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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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1. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Osteopetrosis - abnl fxn of osteoclasts
Connects cells to underlying extracellular - bullous pemphigoid
Head - trunk - extremities - common benign neoplasm in older persons
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

2. Achondroplasia is a failure of what process which results in which characteristic findings
Medial forearm and arm to just under the axilla
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Post GI infxn or chlamydia
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

3. What does I'M DAMN SHARP stand for
Sarcoidosis - black females - ACE
Serum ca - phos - alk phos are NL
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

4. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Endochondroma
Female between 14 and 45 - mostly black
Paralysis of abductors
Erythema multiforme - can be macules - papules vesicles - target lesions -

5. yellow when perpendicular and blue when parallel
Carbonic anhydrase II
B27 - no RF - males
Pseudogout
Paralysis of lateral rotators

6. What autoantibodies are formed in sjogrens syndrome
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Steroids
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

7. What are the lab findings in osteitis fibrosa cystica
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Rigor mortis
Papule
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

8. Other than N. gono - what organisms can cause infectious - septic arthritis
Fever - fatigue - pleuritis - pericarditis
S. aureus - streptococcus
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

9. What nerve is compressed by supracondylar fracture of humerus
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Median nerve
Long thoracic nerve
Supraspinatus - abducts the arm before the deltoid

10. What are the subQ rheumatoid nodules made of...
Widespread skin involvment - rapid progression - early visceral involvement
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Polyostotic fibrous dysplasia
Fibrinoid necrosis surrounded by palisading histiocytes

11. What is a precursor to squamous cell carcinoma
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Actinic keratosis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Upper trunk of brachial plexus

12. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Posterior cord
Lichen planus
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

13. What does MLCK do in smooth muscle contraction
< 2mc found in proximal tibia and femur - men < 25
Phosphorylates myosin light chain which leads to cross bridge formation
Anti - CCP - HLA- DR4
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

14. elevated skin lesion <1cm seen in acne vulgaris
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Expansile glistening mass within the medullary cavity
Papule
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

15. What do palmar interosseous muscles do
Papule
Pemphigus vulgaris
Adduct the fingers
Condyloma acuminatum - caused by HPV

16. What is the sign of Leser - Trelat
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Actin
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

17. What are the classic fractures in pts with osteoporosis

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18. What do xray show in osteopetrosis and What do potential CN abnl result from
Recurrent branch of the median nerve
Abduct the fingers
Erlenmeyer flask bones that flare out - narrowed foramina
Albinism

19. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Cellulitis - s aureus - s pyogenes
Down T tubule
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

20. What kind of bone tumor is associated with FAP and What is the finding
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
GC and cGMP and inhibition of MLCK
Adduct the fingers
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

21. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Antibodies around cells of the epidermis in a reticular or netlike pattern
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Inc blood flow from AV shunts can cause high output heart failure

22. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Precocious puberty
Renal - pulm - CV - GI - 75% female

23. What are the possible origins of the paget's disease
Phosphate is liberated from the myosin head
Viral - maybe paramyxovirus
Lesioned by midshaft fracture of humerus
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign

24. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Actin
Mesenchymal stem cells in periosteum
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

25. What causes total claw
Intraepidermal bullae involving the skin and oral mucosa
Psoriasis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

26. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
4th and 5th finger
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Nl - thickened dense bones
Sarcoidosis - black females - ACE

27. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Osteogenic carcinoma
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Anti - histone
Medially rotates and adducts arm

28. What are the potential causes of gout

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29. What are the signs of ulnar nerve injury

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30. What are the motor defs of a proximal ulnar nerve injury
Men and women > 70 - senile osteporosis
Osteoarthritis
Medial finger flexion - wrist flexion
Myosin releases bound ADP and is displaced on the actin filament

31. small fluid containing blister seen in chickenpox
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Vesicle
Calmodulin - complex activates myosin light chain kinase
Nl - thickened dense bones

32. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Psoriasis
Pemphigus vulgaris
Pseudogout
Inc spinosum - dec granulosum

33. Where is C4 dermatome
Rigor mortis
Thymoma
Over deltoid
Spindle shaped cells with multinucleated giant cells

34. What deformities of the hand are common in RA
Lower trunk of brachial plexus
Acute back pain - loss of height - and kyphosis
Boutonniere - swan neck - zthumb
AP depol opens voltage gated Ca channels - inducing NT release

35. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Sites of tibial attachment
Scleroderma
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Keloid

36. epi of SLE
Female between 14 and 45 - mostly black
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Radial nerve

37. What lesion causes winged scapula
Long thoracic nerve
Cervical disk lesion
Osteosarcoma - multiple myeloma
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

38. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Widespread skin involvment - rapid progression - early visceral involvement
Erlenmeyer flask bones that flare out - narrowed foramina
Metaphysis of long bones - distal femur
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

39. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Lung
Osteoarthritis
Radial nerve becomes compressed in axilla

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

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41. Macule greater than 1cm
Rigor mortis
Dermatitis
Patch
Actinic keratosis

42. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Dermatitis
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
HI shrinks - A stays same
Median nerve

43. Who does osteoporosis type 2 effect
Long thoracic nerve
Men and women > 70 - senile osteporosis
Age - obesity and joint deformity
Chondrosarcoma

44. Where is McBurney's point and What is there
Vesicle
Connects cells to underlying extracellular - bullous pemphigoid
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

45. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Osteoblastoma
Adduct the fingers
Polymyositis - shoulders - perifasicular inflammation
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

46. epidermal hyperplasia (inc spinosum)
Medial 1.5 fingers - hypothenar eminence
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Acanthosis

47. What is the classic presentation of osteoarthritis
Type 2
Pain in weight bearing joints at the end of the day and improving with rest
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

48. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Medial forearm and arm to just under the axilla
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

49. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Crohns and ulcerative colitis
Metaphysis of long bones - distal femur

50. How is diffuse scleroderma characterized
The dermis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Widespread skin involvment - rapid progression - early visceral involvement