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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. osteochondrosis has rare malignant transformation into what cancer
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Seborrheic keratosis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Chondrosarcoma

2. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
AP depol opens voltage gated Ca channels - inducing NT release
ANA - sensitive but not specific
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

3. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Ulnar nerve
Female between 14 and 45 - mostly black
3rd finger
Ulnar nerve - fracture of hook of hamate

4. What is the defect in Paget's disease
Increase in both osteoblast and osteoclast activity
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
McCune - Albright syndrome
Corneum - lucidum - granulosum - spinosum - basalis

5. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Actinic keratosis - risk proportional to epithelial dysplasia
Osteoid osteoma
Ulnar nerve - intrinsic muscles of hand

6. What runs the distance of the A band
Seborrheic keratosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Myosin
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

7. inflammation of the skin
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Dermatitis
Anti ds DNA - poor prognosis

8. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Widespread skin involvment - rapid progression - early visceral involvement
Xeropthalmia - xerostomia - arthritis
B27 - no RF - males

9. What are defining lab findings for polymyalgia rheumatica and What is the TX
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Elevated ESR and nl CK - prednisone
Vitiligo - dec number in melanocytes
Conjunctivitis and anterior uveitis - urethritis and arthritis

10. What happens in the power stroke of skeletal muscle contraction
Phosphate is liberated from the myosin head
Condyloma acuminatum - caused by HPV
Recurrent branch of the median nerve
Steroids

11. What are common features of lupus
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Nl - thickened dense bones
< 2mc found in proximal tibia and femur - men < 25

12. transiet vesicle seen in hives
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Psoriasis
Over deltoid
Wheal

13. What are the most common symtpoms of SLE
Expansile glistening mass within the medullary cavity
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

14. What does abnl passive abduction of the knee indicate
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Torn MCL
Dec estrogen causes inc bone resorption - postmenopausal
Pemphigus vulgaris

15. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Cellulitis - s aureus - s pyogenes
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

16. What nerve is compressed by supracondylar fracture of humerus
Embryologic - childbirth defect - cervical rib compression - atrophy of the thenar and hypothenar eminences - atrophy of interosseous muscles - sensory deficits of the medial side of the forearm and hand - disappearance of the radial pulse upon movin
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Median nerve
Adductor policis brevis

17. What other lesion can cause the appearnce of the ulnar claw
Expansile glistening mass within the medullary cavity
Making fist with a proximal median nerve lesion
4th and 5th finger
Anti ds DNA - poor prognosis

18. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Axillary - deltoid - skin over deltoid - flattened deltoid
HI shrinks - A stays same
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

19. What are the lab findings in osteitis fibrosa cystica
Keloid
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Actinic keratosis - risk proportional to epithelial dysplasia
Xeropthalmia - xerostomia - arthritis

20. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Albinism
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

21. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Osteoblastoma
Scleroderma
Type 2
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

22. Macule greater than 1cm
Upper trunk of brachial plexus
Patch
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Myosin light chain phosphotase

23. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Elevated ESR and nl CK - prednisone
Adduct the fingers

24. What are the possible origins of the paget's disease
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Viral - maybe paramyxovirus
Head - trunk - extremities - common benign neoplasm in older persons

25. 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
Adduct the fingers
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Macule

26. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Ulnar
Anti - histone
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
GC and cGMP and inhibition of MLCK

27. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Patch
Median nerve - same fingers but not on the hand
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Infraspinatus - laterally rotates arm

28. What do lupus pts falsely test positive for syphillis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
85% - advanced paternal age - or auto dominant inheritance
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

29. Patients with pagets disease can develop what cancer
Post GI infxn or chlamydia
Spindle shaped cells with multinucleated giant cells
Gout
Osteogenic carcinoma

30. What are the thin lines along the Z line
Sarcoidosis - black females - ACE
Actin
Osteoarthritis
Elevated ESR and nl CK - prednisone

31. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
S. aureus - streptococcus
Renal - pulm - CV - GI - 75% female
Dermatitis
Pustule

32. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
MCL - ACL - lateral meniscus (esp in athletes)
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Scleroderma

33. What other muscle in the thenar eminence adducts the thumb
Embryologic - childbirth defect - cervical rib compression - atrophy of the thenar and hypothenar eminences - atrophy of interosseous muscles - sensory deficits of the medial side of the forearm and hand - disappearance of the radial pulse upon movin
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Adductor policis brevis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

34. What causes total claw
Myosin releases bound ADP and is displaced on the actin filament
Nl - thickened dense bones
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Verrucae

35. What lesion causes dec in thumb fxn 'ape hand'
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Median nerve
Ulnar deviation - subluxation - bakers cysts (behind knee)

36. What are the causes of inferior trunk plexus compression and What are the findings
Dec estrogen causes inc bone resorption - postmenopausal
Pustule
NC migration
Embryologic - childbirth defect - cervical rib compression - atrophy of the thenar and hypothenar eminences - atrophy of interosseous muscles - sensory deficits of the medial side of the forearm and hand - disappearance of the radial pulse upon movin

37. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Radial nerve becomes compressed in axilla
Osteochondroma - exostosis
Endochondroma
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

38. What lesion causes difficulty flexing elbow with variable sensory loss
85% - advanced paternal age - or auto dominant inheritance
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Musculocutaneous
AP depol opens voltage gated Ca channels - inducing NT release

39. small fluid containing blister seen in chickenpox
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Muslce use - nerve stim/compound muscle test
Biceps
Vesicle

40. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Crohns and ulcerative colitis
Ephelis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Osteopetrosis - abnl fxn of osteoclasts

41. What does injury to the distal ulnar nerve cause
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
GC and cGMP and inhibition of MLCK

42. What is the TX for acute gout
Lichen planus
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
NSAIDs (indomethacin) colchicine
Serum ca - phos - alk phos are NL

43. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Osteoblastoma
Obturator - thigh adduction - medial thigh
Actinic keratosis

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

45. irregular areas of complete depigmentation - condition and cause
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
NSAIDs (indomethacin) colchicine
Vitiligo - dec number in melanocytes
Osteopetrosis - abnl fxn of osteoclasts

46. What do palmar interosseous muscles do
Ulnar
Paralysis of lateral rotators
Adduct the fingers
Teres minor

47. precipitation of monosodium urate crystals into joints due to hyperuricemia
Ulnar nerve
Gout
Expansile glistening mass within the medullary cavity
Infraspinatus - laterally rotates arm

48. What are the borders of the superficial branch of the radial nerve dermatone
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Thymoma
Dysplastic nevus

49. common mole - benign
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Nevocellular nevus
Dermatitis herpetiformis
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

50. knee trauma - nerve - motor and sensory def
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Palisading