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Musculoskeletal

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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. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Mesenchymal stem cells in periosteum
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Dermatitis
Making fist with a proximal median nerve lesion

2. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Type III - RF
Psoriasis
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
TB from dissemination and lyme dz

3. What are defining lab findings for polymyalgia rheumatica and What is the TX
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Muslce use - nerve stim/compound muscle test
Elevated ESR and nl CK - prednisone

4. hyperpigmentation associated with pregnancy or OCP
Melasma (chloasma)
Anti - histone
Ulnar nerve - intrinsic muscles of hand
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

5. What is the precursor to melanom
Dysplastic nevus
Integrin binds laminin in BM
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

6. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Anti Smith
Radial nerve becomes compressed in axilla
Sarcoidosis - black females - ACE

7. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Dermatomyositis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Keloid

8. What supplies innervation to the thenar muscles
Recurrent branch of the median nerve
Serum ca - phos - alk phos are NL
Post GI infxn or chlamydia
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

9. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
3rd finger
Staph scalded skin syndrome
Parotid enlargement - inc risk of B cell lymphoma - dental caries

10. Where is C5 dermatome
Muslce use - nerve stim/compound muscle test
Recurrent branch of the medain nerve
Paralysis of lateral rotators
Outer arm

11. What does the positive anterior drawer sign test indicate
Acanthosis nigcricans
ANA - sensitive but not specific
Tear of the ACL
Inc blood flow from AV shunts can cause high output heart failure

12. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Corneum - lucidum - granulosum - spinosum - basalis
Large goints (knee)
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

13. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Flex at the MCP
Outer arm
Ligand binding leads to muscle depol
Actinic keratosis - risk proportional to epithelial dysplasia

14. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Acantholysis
Median nerve - same fingers but not on the hand
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Ischial spine - relieve pain during delivery

15. What are the systemic symptoms found in RA
Rigor mortis
Supraspinatus - abducts the arm before the deltoid
Fever - fatigue - pleuritis - pericarditis
Macule

16. What are the lab findings in osteitis fibrosa cystica
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Macule
Axillary nerve
Female between 14 and 45 - mostly black

17. What lesion causes difficulty flexing elbow with variable sensory loss
Phosphate is liberated from the myosin head
Over deltoid
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Musculocutaneous

18. Macule greater than 1cm
Patch
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Acantholysis
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

19. Which muscle is the most common rotator cuff injury and What does it do
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Serum ca - phos - PTH are nl alk phos elevated
Adductor policis brevis
Supraspinatus - abducts the arm before the deltoid

20. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Spindle shaped cells with multinucleated giant cells
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

21. What are the lab findings in pagets disease
Crust
Inc alk phos - abnl bone architecture
Sites of tibial attachment
Lesioned by midshaft fracture of humerus

22. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

23. papule > 1cm seen psoriasis
Increase in both osteoblast and osteoclast activity
Plaque
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

24. Achondroplasia is a failure of what process which results in which characteristic findings
Post GI infxn or chlamydia
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Female between 14 and 45 - mostly black
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

25. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Osteoporosis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Papule
Hyperkeratosis

26. epidermal hyperplasia (inc spinosum)
Osteoarthritis
Acanthosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Medial aspect

27. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Polyostotic fibrous dysplasia
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Squamous cell carcinoma
Trauma

28. What percent of these mutations occur sporadically and what parental feature are they associated with
Melasma (chloasma)
Psoriasis
Inc blood flow from AV shunts can cause high output heart failure
85% - advanced paternal age - or auto dominant inheritance

29. In which form is myosin light chain active
Glucocorticoids
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Phosphorylated
S. aureus - streptococcus

30. Where is McBurney's point and What is there
Allopurinaol - uricosurics (probenicid)
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Anti - CCP - HLA- DR4
Osteoarthritis

31. What TX prophylax against osteoporisi
Osteoid osteoma
Acanthosis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Exercise and Ca ingestion before age 30

32. What do the lumbrical muscles do
Flex at the MCP
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Expansile glistening mass within the medullary cavity
Large goints (knee)

33. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Dermatitis herpetiformis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Parakeratosis

34. What is the source of osteoblast cells
Mesenchymal stem cells in periosteum
Head - trunk - extremities - common benign neoplasm in older persons
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Polymyositis - shoulders - perifasicular inflammation

35. What is TX for osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Posterior cord
Abduct the fingers
Phosphorylated

36. freckle - normal number of melanocytes - inc melanin pigment
NC migration
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Ephelis

37. knee trauma - nerve - motor and sensory def
Macule
Phosphate is liberated from the myosin head
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

38. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Post GI infxn or chlamydia
Tear of the ACL
Dysplastic nevus
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

39. What clinical features in vertebral crush fractures
Acute back pain - loss of height - and kyphosis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Pain in weight bearing joints at the end of the day and improving with rest

40. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Anti Scl70 - anti DNA topoisomerase I antibody
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

41. What nerve is injured by a superficial laceration of the hand
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Cellulitis - s aureus - s pyogenes
Female between 14 and 45 - mostly black
Recurrent branch of the medain nerve

42. What does ATP do in skeletal muscle contraction
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Female between 14 and 45 - mostly black
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

43. Loss of what muscles in Erbs causes the forearm to be pronated
Lung
Increase in both osteoblast and osteoclast activity
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Biceps

44. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Ulnar nerve
Pain in weight bearing joints at the end of the day and improving with rest
Erythema multiforme - can be macules - papules vesicles - target lesions -

45. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Hairy leukoplakia - HIV population - EBV mediated
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

46. 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
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Myosin
Macule

47. What antibodies is diffuse scleroderma associated with
Anti Scl70 - anti DNA topoisomerase I antibody
Erythema multiforme - can be macules - papules vesicles - target lesions -
Obturator - thigh adduction - medial thigh
After a large meal or EtOH conspumption

48. Loss of what muslces in Erbs causes the limb to hang by side
In psoriasis - bleeding spots when scales are scraped off
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Paralysis of abductors
MCL - ACL - lateral meniscus (esp in athletes)

49. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Strawberry hemangioma
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

50. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
Connects cells to underlying extracellular - bullous pemphigoid
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Median nerve - lunate bone