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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 lack of ATP cause
Exercise and Ca ingestion before age 30
Female between 14 and 45 - mostly black
Cherry hemangioma
Rigor mortis

2. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Pseudogout
Type 2
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

3. inflammation of the skin
Dermatitis
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
AP depol opens voltage gated Ca channels - inducing NT release
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

4. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
AP depol opens voltage gated Ca channels - inducing NT release
Fibrinoid necrosis surrounded by palisading histiocytes
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

5. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Post GI infxn or chlamydia
Acanthosis nigcricans
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Atopic dermatitis - eczema

6. What antibody is less sensitive than RF but more specific and What is the HLA association
Infraspinatus - laterally rotates arm
Anti - CCP - HLA- DR4
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Parakeratosis

7. What are the associations for sjogrens syndrome
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Anti Smith
4th and 5th finger

8. 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
Ligand binding leads to muscle depol
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

9. What are defining lab findings for polymyalgia rheumatica and What is the TX
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Elevated ESR and nl CK - prednisone

10. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Pain in weight bearing joints at the end of the day and improving with rest
Flex the MCP joints and extend both the DIP and PIP joints

11. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Flex the MCP joints and extend both the DIP and PIP joints
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Basal cell carcinoma - pearly papules - commonly with telangiectasias

12. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Staph scalded skin syndrome
Medially rotates and adducts arm
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

13. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

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14. What causes total claw
Ewings sarcoma - aggressive with early mets - but responsive to chemo
AP depol opens voltage gated Ca channels - inducing NT release
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Rheumatoid arthritis

15. What is the most common NMJ disorder - What causes it and What are common symptoms
Dysplastic nevus
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Supraspinatus - abducts the arm before the deltoid
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

16. What lesion causes wrist drop
Posterior cord
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
Verrucae vulgaris
Long thoracic nerve

17. What other lesion can cause the appearnce of the ulnar claw
Recurrent branch of the median nerve
Psoriasis
Making fist with a proximal median nerve lesion
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

18. How does the radial nerve in the spiral groove become injured
4th and 5th finger
Lesioned by midshaft fracture of humerus
Acantholysis
Erythema nodosum

19. In smooth muscle contraction - What does Ca bind and What is the purpose
Impetigo - s aureus - s pyogenes
Ulnar nerve - intrinsic muscles of hand
Calmodulin - complex activates myosin light chain kinase
Anti Scl70 - anti DNA topoisomerase I antibody

20. epi of SLE
Female between 14 and 45 - mostly black
Acute back pain - loss of height - and kyphosis
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

21. dried exudates from a vesicle - bulla or pustule seen impetigo
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Age - obesity and joint deformity
Crust
Wheal

22. What are the characterstic joints affected in RA
MCP - PIP - no DIP
Conjunctivitis and anterior uveitis - urethritis and arthritis
Myosin releases bound ADP and is displaced on the actin filament
Patch

23. What is the clinically important landmark for pubendal nerve block and When is it used
Ischial spine - relieve pain during delivery
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Median nerve - same fingers but not on the hand
Boutonniere - swan neck - zthumb

24. Where does the muscle contraction travel after leaving the motor end plate
Erythema nodosum
Down T tubule
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
HI shrinks - A stays same

25. What are the common perpetrating infections for Reiters syndrome
Axillary - deltoid - skin over deltoid - flattened deltoid
Lesioned by midshaft fracture of humerus
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Post GI infxn or chlamydia

26. What lesions causes Erb's palsy
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Upper trunk of brachial plexus
Anti - histone

27. What are the most common symtpoms of SLE
Axilla
NSAIDs (indomethacin) colchicine
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

28. What lesion causes difficulty flexing elbow with variable sensory loss
Mesenchymal stem cells in periosteum
Musculocutaneous
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Dermatomyositis

29. What associations go along with sarcoidosis

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30. what changes are seen in stratum spinosum and granulosum in psoriasis
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
Ulnar nerve - fracture of hook of hamate
Xeropthalmia - xerostomia - arthritis
Inc spinosum - dec granulosum

31. What do lupus pts falsely test positive for syphillis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Osteopetrosis - abnl fxn of osteoclasts
Osteogenic carcinoma

32. What nerve is injured by a superficial laceration of the hand
Osteoporosis
Recurrent branch of the medain nerve
Cherry hemangioma
Parotid enlargement - inc risk of B cell lymphoma - dental caries

33. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Hairy leukoplakia - HIV population - EBV mediated
Deep branch of radial nerve
Metaphysis of long bones - distal femur

34. Flat discloration <1cm seen in tinea versicolor
Macule
Making fist with a proximal median nerve lesion
Anti Scl70 - anti DNA topoisomerase I antibody
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

35. What causes a lesion in the axillary nerve
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Dec estrogen causes inc bone resorption - postmenopausal

36. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
85% - advanced paternal age - or auto dominant inheritance
Median nerve - same fingers but not on the hand
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

37. What does I'M DAMN SHARP stand for
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Mesenchymal stem cells in periosteum
Urticaria

38. In which form is myosin light chain active
Phosphorylated
Rheumatoid arthritis
Dysplastic nevus
Staph scalded skin syndrome

39. yellow when parallel and blue when perpendicular
Gout
Keloid
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

40. What causes the symptoms of MG to worsen - and What is used to diagnose
Muslce use - nerve stim/compound muscle test
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Anti ds DNA - poor prognosis
Acute back pain - loss of height - and kyphosis

41. What runs the distance of the A band
Myosin
Wheal
Infraspinatus - laterally rotates arm
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

42. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Fibrinoid necrosis surrounded by palisading histiocytes
Integrin binds laminin in BM
Torn MCL
Cellulitis - s aureus - s pyogenes

43. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
Median nerve - same fingers but not on the hand
Ulnar nerve - intrinsic muscles of hand
Median nerve

44. What is CREST syndrome and What antibody is it associated with
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
After a large meal or EtOH conspumption
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

45. What are the predisposing factors for osteoarthritis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Osteoblastoma
Age - obesity and joint deformity
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

46. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Torn MCL
Axillary - deltoid - skin over deltoid - flattened deltoid
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Flex the MCP joints and extend both the DIP and PIP joints

47. What causes a lesion in the upper trunk of the brachial plexus
Trauma
Vitiligo - dec number in melanocytes
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Median nerve

48. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Vesicle
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Nevocellular nevus
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

49. Macule greater than 1cm
Patch
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Median nerve - same fingers but not on the hand
Crust

50. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Osteoblastoma
Ulnar nerve
Dermatitis
Median nerve - same fingers but not on the hand