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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 abnl passive abduction of the knee indicate
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Torn MCL
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

2. hypothenar eminence - nerve and muscles
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
After a large meal or EtOH conspumption
Osteopetrosis - abnl fxn of osteoclasts
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

3. What clinical features in vertebral crush fractures
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Actinic keratosis
Acute back pain - loss of height - and kyphosis
Axillary - deltoid - skin over deltoid - flattened deltoid

4. What is the TX for acute gout
AP depol opens voltage gated Ca channels - inducing NT release
Recurrent branch of the medain nerve
NSAIDs (indomethacin) colchicine
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

5. What antibodies is diffuse scleroderma associated with
Palisading
Strawberry hemangioma
Large goints (knee)
Anti Scl70 - anti DNA topoisomerase I antibody

6. What are the histo findings in an osteoclastoma
< 2mc found in proximal tibia and femur - men < 25
Spindle shaped cells with multinucleated giant cells
Cervical disk lesion
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

7. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Teres minor
Strawberry hemangioma
Myosin releases bound ADP and is displaced on the actin filament

8. What do lumbricals do
Flex the MCP joints and extend both the DIP and PIP joints
Muslce use - nerve stim/compound muscle test
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

9. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Albinism

10. MG is associated with what neoplasm
Thymoma
Anti ds DNA - poor prognosis
Boutonniere - swan neck - zthumb
Papule

11. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Erythema multiforme - can be macules - papules vesicles - target lesions -
Erlenmeyer flask bones that flare out - narrowed foramina
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
The dermis

12. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Nevocellular nevus
Scleroderma
Seborrheic keratosis
Osteoarthritis

13. What test if specific for lupus but doesn't indicate prognosis
Ligand binding leads to muscle depol
Anti Smith
Paralysis of lateral rotators
Post GI infxn or chlamydia

14. What autoantibodies are formed in sjogrens syndrome
Pain in weight bearing joints at the end of the day and improving with rest
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Osteogenic carcinoma

15. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Dermatomyositis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
3rd finger
Dec estrogen causes inc bone resorption - postmenopausal

16. Where does the muscle contraction travel after leaving the motor end plate
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Exercise and Ca ingestion before age 30
Down T tubule

17. What is the landmark for an LP
Pseudogout
Osteosarcoma - multiple myeloma
Iliac crest
Adduct the fingers

18. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Conjunctivitis and anterior uveitis - urethritis and arthritis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Osteoid osteoma
Anti ds DNA - poor prognosis

19. What kind of jxn is in the zona adherens and Where is it - What is it composed of - and what ion does it does it depend on...
Down T tubule
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Teres minor
Squamous cell carcinoma

20. How is chondrosarcoma described
Hairy leukoplakia - HIV population - EBV mediated
Chondrosarcoma
Serum ca - phos - PTH are nl alk phos elevated
Expansile glistening mass within the medullary cavity

21. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Ulnar deviation - subluxation - bakers cysts (behind knee)
Albinism
After a large meal or EtOH conspumption

22. How is the lower trunk of the brachia plexus injured and what results from it

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23. What happens in the power stroke of skeletal muscle contraction
Dec estrogen causes inc bone resorption - postmenopausal
Actinic keratosis - risk proportional to epithelial dysplasia
Phosphate is liberated from the myosin head
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

24. What kind of jxn is the zona occludens andw What is is composed of...
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Pustule
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Anterior interosseous nerve

25. large fluid containing blisters seen in bullous pemphigoid
Bulla
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Phosphorylated
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

26. What kind of bone tumor is associated with FAP and What is the finding
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Sites of tibial attachment
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Renal - pulm - CV - GI - 75% female

27. What are the borders of the superficial branch of the radial nerve dermatone
Crohns and ulcerative colitis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Actinic keratosis - risk proportional to epithelial dysplasia

28. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
MCL - ACL - lateral meniscus (esp in athletes)
Over deltoid
Impetigo - s aureus - s pyogenes
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

29. What runs the distance of the A band
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Cervical disk lesion
Myosin
McCune - Albright syndrome

30. What is the TX for chronic gout
Allopurinaol - uricosurics (probenicid)
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Anti Smith

31. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Nevocellular nevus
Ulnar nerve - fracture of hook of hamate
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

32. What protects the brachial plexus in clavicle fracture
Keratoacanthoma
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Subclavius
Ulnar nerve

33. Achondroplasia is a failure of what process which results in which characteristic findings
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Staph scalded skin syndrome
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

34. Other than N. gono - what organisms can cause infectious - septic arthritis
Post GI infxn or chlamydia
Corneum - lucidum - granulosum - spinosum - basalis
Iliac crest
S. aureus - streptococcus

35. What are the characteristic bone findings in paget's disease
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Exercise and Ca ingestion before age 30
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Long thoracic nerve

36. epi of SLE
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Female between 14 and 45 - mostly black
B27 - no RF - males
Parotid enlargement - inc risk of B cell lymphoma - dental caries

37. larger osteoid osteoma found in vertebral column
Anti Scl70 - anti DNA topoisomerase I antibody
Precocious puberty
Osteoblastoma
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

38. What nerve is injured in a fracutre of the hook of hamate
Fibrinoid necrosis surrounded by palisading histiocytes
Ulnar nerve
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

39. What are predisposing factors for osteosarcoma - xray finding

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40. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
AP depol opens voltage gated Ca channels - inducing NT release
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

41. What lesion causes difficulty flexing elbow with variable sensory loss
McCune - Albright syndrome
Musculocutaneous
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

42. What are the motor defs of a proximal ulnar nerve injury
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Atopic dermatitis - eczema
Carbonic anhydrase II
Medial finger flexion - wrist flexion

43. What is TX for osteoporosis
Polymyositis - shoulders - perifasicular inflammation
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Long thoracic nerve
Axillary - deltoid - skin over deltoid - flattened deltoid

44. What is the most common NMJ disorder - What causes it and What are common symptoms
Men and women > 70 - senile osteporosis
Inc alk phos - abnl bone architecture
Thymoma
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

45. Where is C7 dermatome
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
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
3rd finger

46. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Type III - RF
Large goints (knee)
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Osteosarcoma - multiple myeloma

47. What are characteristic findings of gout
Lower trunk of brachial plexus
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Serum ca - phos - alk phos are NL

48. What happens at the gap jxn and what molecules create them
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Ligand binding leads to muscle depol
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Flex the MCP joints and extend both the DIP and PIP joints

49. What does PED and Tip stand for

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50. What does injury to the distal median nerve cause

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