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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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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 organisms can cause chronic infectious arthritis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Anterior interosseous nerve
TB from dissemination and lyme dz
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

2. What lesion causes Saturday night wrist drop
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Verrucae vulgaris
Radial nerve
Dysplastic nevus

3. Where is C5 dermatome
Osteoarthritis
Posterior cord
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Outer arm

4. 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
Myosin releases bound ADP and is displaced on the actin filament
Osteoblastoma
Wheal

5. What are the borders of the superficial branch of the radial nerve dermatone
Osteoid osteoma
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
3rd finger
Dec estrogen causes inc bone resorption - postmenopausal

6. What are the motor defs of a proximal ulnar nerve injury
Pemphigus vulgaris
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Medial finger flexion - wrist flexion
After a large meal or EtOH conspumption

7. elevated skin lesion <1cm seen in acne vulgaris
Palisading
Papule
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Sites of tibial attachment

8. What does IM reveal in pemphigus vulgaris
Men and women > 70 - senile osteporosis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Antibodies around cells of the epidermis in a reticular or netlike pattern
Medial aspect

9. Where is C8 dermatome
4th and 5th finger
Osteochondroma - exostosis
Muslce use - nerve stim/compound muscle test
Fibrinoid necrosis surrounded by palisading histiocytes

10. What are defining lab findings for polymyalgia rheumatica and What is the TX
85% - advanced paternal age - or auto dominant inheritance
Vitiligo - dec number in melanocytes
Elevated ESR and nl CK - prednisone
Adductor policis brevis

11. What medication is contraindicated in osteoporosis
Glucocorticoids
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Polyostotic fibrous dysplasia
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

12. What clinical features in vertebral crush fractures
Acute back pain - loss of height - and kyphosis
Chondrosarcoma
Radial nerve
4th and 5th finger

13. What are the subQ rheumatoid nodules made of...
Fibrinoid necrosis surrounded by palisading histiocytes
Medial forearm and arm to just under the axilla
Serum ca - phos - alk phos are NL
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

14. What does injury to the distal ulnar nerve cause
Renal - pulm - CV - GI - 75% female
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

15. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Condyloma acuminatum - caused by HPV
Pityriasis rosea
Lesioned by midshaft fracture of humerus
Axillary nerve

16. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Cherry hemangioma
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

17. What lesions causes Erb's palsy
Upper trunk of brachial plexus
MCP - PIP - no DIP
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
Tear of the ACL

18. What causes osteoporosis type 1 and When does it typically occur
Median nerve
Dec estrogen causes inc bone resorption - postmenopausal
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
NC migration

19. What do the lumbrical muscles do
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Radial nerve becomes compressed in axilla
Flex at the MCP
Viral - maybe paramyxovirus

20. What is the defect in Paget's disease
Corneum - lucidum - granulosum - spinosum - basalis
Paralysis of abductors
Ischial spine - relieve pain during delivery
Increase in both osteoblast and osteoclast activity

21. What is the sign of Leser - Trelat
Median nerve - same fingers but not on the hand
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

22. What is a positive Nikolsky's sign
Albinism
Pseudogout
Pityriasis rosea
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

23. What are characteristic findings of gout
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Osteoarthritis
McCune - Albright syndrome
Osteoporosis

24. What are the lab findings in osteomalacia/rickets
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Chondrosarcoma

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

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26. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Basophilic - rhomboid crystals - weakly birefringent
Seborrheic keratosis
Xeropthalmia - xerostomia - arthritis

27. interlacing trabeculae of woven bone surrounded by osteoblasts
Osteoid osteoma
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Anti - histone
Rigor mortis

28. What are the systemic symptoms found in RA
Fever - fatigue - pleuritis - pericarditis
Gout
In psoriasis - bleeding spots when scales are scraped off
Psoriasis

29. What are the characterstic joints affected in RA
Erythema multiforme - can be macules - papules vesicles - target lesions -
MCP - PIP - no DIP
Phosphorylates myosin light chain which leads to cross bridge formation
Female between 14 and 45 - mostly black

30. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Posterior cord
Polymyositis - shoulders - perifasicular inflammation
Nl - thickened dense bones
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

31. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Ligand binding leads to muscle depol
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

32. Where is C4 dermatome
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Over deltoid
Carbonic anhydrase II
Lung

33. papule > 1cm seen psoriasis
Plaque
Lichen planus
GC and cGMP and inhibition of MLCK
Polymyositis - shoulders - perifasicular inflammation

34. What are the thin lines along the Z line
Actin
Abduct the fingers
Crust
S. aureus - streptococcus

35. What lesion causes wrist drop
Conjunctivitis and anterior uveitis - urethritis and arthritis
Anti - CCP - HLA- DR4
In psoriasis - bleeding spots when scales are scraped off
Posterior cord

36. What antibodies is diffuse scleroderma associated with
Fever - fatigue - pleuritis - pericarditis
Lower trunk of brachial plexus
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Anti Scl70 - anti DNA topoisomerase I antibody

37. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Acute back pain - loss of height - and kyphosis
Supraspinatus - abducts the arm before the deltoid
Ulnar nerve

38. Why does EtOH consumption precipitate gout
Calmodulin - complex activates myosin light chain kinase
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

39. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Seborrheic keratosis
< 2mc found in proximal tibia and femur - men < 25
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Age - obesity and joint deformity

40. What do palmar interosseous muscles do
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Spindle shaped cells with multinucleated giant cells
Adduct the fingers
Pain in weight bearing joints at the end of the day and improving with rest

41. transiet vesicle seen in hives
Adductor policis brevis
Paralysis of abductors
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Wheal

42. What development failure can results in albinism
AP depol opens voltage gated Ca channels - inducing NT release
Median nerve - same fingers but not on the hand
NC migration
Recurrent branch of the median nerve

43. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Erlenmeyer flask bones that flare out - narrowed foramina
Cellulitis - s aureus - s pyogenes
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Lichen planus

44. What nerve become injured in the incorrect use of a crutch
Abduct the fingers
Posterior cord
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Radial nerve becomes compressed in axilla

45. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Melasma (chloasma)
Sarcoidosis - black females - ACE
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
MCL - ACL - lateral meniscus (esp in athletes)

46. In which form is myosin light chain active
Obturator - thigh adduction - medial thigh
Phosphorylated
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

47. Which nerve is compressed in deep forearm
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Type 2
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Anterior interosseous nerve

48. What nerve is injured in a fracutre of the hook of hamate
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Conjunctivitis and anterior uveitis - urethritis and arthritis
Ulnar nerve

49. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Exercise and Ca ingestion before age 30
Head - trunk - extremities - common benign neoplasm in older persons
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Impetigo - s aureus - s pyogenes

50. hyperpigmentation associated with pregnancy or OCP
Type 2
Gout
Melasma (chloasma)
< 2mc found in proximal tibia and femur - men < 25