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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. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
4th and 5th finger
Hairy leukoplakia - HIV population - EBV mediated
Endochondroma

2. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Post GI infxn or chlamydia
Albinism
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

3. What kind of endocrine abnl are associated with McCune Albright
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Integrin binds laminin in BM
Sarcoidosis - black females - ACE
Precocious puberty

4. What is the TX for chronic gout
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Allopurinaol - uricosurics (probenicid)
Dermatitis
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

5. What lesion causes winged scapula
Papule
Long thoracic nerve
Upper trunk of brachial plexus
Inc alk phos - abnl bone architecture

6. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
After a large meal or EtOH conspumption
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
Boutonniere - swan neck - zthumb

7. What are the possible origins of the paget's disease
Hyperkeratosis
Viral - maybe paramyxovirus
Medial aspect
Men and women > 70 - senile osteporosis

8. What are the signs of ulnar nerve injury

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9. What is CREST syndrome and What antibody is it associated with
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Axillary nerve
Median nerve - lunate bone

10. What is a very specific test for lupus
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Anti ds DNA - poor prognosis
Macule

11. What are the borders of the superficial branch of the radial nerve dermatone
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Phosphorylated

12. small fluid containing blister seen in chickenpox
Patch
Axillary nerve
Vesicle
Ischial spine - relieve pain during delivery

13. What are the bone mineralization lab findings in osteopetrosis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Cherry hemangioma
Serum ca - phos - alk phos are NL
Actinic keratosis - risk proportional to epithelial dysplasia

14. appreas in 30s to 40s - does not regress
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Cherry hemangioma
Squamous cell carcinoma
Medial forearm and arm to just under the axilla

15. What is a precursor to squamous cell carcinoma
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Actinic keratosis
Squamous cell carcinoma
Phosphate is liberated from the myosin head

16. How does the radial nerve in the spiral groove become injured
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Albinism
Verrucae
Lesioned by midshaft fracture of humerus

17. What molecule maintatins integrity of basement membrane and What does it bind
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Integrin binds laminin in BM
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

18. What does the positive anterior drawer sign test indicate
Tear of the ACL
Increase in both osteoblast and osteoclast activity
Myosin
Age - obesity and joint deformity

19. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Albinism
Median nerve
Lung
Allopurinaol - uricosurics (probenicid)

20. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Tear of the ACL
Xeropthalmia - xerostomia - arthritis

21. Dermatomyositis places the pt at inc risk For what malignancy in particular
Lung
Vesicle
Allopurinaol - uricosurics (probenicid)
Rigor mortis

22. How is diffuse scleroderma characterized
Axilla
MCP - PIP - no DIP
Widespread skin involvment - rapid progression - early visceral involvement
Dysplastic nevus

23. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Pityriasis rosea
Pemphigus vulgaris
< 2mc found in proximal tibia and femur - men < 25
After a large meal or EtOH conspumption

24. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Thymoma
Allopurinaol - uricosurics (probenicid)
Recurrent branch of the median nerve
Connects cells to underlying extracellular - bullous pemphigoid

25. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Lichen planus
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Age - obesity and joint deformity

26. inflammation of the skin
Radial nerve
Actinic keratosis
Elevated ESR and nl CK - prednisone
Dermatitis

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

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28. What is the test for drug induced lupus
GC and cGMP and inhibition of MLCK
Anti - histone
Median nerve - same fingers but not on the hand
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

29. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Atopic dermatitis - eczema
Plaque

30. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Allopurinaol - uricosurics (probenicid)
McCune - Albright syndrome
Lichen planus
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

31. What is contained within epithelial granulomas of pts with sarcoid
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
MCP - PIP - no DIP
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

32. What nerve is injured in a fracutre of the hook of hamate
Basophilic - rhomboid crystals - weakly birefringent
Melasma (chloasma)
Dermatomyositis
Ulnar nerve

33. What are the lab findings in pagets disease
Erythema nodosum
Inc alk phos - abnl bone architecture
GC and cGMP and inhibition of MLCK
Cherry hemangioma

34. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Hyperkeratosis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

35. What are the histo findings in an osteoclastoma
NSAIDs (indomethacin) colchicine
Spindle shaped cells with multinucleated giant cells
Dec estrogen causes inc bone resorption - postmenopausal
NC migration

36. What are the lab findings and TX in dermatomyositis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Adduct the fingers
Urticaria

37. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Outer arm
Ulnar deviation - subluxation - bakers cysts (behind knee)
Endochondroma

38. What causes compression of the C7 nerve root
Acantholysis
Precocious puberty
Median nerve
Cervical disk lesion

39. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Serum ca - phos - PTH are nl alk phos elevated
Female between 14 and 45 - mostly black
Pemphigus vulgaris
Tear of the ACL

40. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Ulnar nerve
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
In psoriasis - bleeding spots when scales are scraped off
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

41. What are characteristic findings of gout
S. aureus - streptococcus
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Post GI infxn or chlamydia

42. What is the sensory def of an ulnar nerve injury
Widespread skin involvment - rapid progression - early visceral involvement
Medial 1.5 fingers - hypothenar eminence
Ephelis
Renal - pulm - CV - GI - 75% female

43. What is below the epidermis
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Osteoarthritis
The dermis
Ulnar nerve - intrinsic muscles of hand

44. What is the primary screening test for lupus
ANA - sensitive but not specific
Axilla
< 2mc found in proximal tibia and femur - men < 25
Recurrent branch of the medain nerve

45. Where is McBurney's point and What is there
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
HI shrinks - A stays same

46. What do anterior and posterior in ACL and PCL refer to...
Head - trunk - extremities - common benign neoplasm in older persons
Anti ds DNA - poor prognosis
Sites of tibial attachment
In psoriasis - bleeding spots when scales are scraped off

47. What causes ape hand
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
NSAIDs (indomethacin) colchicine
Increase in both osteoblast and osteoclast activity
Impetigo - s aureus - s pyogenes

48. What is the defect in Paget's disease
Men and women > 70 - senile osteporosis
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Increase in both osteoblast and osteoclast activity
Ewings sarcoma - aggressive with early mets - but responsive to chemo

49. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Anti - CCP - HLA- DR4
Musculocutaneous
Gout
Impetigo - s aureus - s pyogenes

50. freckle - normal number of melanocytes - inc melanin pigment
Serum ca - phos - alk phos are NL
Dermatomyositis
Ephelis
Paralysis of abductors