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Musculoskeletal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What are the lab findings and TX in dermatomyositis
Plaque
Verrucae vulgaris
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Paralysis of abductors

2. What causes the symptoms of MG to worsen - and What is used to diagnose
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Elevated ESR and nl CK - prednisone
Muslce use - nerve stim/compound muscle test
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

3. What enzyme defect in responsible for osteopetrosis
Carbonic anhydrase II
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Ulnar nerve
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

4. What is the defect in Paget's disease
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Increase in both osteoblast and osteoclast activity
MCL - ACL - lateral meniscus (esp in athletes)
Basal cell carcinoma - pearly papules - commonly with telangiectasias

5. What kind of jxn is the zona occludens andw What is is composed of...
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Acanthosis nigcricans
Boutonniere - swan neck - zthumb
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

6. What clinical features in vertebral crush fractures
Psoriasis
Acute back pain - loss of height - and kyphosis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Increase in both osteoblast and osteoclast activity

7. What causes osteoporosis type 1 and When does it typically occur
Condyloma acuminatum - caused by HPV
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Fever - fatigue - pleuritis - pericarditis
Dec estrogen causes inc bone resorption - postmenopausal

8. inflammation of the skin
Lichen planus
Dermatitis
Median nerve - same fingers but not on the hand
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

9. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Abduct the fingers
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Endochondroma

10. What are the associations for sjogrens syndrome
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Metaphysis of long bones - distal femur
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Parotid enlargement - inc risk of B cell lymphoma - dental caries

11. What does the positive anterior drawer sign test indicate
Tear of the ACL
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Lower trunk of brachial plexus
Increase in both osteoblast and osteoclast activity

12. In smooth muscle contraction - What does Ca bind and What is the purpose
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Calmodulin - complex activates myosin light chain kinase
Osteoblastoma
Post GI infxn or chlamydia

13. common mole - benign
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Median nerve
Nevocellular nevus
Medial aspect

14. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Verrucae
Large goints (knee)
Erythema multiforme - can be macules - papules vesicles - target lesions -
Ulnar nerve

15. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Supraspinatus - abducts the arm before the deltoid
Osteoporosis
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

16. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Macule
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Rigor mortis

17. What are common features of lupus
Abduct the fingers
Median nerve - lunate bone
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

18. What does injury to the distal median nerve cause

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19. What are the borders of the superficial branch of the radial nerve dermatone
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Ulnar nerve
McCune - Albright syndrome

20. What does IM reveal in pemphigus vulgaris
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Antibodies around cells of the epidermis in a reticular or netlike pattern
Lichen planus

21. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Impetigo - s aureus - s pyogenes
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Medial forearm and arm to just under the axilla
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

22. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Ulnar nerve - intrinsic muscles of hand
Connects cells to underlying extracellular - bullous pemphigoid
Iliac crest
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

23. What does subscapularis do
Plaque
MCP - PIP - no DIP
ANA - sensitive but not specific
Medially rotates and adducts arm

24. What are the lab findings in osteoporosis
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Rigor mortis
4th and 5th finger
Nl - decreased bone mass

25. What lesion causes total claw (klumpke's hand)
Lower trunk of brachial plexus
Lung
Osteoarthritis
The dermis

26. What kind of bone tumor is associated with FAP and What is the finding
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Type III - RF
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

27. yellow when parallel and blue when perpendicular
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Gout
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Erlenmeyer flask bones that flare out - narrowed foramina

28. What nerve become injured in the incorrect use of a crutch
Antibodies around cells of the epidermis in a reticular or netlike pattern
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Radial nerve becomes compressed in axilla
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

29. IBS - 2 dz's
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Crohns and ulcerative colitis
Hyperkeratosis
Corneum - lucidum - granulosum - spinosum - basalis

30. What are the lab findings in pagets disease
Bulla
Inc alk phos - abnl bone architecture
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

31. What do anterior and posterior in ACL and PCL refer to...
Lesioned by midshaft fracture of humerus
Osteopetrosis - abnl fxn of osteoclasts
Pseudogout
Sites of tibial attachment

32. In which form is myosin light chain active
Phosphorylated
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Nl - thickened dense bones

33. What does injury to the distal ulnar nerve cause
Flex at the MCP
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Impetigo - s aureus - s pyogenes
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

34. inc thickness of stratum corneum seen in psoriasis
Sarcoidosis - black females - ACE
Median nerve - same fingers but not on the hand
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Hyperkeratosis

35. small fluid containing blister seen in chickenpox
Vesicle
Vitiligo - dec number in melanocytes
Long thoracic nerve
Musculocutaneous

36. What are the most common symtpoms of SLE
Pseudogout
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Myosin light chain phosphotase
Medial aspect

37. warts on hands
Verrucae vulgaris
Ulnar nerve - intrinsic muscles of hand
Infraspinatus - laterally rotates arm
Anti ds DNA - poor prognosis

38. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Wheal
Polymyositis - shoulders - perifasicular inflammation
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Endochondroma

39. How does gonococcal arthritis present
Allopurinaol - uricosurics (probenicid)
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Serum ca - phos - alk phos are NL
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

40. What is the Sicca syndrome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Seborrheic keratosis
Axilla
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

41. What is the power stroke of muscle contraction
Myosin releases bound ADP and is displaced on the actin filament
Axilla
Anti Scl70 - anti DNA topoisomerase I antibody
Nevocellular nevus

42. What are defining lab findings for polymyalgia rheumatica and What is the TX
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Elevated ESR and nl CK - prednisone
GC and cGMP and inhibition of MLCK
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

43. What antibodies is diffuse scleroderma associated with
Abduct the fingers
Acantholysis
Anti - CCP - HLA- DR4
Anti Scl70 - anti DNA topoisomerase I antibody

44. Macule greater than 1cm
Patch
Rheumatoid arthritis
Osteochondroma - exostosis
Large goints (knee)

45. Damage to what 3 structures is common for the unhappy triad
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Crohns and ulcerative colitis
MCL - ACL - lateral meniscus (esp in athletes)
Connects cells to underlying extracellular - bullous pemphigoid

46. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Ulnar deviation - subluxation - bakers cysts (behind knee)
Pemphigus vulgaris
Sites of tibial attachment
S. aureus - streptococcus

47. How is diffuse scleroderma characterized
Ulnar deviation - subluxation - bakers cysts (behind knee)
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)
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

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

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49. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Median nerve
Ulnar nerve
Sarcoidosis - black females - ACE
Condyloma acuminatum - caused by HPV

50. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Actin
McCune - Albright syndrome
Axilla