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Musculoskeletal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Macule greater than 1cm
Patch
< 2mc found in proximal tibia and femur - men < 25
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Osteoarthritis

2. Where do sebhorrheic keratosis lesions occur and in who
Rheumatoid arthritis
Verrucae vulgaris
Head - trunk - extremities - common benign neoplasm in older persons
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

3. What signal initiates a muscle contraction
Squamous cell carcinoma
Median nerve - lunate bone
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
AP depol opens voltage gated Ca channels - inducing NT release

4. What happens at the gap jxn and what molecules create them
Hairy leukoplakia - HIV population - EBV mediated
Conjunctivitis and anterior uveitis - urethritis and arthritis
Iliac crest
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

5. What lesion causes deltoid paralysis
Patch
Steroids
Erlenmeyer flask bones that flare out - narrowed foramina
Axillary nerve

6. What is the power stroke of muscle contraction
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Ulnar
Muslce use - nerve stim/compound muscle test
Myosin releases bound ADP and is displaced on the actin filament

7. What are the subQ rheumatoid nodules made of...
Fibrinoid necrosis surrounded by palisading histiocytes
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Precocious puberty
Atopic dermatitis - eczema

8. dried exudates from a vesicle - bulla or pustule seen impetigo
Crust
Acanthosis nigcricans
Median nerve - same fingers but not on the hand
Men and women > 70 - senile osteporosis

9. What is the sensory def of an ulnar nerve injury
Corneum - lucidum - granulosum - spinosum - basalis
Obturator - thigh adduction - medial thigh
Medial 1.5 fingers - hypothenar eminence
4th and 5th finger

10. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

11. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Osteochondroma - exostosis

12. What antibody is less sensitive than RF but more specific and What is the HLA association
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Ischial spine - relieve pain during delivery
Anti - CCP - HLA- DR4
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

13. What clinical features in vertebral crush fractures
Down T tubule
Renal - pulm - CV - GI - 75% female
Acute back pain - loss of height - and kyphosis
Polyostotic fibrous dysplasia

14. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Keloid
Lower trunk of brachial plexus
Ulnar nerve
Gout

15. What are the the common causes of Erb palsy - and What are the associated findings
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Exercise and Ca ingestion before age 30
Ephelis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

16. What is the source of osteoblast cells
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Mesenchymal stem cells in periosteum
McCune - Albright syndrome
Precocious puberty

17. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
HI shrinks - A stays same
Pityriasis rosea
Upper trunk of brachial plexus

18. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Bulla
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Urticaria
Osteoblastoma

19. What causes heart failure in with Paget's disease
Inc blood flow from AV shunts can cause high output heart failure
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

20. Which muscle is the pitching injury and What does it do
Osteosarcoma - multiple myeloma
Infraspinatus - laterally rotates arm
Phosphate is liberated from the myosin head
Antibodies around cells of the epidermis in a reticular or netlike pattern

21. What does soft bones result from and What is the dz called in adults and children
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Dermatomyositis
Medial aspect
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

22. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Intraepidermal bullae involving the skin and oral mucosa
Ulnar nerve
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Median nerve

23. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
After a large meal or EtOH conspumption
Serum ca - phos - PTH are nl alk phos elevated
Femoral - thing flexion and leg extension - anterior thigh and medial leg

24. What causes hypercalcemia in pts with sarcoid
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Lichen planus
Adductor policis brevis
Patch

25. precipitation of monosodium urate crystals into joints due to hyperuricemia
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Fibrinoid necrosis surrounded by palisading histiocytes
Gout

26. What are the characteristic bone findings in paget's disease
< 2mc found in proximal tibia and femur - men < 25
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Osteochondroma - exostosis

27. 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
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Nl - decreased bone mass
Scleroderma

28. 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
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Acanthosis
B27 - no RF - males

29. what changes are seen in stratum spinosum and granulosum in psoriasis
Inc spinosum - dec granulosum
Adduct the fingers
Supraspinatus - abducts the arm before the deltoid
Anti - CCP - HLA- DR4

30. warts on genitals
Condyloma acuminatum - caused by HPV
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Femoral - thing flexion and leg extension - anterior thigh and medial leg
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
Myosin light chain phosphotase
Patch
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

32. What are the classic fractures in pts with osteoporosis

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33. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Median nerve - lunate bone
Scleroderma
Vitiligo - dec number in melanocytes
Long thoracic nerve

34. larger osteoid osteoma found in vertebral column
Osteoblastoma
Posterior cord
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

35. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Strawberry hemangioma
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

36. What causes a lesion in the axillary nerve
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

37. What are defining lab findings for polymyalgia rheumatica and What is the TX
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Elevated ESR and nl CK - prednisone
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Osteoarthritis

38. Which type of muscle fiber is hypertrophied during weight training
Psoriasis
Pustule
Pseudogout
Type 2

39. What are the common perpetrating infections for Reiters syndrome
Ewings sarcoma - aggressive with early mets - but responsive to chemo
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Post GI infxn or chlamydia
Verrucae

40. What do dorsal interosseous muscles do
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Chondrosarcoma
Inc blood flow from AV shunts can cause high output heart failure
Abduct the fingers

41. What are the lab findings in osteomalacia/rickets
Spindle shaped cells with multinucleated giant cells
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
< 2mc found in proximal tibia and femur - men < 25

42. What are predisposing factors for osteosarcoma - xray finding

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43. What is the TX for chronic gout
Seborrheic keratosis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Allopurinaol - uricosurics (probenicid)

44. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Albinism
Femoral - thing flexion and leg extension - anterior thigh and medial leg
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Dermatomyositis

45. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Seborrheic keratosis
Type III - RF
Increase in both osteoblast and osteoclast activity

46. What development failure can results in albinism
NC migration
Deep branch of radial nerve
Increase in both osteoblast and osteoclast activity
Connects cells to underlying extracellular - bullous pemphigoid

47. What lesion causes wrist drop
Posterior cord
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
GC and cGMP and inhibition of MLCK

48. What muscles of the shoulder form the rotator cuff
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Gout
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

49. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Rheumatoid arthritis
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
85% - advanced paternal age - or auto dominant inheritance
Impetigo - s aureus - s pyogenes

50. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
Wheal
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)