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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. Where is C8 dermatome
4th and 5th finger
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Crust

2. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
AP depol opens voltage gated Ca channels - inducing NT release
Erythema multiforme - can be macules - papules vesicles - target lesions -
Osteoarthritis
Myosin

3. yellow when parallel and blue when perpendicular
Gout
Over deltoid
Acute back pain - loss of height - and kyphosis
Boutonniere - swan neck - zthumb

4. What do lupus pts falsely test positive for syphillis
Fibrinoid necrosis surrounded by palisading histiocytes
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
TB from dissemination and lyme dz
Anti - CCP - HLA- DR4

5. What do the lumbrical muscles do
Flex at the MCP
Precocious puberty
Posterior cord
ANA - sensitive but not specific

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

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7. What lesions causes Erb's palsy
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
In psoriasis - bleeding spots when scales are scraped off
Osteoarthritis
Upper trunk of brachial plexus

8. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Psoriasis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

9. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Outer arm
Medial 1.5 fingers - hypothenar eminence
Squamous cell carcinoma
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

10. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Pustule
Medial aspect
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
ANA - sensitive but not specific

11. What are characteristic findings of gout
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Albinism
Crust
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

12. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Parakeratosis
Increase in both osteoblast and osteoclast activity
Seborrheic keratosis

13. What deformities of the hand are common in RA
Boutonniere - swan neck - zthumb
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Ischial spine - relieve pain during delivery
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

14. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Endochondroma
Urticaria
Actinic keratosis - risk proportional to epithelial dysplasia
Parakeratosis

15. Where do sebhorrheic keratosis lesions occur and in who
Scleroderma
Intraepidermal bullae involving the skin and oral mucosa
Head - trunk - extremities - common benign neoplasm in older persons
Plaque

16. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Median nerve
Osteoporosis
Widespread skin involvment - rapid progression - early visceral involvement
GC and cGMP and inhibition of MLCK

17. What associations go along with sarcoidosis

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18. Achondroplasia is a failure of what process which results in which characteristic findings
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Muslce use - nerve stim/compound muscle test
85% - advanced paternal age - or auto dominant inheritance
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

19. Which type of muscle fiber is hypertrophied during weight training
HI shrinks - A stays same
Steroids
Type 2
Lichen planus

20. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Iliac crest
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Pemphigus vulgaris
Adductor policis brevis

21. In which form is myosin light chain active
Axilla
Long thoracic nerve
Paralysis of lateral rotators
Phosphorylated

22. Ca2+ released from the SR binds what structure and What does it cause
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
TB from dissemination and lyme dz
Radial nerve becomes compressed in axilla
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

23. which muscle type is fast twitch and why are fibers white
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Inc spinosum - dec granulosum
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Large goints (knee)

24. What is the TX for acute gout
NSAIDs (indomethacin) colchicine
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Atopic dermatitis - eczema

25. transiet vesicle seen in hives
Adductor policis brevis
Wheal
Rigor mortis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

26. What muscles of the shoulder form the rotator cuff
Osteoid osteoma
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Increase in both osteoblast and osteoclast activity
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

27. precipitation of monosodium urate crystals into joints due to hyperuricemia
Gout
Trauma
Flex at the MCP
Pseudogout

28. papule > 1cm seen psoriasis
Axillary - deltoid - skin over deltoid - flattened deltoid
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Plaque
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

29. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Lesioned by midshaft fracture of humerus
Cellulitis - s aureus - s pyogenes
Glucocorticoids
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

30. What are the potential causes of gout

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31. 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
Actin
Osteoarthritis
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

32. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Phosphorylates myosin light chain which leads to cross bridge formation
Wheal
Macule
Sarcoidosis - black females - ACE

33. What is the sensory def of an ulnar nerve injury
Medial 1.5 fingers - hypothenar eminence
Hairy leukoplakia - HIV population - EBV mediated
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Keloid

34. What development failure can results in albinism
NC migration
Post GI infxn or chlamydia
Serum ca - phos - alk phos are NL
Sites of tibial attachment

35. Which muscle fiber type is slow twitch and why are fibers red
Carbonic anhydrase II
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Scleroderma
Keloid

36. What are the motor defs of a proximal ulnar nerve injury
Lichen planus
Medial finger flexion - wrist flexion
Vesicle
Steroids

37. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Medial finger flexion - wrist flexion
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Scleroderma

38. Where is C6 dermatome
Connects cells to underlying extracellular - bullous pemphigoid
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

39. Where is T1 dermatome
Down T tubule
Medial forearm and arm to just under the axilla
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

40. What causes the symptoms of MG to worsen - and What is used to diagnose
Muslce use - nerve stim/compound muscle test
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Median nerve - same fingers but not on the hand
Polyostotic fibrous dysplasia

41. Which muscle laterally rotates and adducts arm
Teres minor
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Serum ca - phos - alk phos are NL
Renal - pulm - CV - GI - 75% female

42. What lesion causes wrist drop
Bulla
3rd finger
Posterior cord
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

43. hives - intensely pruritic wheals that form after mast cell degranulation
Anti ds DNA - poor prognosis
Gout
Acute back pain - loss of height - and kyphosis
Urticaria

44. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Anti - histone
Verrucae
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

45. Where are most osteoid osteoma found and In what population
Medial 1.5 fingers - hypothenar eminence
Spindle shaped cells with multinucleated giant cells
Anti - CCP - HLA- DR4
< 2mc found in proximal tibia and femur - men < 25

46. hyperpigmentation associated with pregnancy or OCP
Verrucae
Serum ca - phos - PTH are nl alk phos elevated
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Melasma (chloasma)

47. What is the primary screening test for lupus
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
ANA - sensitive but not specific
Pustule
Acantholysis

48. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Ischial spine - relieve pain during delivery
Osteoid osteoma
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

49. Decrease marrow space in osteopetrosis leads to what?
Type III - RF
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Atopic dermatitis - eczema

50. warts on hands
Corneum - lucidum - granulosum - spinosum - basalis
Anti ds DNA - poor prognosis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Verrucae vulgaris