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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. In smooth muscle contraction - What does Ca bind and What is the purpose
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Calmodulin - complex activates myosin light chain kinase

2. What nerve is injured in a fracutre of the hook of hamate
Muslce use - nerve stim/compound muscle test
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Ulnar nerve
Seborrheic keratosis

3. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Ulnar deviation - subluxation - bakers cysts (behind knee)
Atopic dermatitis - eczema
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Actinic keratosis

4. What is a precursor to squamous cell carcinoma
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Actinic keratosis
Nevocellular nevus
Atopic dermatitis - eczema

5. papule > 1cm seen psoriasis
Plaque
Median nerve
Urticaria
Phosphorylates myosin light chain which leads to cross bridge formation

6. precipitation of monosodium urate crystals into joints due to hyperuricemia
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Gout
Metaphysis of long bones - distal femur

7. What do lumbricals do
Endochondroma
Flex the MCP joints and extend both the DIP and PIP joints
In psoriasis - bleeding spots when scales are scraped off
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

8. inflammatory disorder affective synovial joints with pannus formation in joints
Iliac crest
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Strawberry hemangioma
Rheumatoid arthritis

9. Where is C8 dermatome
Mesenchymal stem cells in periosteum
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
4th and 5th finger
< 2mc found in proximal tibia and femur - men < 25

10. What is a positive Nikolsky's sign
Impetigo - s aureus - s pyogenes
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Pain in weight bearing joints at the end of the day and improving with rest
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

11. mechanical wear and tear of joints leading to destruction of articular cartilage
Integrin binds laminin in BM
Erythema nodosum
Paralysis of abductors
Osteoarthritis

12. What are the associations for sjogrens syndrome
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Allopurinaol - uricosurics (probenicid)
Flex the MCP joints and extend both the DIP and PIP joints

13. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Dermatomyositis
Keloid
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

14. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Crust
Flex the MCP joints and extend both the DIP and PIP joints
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Outer arm

15. What signal initiates a muscle contraction
Ulnar nerve - fracture of hook of hamate
Exercise and Ca ingestion before age 30
AP depol opens voltage gated Ca channels - inducing NT release
Hyperkeratosis

16. yellow when perpendicular and blue when parallel
Corneum - lucidum - granulosum - spinosum - basalis
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Pseudogout
Lichen planus

17. Loss of what muslces in Erbs causes the limb to hang by side
Pemphigus vulgaris
Connects cells to underlying extracellular - bullous pemphigoid
Paralysis of abductors
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

18. Where are most osteoid osteoma found and In what population
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
< 2mc found in proximal tibia and femur - men < 25
Recurrent branch of the median nerve
Muslce use - nerve stim/compound muscle test

19. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Ulnar deviation - subluxation - bakers cysts (behind knee)
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Biceps

20. What do palmar interosseous muscles do
Squamous cell carcinoma
Lichen planus
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Adduct the fingers

21. loss of what muscles in Erbs causes the medial rotation
Over deltoid
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Paralysis of lateral rotators
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

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

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23. What are the the common causes of Erb palsy - and What are the associated findings
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Verrucae
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

24. What are the layers of of the epidermis from surface to base
Paralysis of abductors
Actinic keratosis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Corneum - lucidum - granulosum - spinosum - basalis

25. Where does cartilage loss begin in osteoarthritis
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Medial aspect

26. Which muscle fiber type is slow twitch and why are fibers red
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

27. What causes a lesion in the axillary nerve
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Hyperkeratosis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

28. What do lupus pts falsely test positive for syphillis
Fibrinoid necrosis surrounded by palisading histiocytes
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

29. Where is C5 dermatome
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Phosphate is liberated from the myosin head
Outer arm

30. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
MCP - PIP - no DIP
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

31. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Ligand binding leads to muscle depol
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

32. freckle - normal number of melanocytes - inc melanin pigment
Mesenchymal stem cells in periosteum
Ephelis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Actin

33. 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
Carbonic anhydrase II
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Parakeratosis

34. What lesion causes deltoid paralysis
Phosphate is liberated from the myosin head
AP depol opens voltage gated Ca channels - inducing NT release
Cellulitis - s aureus - s pyogenes
Axillary nerve

35. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Serum ca - phos - PTH are nl alk phos elevated
Actin
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

36. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Median nerve
B27 - no RF - males
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Paralysis of abductors

37. Where is T1 dermatome
Osteopetrosis - abnl fxn of osteoclasts
Medial forearm and arm to just under the axilla
Connects cells to underlying extracellular - bullous pemphigoid
Dermatomyositis

38. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Mesenchymal stem cells in periosteum
85% - advanced paternal age - or auto dominant inheritance
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
TB from dissemination and lyme dz

39. In which form is myosin light chain active
Pseudogout
Infraspinatus - laterally rotates arm
Phosphorylated
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

40. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
MCL - ACL - lateral meniscus (esp in athletes)
ANA - sensitive but not specific
Scleroderma
Recurrent branch of the medain nerve

41. What does lack of ATP cause
Infraspinatus - laterally rotates arm
Pseudogout
Rigor mortis
Thymoma

42. What supplies innervation to the thenar muscles
Polyostotic fibrous dysplasia
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Recurrent branch of the median nerve
Adduct the fingers

43. Thenar eminence - nerve and muscles
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Upper trunk of brachial plexus
Connects cells to underlying extracellular - bullous pemphigoid

44. What are the motor - sensory deficits and sign of carpal tunnel syndrome
In psoriasis - bleeding spots when scales are scraped off
AP depol opens voltage gated Ca channels - inducing NT release
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

45. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Type 2
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

46. When does membranous ossification occur and What is the difference between membranous and endochondrial
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Pustule
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

47. What are the classic fractures in pts with osteoporosis

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48. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
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 - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Dermatitis herpetiformis
Myosin light chain phosphotase

49. What do anterior and posterior in ACL and PCL refer to...
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Long thoracic nerve
Sites of tibial attachment
Increase in both osteoblast and osteoclast activity

50. What molecule maintatins integrity of basement membrane and What does it bind
Integrin binds laminin in BM
Dermatitis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Paralysis of lateral rotators