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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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1. yellow when parallel and blue when perpendicular
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Basophilic - rhomboid crystals - weakly birefringent
Urticaria
Gout

2. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

3. Contraction results in shortening of what bands - and what band remains the same length
HI shrinks - A stays same
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Nl - thickened dense bones
Cellulitis - s aureus - s pyogenes

4. What test if specific for lupus but doesn't indicate prognosis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Carbonic anhydrase II
Anti Smith
Patch

5. When does membranous ossification occur and What is the difference between membranous and endochondrial
Albinism
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

6. What are the causes of inferior trunk plexus compression and What are the findings
Osteochondroma - exostosis
Renal - pulm - CV - GI - 75% female
Musculocutaneous
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

7. What autoantibodies are formed in sjogrens syndrome
Fibrinoid necrosis surrounded by palisading histiocytes
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Medial 1.5 fingers - hypothenar eminence
NC migration

8. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Radial nerve becomes compressed in axilla
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Osteosarcoma - multiple myeloma
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

9. What lesions causes Erb's palsy
Axillary nerve
Osteoarthritis
Inc alk phos - abnl bone architecture
Upper trunk of brachial plexus

10. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Median nerve
Conjunctivitis and anterior uveitis - urethritis and arthritis
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

11. IBS - 2 dz's
Crohns and ulcerative colitis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Conjunctivitis and anterior uveitis - urethritis and arthritis

12. Where are most osteoid osteoma found and In what population
< 2mc found in proximal tibia and femur - men < 25
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Palisading
Dermatitis

13. What is a precursor to squamous cell carcinoma
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Actinic keratosis
Down T tubule

14. What are the motor defs of a proximal ulnar nerve injury
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Medial finger flexion - wrist flexion
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

15. Other than N. gono - what organisms can cause infectious - septic arthritis
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Femoral - thing flexion and leg extension - anterior thigh and medial leg
S. aureus - streptococcus
Post GI infxn or chlamydia

16. What causes total claw
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Vesicle
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

17. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
TB from dissemination and lyme dz
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

18. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Dermatomyositis
McCune - Albright syndrome
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Renal - pulm - CV - GI - 75% female

19. epi of SLE
Female between 14 and 45 - mostly black
The dermis
Nl - thickened dense bones
Condyloma acuminatum - caused by HPV

20. What enzyme defect in responsible for osteopetrosis
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Carbonic anhydrase II

21. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Medial finger flexion - wrist flexion
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Ewings sarcoma - aggressive with early mets - but responsive to chemo

22. What is the TX for chronic gout
Allopurinaol - uricosurics (probenicid)
Interossei and adductor policis
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Macule

23. What medication is contraindicated in osteoporosis
Glucocorticoids
85% - advanced paternal age - or auto dominant inheritance
Actinic keratosis - risk proportional to epithelial dysplasia
Fever - fatigue - pleuritis - pericarditis

24. What are the layers of of the epidermis from surface to base
Actinic keratosis - risk proportional to epithelial dysplasia
Corneum - lucidum - granulosum - spinosum - basalis
Serum ca - phos - alk phos are NL
After a large meal or EtOH conspumption

25. What lesion causes claw hand and What are the muscles involved
Ulnar nerve - intrinsic muscles of hand
Metaphysis of long bones - distal femur
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
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

26. Which muscle is the pitching injury and What does it do
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Infraspinatus - laterally rotates arm
Strawberry hemangioma

27. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
MCP - PIP - no DIP
Upper trunk of brachial plexus

28. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Precocious puberty
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Cellulitis - s aureus - s pyogenes
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

29. What molecule maintatins integrity of basement membrane and What does it bind
Integrin binds laminin in BM
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Medially rotates and adducts arm

30. What is the primary screening test for lupus
ANA - sensitive but not specific
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

31. What nerve and branch are stretche by subluxation of the radius
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Increase in both osteoblast and osteoclast activity
Type III - RF
Deep branch of radial nerve

32. What causes the symptoms of MG to worsen - and What is used to diagnose
Nl - decreased bone mass
Muslce use - nerve stim/compound muscle test
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

33. What is the defect in Paget's disease
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Increase in both osteoblast and osteoclast activity
Bulla

34. What lesion causes wrist drop
Urticaria
Precocious puberty
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Posterior cord

35. 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
Verrucae vulgaris
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

36. In smooth muscle contraction - What does Ca bind and What is the purpose
Parakeratosis
Ulnar nerve
Calmodulin - complex activates myosin light chain kinase
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

37. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Melasma (chloasma)
Connects cells to underlying extracellular - bullous pemphigoid
Verrucae

38. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
In psoriasis - bleeding spots when scales are scraped off
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Dermatomyositis

39. Decrease marrow space in osteopetrosis leads to what?
MCP - PIP - no DIP
Serum ca - phos - PTH are nl alk phos elevated
Cellulitis - s aureus - s pyogenes
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

40. inflammation of the skin
Dermatitis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Ligand binding leads to muscle depol
Basal cell carcinoma - pearly papules - commonly with telangiectasias

41. What nerve is injured by a superficial laceration of the hand
Psoriasis
Dysplastic nevus
Recurrent branch of the medain nerve
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

42. Where do sebhorrheic keratosis lesions occur and in who
Head - trunk - extremities - common benign neoplasm in older persons
Recurrent branch of the median nerve
Over deltoid
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

43. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Obturator - thigh adduction - medial thigh
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Seborrheic keratosis
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

44. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Type III - RF
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
4th and 5th finger

45. Where does the muscle contraction travel after leaving the motor end plate
Down T tubule
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Strawberry hemangioma
In psoriasis - bleeding spots when scales are scraped off

46. thickened - dense bones that are prone to fracture - dz and primary defect
Ulnar nerve
Parakeratosis
85% - advanced paternal age - or auto dominant inheritance
Osteopetrosis - abnl fxn of osteoclasts

47. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Keratoacanthoma
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Ephelis
Ulnar nerve

48. What associations go along with sarcoidosis

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49. What are the borders of the superficial branch of the radial nerve dermatone
Myosin light chain phosphotase
Dermatitis herpetiformis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

50. epidermal hyperplasia (inc spinosum)
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Type III - RF
Acanthosis
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

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