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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. Which type of muscle fiber is hypertrophied during weight training
Radial nerve
Type 2
Posterior cord
Boutonniere - swan neck - zthumb

2. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Melasma (chloasma)
Anti Smith
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Parakeratosis

3. What lesion causes wrist drop
Dysplastic nevus
HI shrinks - A stays same
Posterior cord
Myosin light chain phosphotase

4. What are the characteristic bone findings in paget's disease
Anti Smith
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

5. Decrease marrow space in osteopetrosis leads to what?
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Myosin
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Medial aspect

6. which muscle type is fast twitch and why are fibers white
Head - trunk - extremities - common benign neoplasm in older persons
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Making fist with a proximal median nerve lesion
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

7. What are the lab findings in osteopetrosis
Nl - thickened dense bones
Musculocutaneous
Abduct the fingers
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

8. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Erlenmeyer flask bones that flare out - narrowed foramina
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Radial nerve becomes compressed in axilla

9. What does IM reveal in pemphigus vulgaris
Actinic keratosis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Long thoracic nerve
Antibodies around cells of the epidermis in a reticular or netlike pattern

10. What causes heart failure in with Paget's disease
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
B27 - no RF - males
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Inc blood flow from AV shunts can cause high output heart failure

11. What medication is contraindicated in osteoporosis
Dermatitis
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Glucocorticoids
Carbonic anhydrase II

12. loss of what muscles in Erbs causes the medial rotation
Renal - pulm - CV - GI - 75% female
Paralysis of lateral rotators
The dermis
NC migration

13. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
85% - advanced paternal age - or auto dominant inheritance

14. What are the characterstic joints affected in RA
Ligand binding leads to muscle depol
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Serum ca - phos - alk phos are NL
MCP - PIP - no DIP

15. What causes the symptoms of MG to worsen - and What is used to diagnose
Fibrinoid necrosis surrounded by palisading histiocytes
Basophilic - rhomboid crystals - weakly birefringent
Muslce use - nerve stim/compound muscle test
Boutonniere - swan neck - zthumb

16. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
TB from dissemination and lyme dz
Basophilic - rhomboid crystals - weakly birefringent
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Exercise and Ca ingestion before age 30

17. What causes total claw
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Tear of the ACL

18. What is the Sicca syndrome
Vitiligo - dec number in melanocytes
Over deltoid
Albinism
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

19. What is the precursor to melanom
Wheal
Posterior cord
Dysplastic nevus
Men and women > 70 - senile osteporosis

20. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Papule
Actinic keratosis - risk proportional to epithelial dysplasia
3rd finger
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

21. What is the most common NMJ disorder - What causes it and What are common symptoms
Serum ca - phos - PTH are nl alk phos elevated
Spindle shaped cells with multinucleated giant cells
Acute back pain - loss of height - and kyphosis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

22. What enzyme defect in responsible for osteopetrosis
Pityriasis rosea
Carbonic anhydrase II
AP depol opens voltage gated Ca channels - inducing NT release
Posterior cord

23. What do anterior and posterior in ACL and PCL refer to...
Osteoporosis
Sites of tibial attachment
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Outer arm

24. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Verrucae
Female between 14 and 45 - mostly black
Interossei and adductor policis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

25. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Phosphorylated
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Anti Scl70 - anti DNA topoisomerase I antibody
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

26. What lesion causes total claw (klumpke's hand)
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Lower trunk of brachial plexus
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

27. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Gout
Age - obesity and joint deformity
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

28. Where does cartilage loss begin in osteoarthritis
Myosin
B27 - no RF - males
Medial aspect
MCP - PIP - no DIP

29. blister containing pus
Erythema multiforme - can be macules - papules vesicles - target lesions -
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Pustule
Lesioned by midshaft fracture of humerus

30. Through what pathway does NO work and What is the downstream effect
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Steroids
Parakeratosis
GC and cGMP and inhibition of MLCK

31. What signal initiates a muscle contraction
Parotid enlargement - inc risk of B cell lymphoma - dental caries
AP depol opens voltage gated Ca channels - inducing NT release
Patch
Pseudogout

32. Patients with pagets disease can develop what cancer
Dec estrogen causes inc bone resorption - postmenopausal
Osteogenic carcinoma
Ulnar deviation - subluxation - bakers cysts (behind knee)
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

33. what changes are seen in stratum spinosum and granulosum in psoriasis
After a large meal or EtOH conspumption
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Inc spinosum - dec granulosum
Connects cells to underlying extracellular - bullous pemphigoid

34. What does PED and Tip stand for

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35. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Median nerve - lunate bone
Polymyositis - shoulders - perifasicular inflammation
Myosin
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

36. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Impetigo - s aureus - s pyogenes
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

37. What is below the epidermis
Ulnar nerve - intrinsic muscles of hand
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
The dermis
Anti Smith

38. What antibody is less sensitive than RF but more specific and What is the HLA association
Anti - CCP - HLA- DR4
Deep branch of radial nerve
ANA - sensitive but not specific
Carbonic anhydrase II

39. What are the systemic symptoms found in RA
Medial finger flexion - wrist flexion
Inc alk phos - abnl bone architecture
Fever - fatigue - pleuritis - pericarditis
Axilla

40. osteochondrosis has rare malignant transformation into what cancer
Anti - histone
Expansile glistening mass within the medullary cavity
Outer arm
Chondrosarcoma

41. What is contained within epithelial granulomas of pts with sarcoid
Men and women > 70 - senile osteporosis
Polymyositis - shoulders - perifasicular inflammation
Iliac crest
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

42. What happens at the gap jxn and what molecules create them
S. aureus - streptococcus
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Acute back pain - loss of height - and kyphosis

43. large fluid containing blisters seen in bullous pemphigoid
Patch
Age - obesity and joint deformity
Bulla
Medial aspect

44. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Albinism
Anti - histone

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

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46. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Recurrent branch of the median nerve
Osteoporosis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

47. What is the source of osteoblast cells
Median nerve - lunate bone
Mesenchymal stem cells in periosteum
Lung
Nl - decreased bone mass

48. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Actinic keratosis - risk proportional to epithelial dysplasia
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Median nerve - same fingers but not on the hand

49. Which muscle is the most common rotator cuff injury and What does it do
The dermis
Vesicle
Pityriasis rosea
Supraspinatus - abducts the arm before the deltoid

50. What is the sign of Leser - Trelat
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Metaphysis of long bones - distal femur
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Rigor mortis