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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
Calmodulin - complex activates myosin light chain kinase
Hairy leukoplakia - HIV population - EBV mediated
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

2. What supplies innervation to the thenar muscles
Bulla
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
Recurrent branch of the medain nerve
Recurrent branch of the median nerve

3. What lesion causes wrist drop
Staph scalded skin syndrome
Posterior cord
Nl - thickened dense bones
Cellulitis - s aureus - s pyogenes

4. What does subscapularis do
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Median nerve - same fingers but not on the hand
Medially rotates and adducts arm

5. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Lichen planus
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Myosin light chain phosphotase

6. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Cherry hemangioma
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Mesenchymal stem cells in periosteum
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

7. What do palmar interosseous muscles do
Adduct the fingers
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Plaque
Nevocellular nevus

8. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Ischial spine - relieve pain during delivery
Long thoracic nerve
Erythema multiforme - can be macules - papules vesicles - target lesions -
Integrin binds laminin in BM

9. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Type 2
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Actinic keratosis - risk proportional to epithelial dysplasia
Osteoarthritis

10. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Myosin
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Adduct the fingers

11. Sarcoid TX
Acantholysis
Medial finger flexion - wrist flexion
Steroids
Melasma (chloasma)

12. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Pemphigus vulgaris
Myosin light chain phosphotase
Pustule
Albinism

13. What is the sensory def of an ulnar nerve injury
Osteosarcoma - multiple myeloma
Flex at the MCP
Lesioned by midshaft fracture of humerus
Medial 1.5 fingers - hypothenar eminence

14. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
Medial aspect
Inc spinosum - dec granulosum
Erlenmeyer flask bones that flare out - narrowed foramina

15. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Lichen planus
Vesicle
Verrucae

16. hyperpigmentation associated with pregnancy or OCP
Melasma (chloasma)
Paralysis of abductors
NSAIDs (indomethacin) colchicine
Age - obesity and joint deformity

17. What are the layers of of the epidermis from surface to base
Actin
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
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
Corneum - lucidum - granulosum - spinosum - basalis

18. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Inc spinosum - dec granulosum
Erythema multiforme - can be macules - papules vesicles - target lesions -
Axillary - deltoid - skin over deltoid - flattened deltoid
Large goints (knee)

19. yellow when parallel and blue when perpendicular
NC migration
Allopurinaol - uricosurics (probenicid)
Gout
Albinism

20. What do lumbricals do
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
3rd finger
Flex the MCP joints and extend both the DIP and PIP joints
Bulla

21. What is the classic traid of sjogrens syndrome
Xeropthalmia - xerostomia - arthritis
Elevated ESR and nl CK - prednisone
Median nerve - lunate bone
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

22. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Acanthosis nigcricans
Radial nerve becomes compressed in axilla
B27 - no RF - males

23. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Flex the MCP joints and extend both the DIP and PIP joints
Ulnar nerve - fracture of hook of hamate
Impetigo - s aureus - s pyogenes
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

24. What are the potential causes of gout

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25. What causes compression of the C7 nerve root
S. aureus - streptococcus
85% - advanced paternal age - or auto dominant inheritance
Dermatomyositis
Cervical disk lesion

26. What is CREST syndrome and What antibody is it associated with
Thymoma
Expansile glistening mass within the medullary cavity
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

27. What nerve and branch are stretche by subluxation of the radius
Keloid
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Pityriasis rosea
Deep branch of radial nerve

28. large fluid containing blisters seen in bullous pemphigoid
Carbonic anhydrase II
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Bulla
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

29. What are the bone mineralization lab findings in osteopetrosis
Recurrent branch of the medain nerve
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Serum ca - phos - alk phos are NL
Antibodies around cells of the epidermis in a reticular or netlike pattern

30. Which muscle laterally rotates and adducts arm
Myosin light chain phosphotase
Teres minor
Carbonic anhydrase II
Anti Scl70 - anti DNA topoisomerase I antibody

31. skin cancer associatd associated with excessive exposure to sunlight and arsenic
NC migration
Fibrinoid necrosis surrounded by palisading histiocytes
Female between 14 and 45 - mostly black
Squamous cell carcinoma

32. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Lower trunk of brachial plexus
Dermatitis herpetiformis
Median nerve - same fingers but not on the hand
Pustule

33. Patients with pagets disease can develop what cancer
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
ANA - sensitive but not specific
Osteogenic carcinoma
Verrucae vulgaris

34. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Glucocorticoids
The dermis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Renal - pulm - CV - GI - 75% female

35. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
HI shrinks - A stays same
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Polyostotic fibrous dysplasia
85% - advanced paternal age - or auto dominant inheritance

36. What is the Auspitz sign
Medial aspect
In psoriasis - bleeding spots when scales are scraped off
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Over deltoid

37. What are the bone mineral lab findings in paget's disease
Anterior interosseous nerve
Serum ca - phos - PTH are nl alk phos elevated
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

38. What muscles of the shoulder form the rotator cuff
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Medial 1.5 fingers - hypothenar eminence
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Pityriasis rosea

39. What do anterior and posterior in ACL and PCL refer to...
Sites of tibial attachment
B27 - no RF - males
Erythema multiforme - can be macules - papules vesicles - target lesions -
Radial nerve becomes compressed in axilla

40. What is the classic presentation of osteoarthritis
Verrucae
Pain in weight bearing joints at the end of the day and improving with rest
Acantholysis
Actinic keratosis

41. When do acute attacks of gout typically occur
Vesicle
Impetigo - s aureus - s pyogenes
After a large meal or EtOH conspumption
Phosphorylated

42. What does MLCK do in smooth muscle contraction
Psoriasis
Phosphorylates myosin light chain which leads to cross bridge formation
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Female between 14 and 45 - mostly black

43. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Spindle shaped cells with multinucleated giant cells
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Adductor policis brevis

44. What is the primary screening test for lupus
ANA - sensitive but not specific
Inc blood flow from AV shunts can cause high output heart failure
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

45. What causes total claw
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Supraspinatus - abducts the arm before the deltoid

46. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Serum ca - phos - PTH are nl alk phos elevated
Type III - RF
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
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

47. What other lesion can cause the appearnce of the ulnar claw
3rd finger
Rheumatoid arthritis
Anti - histone
Making fist with a proximal median nerve lesion

48. What does IM reveal in pemphigus vulgaris
Age - obesity and joint deformity
Axilla
Antibodies around cells of the epidermis in a reticular or netlike pattern
Plaque

49. epi of SLE
Spindle shaped cells with multinucleated giant cells
Calmodulin - complex activates myosin light chain kinase
Female between 14 and 45 - mostly black
Xeropthalmia - xerostomia - arthritis

50. hives - intensely pruritic wheals that form after mast cell degranulation
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Urticaria
Acanthosis
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head