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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 do lumbricals do
Paralysis of lateral rotators
Flex the MCP joints and extend both the DIP and PIP joints
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

2. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Carbonic anhydrase II
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

3. larger osteoid osteoma found in vertebral column
Osteoblastoma
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ulnar
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

4. What lesion causes winged scapula
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Actin
Long thoracic nerve

5. How does gonococcal arthritis present
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Type 2
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Hyperkeratosis

6. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Head - trunk - extremities - common benign neoplasm in older persons
Cherry hemangioma
Lung
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

7. What lesion causes difficulty flexing elbow with variable sensory loss
Osteoid osteoma
Albinism
Paralysis of abductors
Musculocutaneous

8. which muscle type is fast twitch and why are fibers white
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Osteochondroma - exostosis
Outer arm
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

9. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Acanthosis nigcricans

10. What kind of nuclei do basal cell tumors have
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Actinic keratosis
Tear of the ACL
Palisading

11. Patients with pagets disease can develop what cancer
Dermatomyositis
Trauma
Osteogenic carcinoma
Deep branch of radial nerve

12. What does MLCK do in smooth muscle contraction
Osteopetrosis - abnl fxn of osteoclasts
Phosphorylates myosin light chain which leads to cross bridge formation
Osteoblastoma
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

13. Which muscle laterally rotates and adducts arm
Pseudogout
Polyostotic fibrous dysplasia
Osteoblastoma
Teres minor

14. Where is osteosarcoma found in the bone
Verrucae vulgaris
Flex the MCP joints and extend both the DIP and PIP joints
Hairy leukoplakia - HIV population - EBV mediated
Metaphysis of long bones - distal femur

15. large fluid containing blisters seen in bullous pemphigoid
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Ligand binding leads to muscle depol
Subclavius
Bulla

16. What do the branches of the deep ulnar nerve innervate
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Pain in weight bearing joints at the end of the day and improving with rest
Age - obesity and joint deformity
Interossei and adductor policis

17. What are the common perpetrating infections for Reiters syndrome
Post GI infxn or chlamydia
Radial nerve becomes compressed in axilla
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Expansile glistening mass within the medullary cavity

18. MG is associated with what neoplasm
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Patch
Thymoma
Wheal

19. hives - intensely pruritic wheals that form after mast cell degranulation
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
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Exercise and Ca ingestion before age 30
Urticaria

20. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Anterior interosseous nerve
Hairy leukoplakia - HIV population - EBV mediated
Osteoid osteoma
Cherry hemangioma

21. papule > 1cm seen psoriasis
Plaque
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Endochondroma
Men and women > 70 - senile osteporosis

22. Which muscle is the pitching injury and What does it do
Conjunctivitis and anterior uveitis - urethritis and arthritis
Acantholysis
Verrucae
Infraspinatus - laterally rotates arm

23. hyperpigmentation associated with pregnancy or OCP
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Melasma (chloasma)
ANA - sensitive but not specific
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

24. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Renal - pulm - CV - GI - 75% female
Crohns and ulcerative colitis
Making fist with a proximal median nerve lesion
Anti ds DNA - poor prognosis

25. What causes osteoporosis type 1 and When does it typically occur
The dermis
Adduct the fingers
Age - obesity and joint deformity
Dec estrogen causes inc bone resorption - postmenopausal

26. Which nerve is compressed in deep forearm
Anterior interosseous nerve
Endochondroma
Pemphigus vulgaris
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

27. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Subclavius
Abduct the fingers
Pemphigus vulgaris
Cherry hemangioma

28. What is the sign of Leser - Trelat
Fever - fatigue - pleuritis - pericarditis
Anti Scl70 - anti DNA topoisomerase I antibody
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Connects cells to underlying extracellular - bullous pemphigoid

29. inflammation of the skin
Anti Smith
Dermatomyositis
Dermatitis
Elevated ESR and nl CK - prednisone

30. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Musculocutaneous
Paralysis of lateral rotators
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

31. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
MCP - PIP - no DIP
Iliac crest
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Anti ds DNA - poor prognosis

32. What is the Auspitz sign
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Making fist with a proximal median nerve lesion
In psoriasis - bleeding spots when scales are scraped off
Impetigo - s aureus - s pyogenes

33. Dermatomyositis places the pt at inc risk For what malignancy in particular
Polymyositis - shoulders - perifasicular inflammation
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Lung

34. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Anti Smith
Seborrheic keratosis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Nl - decreased bone mass

35. What autoantibodies are formed in sjogrens syndrome
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Age - obesity and joint deformity
Ischial spine - relieve pain during delivery

36. What is the primary screening test for lupus
Over deltoid
ANA - sensitive but not specific
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Biceps

37. What antibodies is diffuse scleroderma associated with
Tear of the ACL
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Anti Scl70 - anti DNA topoisomerase I antibody
Cellulitis - s aureus - s pyogenes

38. Thenar eminence - nerve and muscles
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
S. aureus - streptococcus

39. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Precocious puberty
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Psoriasis

40. What nerve is injured by a superficial laceration of the hand
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Recurrent branch of the medain nerve
Spindle shaped cells with multinucleated giant cells
Pain in weight bearing joints at the end of the day and improving with rest

41. What is the source of osteoblast cells
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Fibrinoid necrosis surrounded by palisading histiocytes
Mesenchymal stem cells in periosteum
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

42. what changes are seen in stratum spinosum and granulosum in psoriasis
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Inc spinosum - dec granulosum
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
NC migration

43. Where is C4 dermatome
Over deltoid
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Nevocellular nevus

44. What are the the common causes of Erb palsy - and What are the associated findings
Intraepidermal bullae involving the skin and oral mucosa
Osteoarthritis
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

45. What are the layers of of the epidermis from surface to base
Corneum - lucidum - granulosum - spinosum - basalis
Elevated ESR and nl CK - prednisone
Osteoarthritis
Palisading

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
Over deltoid
3rd finger
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

47. What is a very specific test for lupus
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Osteoarthritis
Anti ds DNA - poor prognosis
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

48. What associations go along with sarcoidosis

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49. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Carbonic anhydrase II
Calmodulin - complex activates myosin light chain kinase
Strawberry hemangioma

50. What does injury to the distal ulnar nerve cause
Sites of tibial attachment
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Median nerve
In psoriasis - bleeding spots when scales are scraped off