Test your basic knowledge |

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. What causes the symptoms of MG to worsen - and What is used to diagnose
Erythema nodosum
Vesicle
Muslce use - nerve stim/compound muscle test
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

2. What do pseudogout crystals appear like microscopically
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Type III - RF
Psoriasis
Basophilic - rhomboid crystals - weakly birefringent

3. What lesion causes deltoid paralysis
Erlenmeyer flask bones that flare out - narrowed foramina
Axillary nerve
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

4. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Osteoporosis
Keratoacanthoma
Actinic keratosis

5. What kind of nuclei do basal cell tumors have
Cervical disk lesion
Palisading
Long thoracic nerve
Supraspinatus - abducts the arm before the deltoid

6. What does injury to the distal median nerve cause

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7. What lesion causes Saturday night wrist drop
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Radial nerve
Osteogenic carcinoma

8. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Cellulitis - s aureus - s pyogenes
Fibrinoid necrosis surrounded by palisading histiocytes
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

9. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Verrucae
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Anti Smith
Lichen planus

10. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Crust
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Flex at the MCP
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

11. Through what pathway does NO work and What is the downstream effect
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Large goints (knee)
Widespread skin involvment - rapid progression - early visceral involvement
GC and cGMP and inhibition of MLCK

12. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Subclavius
Myosin
Bulla

13. What is the classic triad of reactive arthritis
Making fist with a proximal median nerve lesion
Dec estrogen causes inc bone resorption - postmenopausal
Medial finger flexion - wrist flexion
Conjunctivitis and anterior uveitis - urethritis and arthritis

14. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Recurrent branch of the median nerve
Impetigo - s aureus - s pyogenes
Over deltoid
AP depol opens voltage gated Ca channels - inducing NT release

15. Which muscle laterally rotates and adducts arm
Atopic dermatitis - eczema
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Keloid
Teres minor

16. What muscles of the shoulder form the rotator cuff
Inc blood flow from AV shunts can cause high output heart failure
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Intraepidermal bullae involving the skin and oral mucosa
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

17. 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
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

18. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Infraspinatus - laterally rotates arm
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Hyperkeratosis

19. What are the lab findings in pagets disease
Inc alk phos - abnl bone architecture
Nevocellular nevus
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Pustule

20. small fluid containing blister seen in chickenpox
Vesicle
Infraspinatus - laterally rotates arm
Posterior cord
Abduct the fingers

21. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Anti Smith
Median nerve - lunate bone
Keloid
In psoriasis - bleeding spots when scales are scraped off

22. What does ATP do in skeletal muscle contraction
Albinism
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Crust
Dermatitis herpetiformis

23. What is the classic presentation of osteoarthritis
Pain in weight bearing joints at the end of the day and improving with rest
Seborrheic keratosis
Anterior interosseous nerve
Inc alk phos - abnl bone architecture

24. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
Osteoarthritis
Myosin
NSAIDs (indomethacin) colchicine

25. What is contained within epithelial granulomas of pts with sarcoid
Lung
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Expansile glistening mass within the medullary cavity
Vitiligo - dec number in melanocytes

26. What is the primary screening test for lupus
Albinism
Upper trunk of brachial plexus
Median nerve - same fingers but not on the hand
ANA - sensitive but not specific

27. What are the thin lines along the Z line
Actin
Ligand binding leads to muscle depol
Adductor policis brevis
Lower trunk of brachial plexus

28. What kind of jxn is in the zona adherens and Where is it - What is it composed of - and what ion does it does it depend on...
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Ephelis
Nl - thickened dense bones

29. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
ANA - sensitive but not specific
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

30. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Tear of the ACL
Dermatitis herpetiformis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

31. What supplies innervation to the thenar muscles
Teres minor
Vesicle
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Recurrent branch of the median nerve

32. What is the classic presentation of RA
Inc blood flow from AV shunts can cause high output heart failure
Ischial spine - relieve pain during delivery
Serum ca - phos - alk phos are NL
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

33. What causes compression of the C7 nerve root
Median nerve
Cervical disk lesion
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

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

35. Thenar eminence - nerve and muscles
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Vitiligo - dec number in melanocytes
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

36. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
AP depol opens voltage gated Ca channels - inducing NT release
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Biceps
Type III - RF

37. Macule greater than 1cm
Xeropthalmia - xerostomia - arthritis
Large goints (knee)
Patch
Osteogenic carcinoma

38. inflammation of the skin
Dermatitis
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
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

39. transiet vesicle seen in hives
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Wheal
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Ulnar deviation - subluxation - bakers cysts (behind knee)

40. How is chondrosarcoma described
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Expansile glistening mass within the medullary cavity
Down T tubule
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

41. precipitation of monosodium urate crystals into joints due to hyperuricemia
Osteopetrosis - abnl fxn of osteoclasts
Gout
Interossei and adductor policis
Torn MCL

42. Where is C7 dermatome
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Expansile glistening mass within the medullary cavity
3rd finger
Atopic dermatitis - eczema

43. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Recurrent branch of the median nerve
Seborrheic keratosis
Antibodies around cells of the epidermis in a reticular or netlike pattern
NSAIDs (indomethacin) colchicine

44. which muscle type is fast twitch and why are fibers white
Expansile glistening mass within the medullary cavity
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Phosphate is liberated from the myosin head
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

45. What lesion causes dec in thumb fxn 'ape hand'
Median nerve
Subclavius
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

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

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47. thickened - dense bones that are prone to fracture - dz and primary defect
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Metaphysis of long bones - distal femur
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Osteopetrosis - abnl fxn of osteoclasts

48. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Impetigo - s aureus - s pyogenes
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

49. What are the associations for sjogrens syndrome
Over deltoid
Thymoma
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Parotid enlargement - inc risk of B cell lymphoma - dental caries

50. Other than N. gono - what organisms can cause infectious - septic arthritis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Chondrosarcoma
S. aureus - streptococcus
Medial finger flexion - wrist flexion