Test your basic knowledge |

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 is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Phosphorylated
Ulnar nerve - intrinsic muscles of hand
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

2. freckle - normal number of melanocytes - inc melanin pigment
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Ephelis
HI shrinks - A stays same

3. What do lupus pts falsely test positive for syphillis
Hairy leukoplakia - HIV population - EBV mediated
Down T tubule
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Erythema nodosum

4. What does soft bones result from and What is the dz called in adults and children
Trauma
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Bulla

5. blister containing pus
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Pustule
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

6. What do palmar interosseous muscles do
Adduct the fingers
Serum ca - phos - PTH are nl alk phos elevated
Osteosarcoma - multiple myeloma
Pemphigus vulgaris

7. What is CREST syndrome and What antibody is it associated with
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Osteogenic carcinoma
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

8. What are the most common symtpoms of SLE
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Intraepidermal bullae involving the skin and oral mucosa
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

9. What enzyme defect in responsible for osteopetrosis
Phosphorylates myosin light chain which leads to cross bridge formation
Carbonic anhydrase II
Widespread skin involvment - rapid progression - early visceral involvement
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

10. Where is C6 dermatome
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Keratoacanthoma
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

11. What muscles of the shoulder form the rotator cuff
Axilla
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Down T tubule
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

12. When do acute attacks of gout typically occur
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Radial nerve becomes compressed in axilla
After a large meal or EtOH conspumption

13. What are the classic fractures in pts with osteoporosis

14. What does ATP do in skeletal muscle contraction
Recurrent branch of the median nerve
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Men and women > 70 - senile osteporosis
Female between 14 and 45 - mostly black

15. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Cervical disk lesion
Ulnar nerve
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
85% - advanced paternal age - or auto dominant inheritance

16. What are the borders of the superficial branch of the radial nerve dermatone
Intraepidermal bullae involving the skin and oral mucosa
Crohns and ulcerative colitis
Type III - RF
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

17. What is the defect in Paget's disease
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Pseudogout
Increase in both osteoblast and osteoclast activity
Osteoarthritis

18. which muscle type is fast twitch and why are fibers white
Outer arm
Paralysis of lateral rotators
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

19. What lesion causes deltoid paralysis
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ulnar nerve - intrinsic muscles of hand
Axillary nerve
Dysplastic nevus

20. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Inc alk phos - abnl bone architecture
Osteoporosis
Precocious puberty
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

21. What are the common perpetrating infections for Reiters syndrome
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Post GI infxn or chlamydia
Adduct the fingers
B27 - no RF - males

22. What are predisposing factors for osteosarcoma - xray finding

23. separation of epidermal cells
Actinic keratosis
Scleroderma
Acantholysis
Flex at the MCP

24. What nerve become injured in the incorrect use of a crutch
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Radial nerve becomes compressed in axilla
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Flex the MCP joints and extend both the DIP and PIP joints

25. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
In psoriasis - bleeding spots when scales are scraped off
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Anti Smith
Ulnar

26. What are the potential causes of gout

27. papule > 1cm seen psoriasis
Head - trunk - extremities - common benign neoplasm in older persons
Plaque
Adductor policis brevis
Osteogenic carcinoma

28. What medication is contraindicated in osteoporosis
Anti - histone
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Glucocorticoids

29. What do pseudogout crystals appear like microscopically
Deep branch of radial nerve
Basophilic - rhomboid crystals - weakly birefringent
Phosphate is liberated from the myosin head
B27 - no RF - males

30. What is below the epidermis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
The dermis
Calmodulin - complex activates myosin light chain kinase
Myosin light chain phosphotase

31. What is the classic traid of sjogrens syndrome
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Xeropthalmia - xerostomia - arthritis
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Anti Smith

32. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Keratoacanthoma
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Actin

33. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Trauma
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Endochondroma

34. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Adductor policis brevis
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

35. Where is T1 dermatome
Medial forearm and arm to just under the axilla
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Staph scalded skin syndrome
Down T tubule

36. inflammation of the skin
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Rheumatoid arthritis
Acanthosis
Dermatitis

37. What enzyme is necessary for smooth muscle relaxation after contraction
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Cellulitis - s aureus - s pyogenes
Myosin light chain phosphotase
Myosin

38. In which form is myosin light chain active
Phosphorylated
Impetigo - s aureus - s pyogenes
Phosphate is liberated from the myosin head
Down T tubule

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

40. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Obturator - thigh adduction - medial thigh
Median nerve - lunate bone
Dermatomyositis

41. What does I'M DAMN SHARP stand for
Acanthosis
Hairy leukoplakia - HIV population - EBV mediated
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Hyperkeratosis

42. What development failure can results in albinism
Nl - thickened dense bones
NC migration
Median nerve
Inc spinosum - dec granulosum

43. What causes compression of the C7 nerve root
Ulnar
Cervical disk lesion
The dermis
Muslce use - nerve stim/compound muscle test

44. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

45. What lesion causes total claw (klumpke's hand)
Teres minor
Lower trunk of brachial plexus
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Iliac crest

46. What lesion causes dec in thumb fxn 'ape hand'
In psoriasis - bleeding spots when scales are scraped off
Median nerve
Ulnar nerve
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

47. What does MLCK do in smooth muscle contraction
Bulla
NSAIDs (indomethacin) colchicine
Myosin
Phosphorylates myosin light chain which leads to cross bridge formation

48. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Strawberry hemangioma
NSAIDs (indomethacin) colchicine
Median nerve - lunate bone
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

49. What are the systemic symptoms found in RA
Head - trunk - extremities - common benign neoplasm in older persons
Fever - fatigue - pleuritis - pericarditis
Squamous cell carcinoma
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

50. What is the classic presentation of osteoarthritis
GC and cGMP and inhibition of MLCK
Musculocutaneous
Radial nerve becomes compressed in axilla
Pain in weight bearing joints at the end of the day and improving with rest