonic anhydrase II

43. Loss of what muslces in Erbs causes the limb to hang by side
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Interossei and adductor policis
Paralysis of abductors
Ischial spine - relieve pain during delivery

44. elevated skin lesion <1cm seen in acne vulgaris
Medial forearm and arm to just under the axilla
Outer arm
Papule
Tear of the ACL

45. What deformities of the hand are common in RA
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Lesioned by midshaft fracture of humerus
Radial nerve
Boutonniere - swan neck - zthumb

46. What clinical features in vertebral crush fractures
Vitiligo - dec number in melanocytes
Crohns and ulcerative colitis
Acute back pain - loss of height - and kyphosis
Anti ds DNA - poor prognosis

47. What are the motor defs of a proximal ulnar nerve injury
Head - trunk - extremities - common benign neoplasm in older persons
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Medial finger flexion - wrist flexion
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

48. What happens in the power stroke of skeletal muscle contraction
Ephelis
Female between 14 and 45 - mostly black
3rd finger
Phosphate is liberated from the myosin head

49. What do the branches of the deep ulnar nerve innervate
Recurrent branch of the median nerve
Axillary - deltoid - skin over deltoid - flattened deltoid
Interossei and adductor policis
Antibodies around cells of the epidermis in a reticular or netlike pattern

50. Loss of what muscles in Erbs causes the forearm to be pronated
Dermatomyositis
Biceps
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Making fist with a proximal median nerve lesion