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Musculoskeletal

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Answer 50 questions in 15 minutes.
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1. What is below the epidermis
Squamous cell carcinoma
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Scleroderma
The dermis

2. What causes ape hand
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Dermatomyositis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

3. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
The dermis
Papule
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Obturator - thigh adduction - medial thigh

4. Where is T2 dermatome
Patch
Osteoporosis
Pseudogout
Axilla

5. 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
Nl - thickened dense bones
Torn MCL
< 2mc found in proximal tibia and femur - men < 25

6. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
In psoriasis - bleeding spots when scales are scraped off

7. What causes hypercalcemia in pts with sarcoid
S. aureus - streptococcus
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Conjunctivitis and anterior uveitis - urethritis and arthritis

8. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
MCL - ACL - lateral meniscus (esp in athletes)
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Strawberry hemangioma
Female between 14 and 45 - mostly black

9. What is the power stroke of muscle contraction
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
After a large meal or EtOH conspumption
Integrin binds laminin in BM
Myosin releases bound ADP and is displaced on the actin filament

10. Decrease marrow space in osteopetrosis leads to what?
Bulla
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Post GI infxn or chlamydia
McCune - Albright syndrome

11. What are the lab findings in pagets disease
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Impetigo - s aureus - s pyogenes
Inc alk phos - abnl bone architecture
Erlenmeyer flask bones that flare out - narrowed foramina

12. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Anti Smith
TB from dissemination and lyme dz
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

13. MG is associated with what neoplasm
Fibrinoid necrosis surrounded by palisading histiocytes
Thymoma
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Atopic dermatitis - eczema

14. What is a precursor to squamous cell carcinoma
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Actinic keratosis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Verrucae

15. Which muscle fiber type is slow twitch and why are fibers red
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Actinic keratosis - risk proportional to epithelial dysplasia
Allopurinaol - uricosurics (probenicid)

16. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

17. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Keratoacanthoma
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

18. epidermal hyperplasia (inc spinosum)
Type 2
Osteoporosis
Acanthosis
Subclavius

19. normal melanocyte number with dec melanin production due to inactivity of tyrosine
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
Albinism
Endochondroma
Parakeratosis

20. What are the possible origins of the paget's disease
Viral - maybe paramyxovirus
Fibrinoid necrosis surrounded by palisading histiocytes
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

21. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Median nerve
Musculocutaneous
Ulnar deviation - subluxation - bakers cysts (behind knee)
Femoral - thing flexion and leg extension - anterior thigh and medial leg

22. What is the clinically important landmark for pubendal nerve block and When is it used
Atopic dermatitis - eczema
Steroids
Ischial spine - relieve pain during delivery
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds

23. What do palmar interosseous muscles do
Adduct the fingers
Lower trunk of brachial plexus
Serum ca - phos - alk phos are NL
Basophilic - rhomboid crystals - weakly birefringent

24. hypothenar eminence - nerve and muscles
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Phosphorylated
Intraepidermal bullae involving the skin and oral mucosa

25. Where is C6 dermatome
< 2mc found in proximal tibia and femur - men < 25
Integrin binds laminin in BM
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

26. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
85% - advanced paternal age - or auto dominant inheritance
Parakeratosis
Psoriasis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

27. When do acute attacks of gout typically occur
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
After a large meal or EtOH conspumption
Medial aspect
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

28. What are the potential causes of gout

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29. What is TX for osteoporosis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Fibrinoid necrosis surrounded by palisading histiocytes
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

30. What does lack of ATP cause
Conjunctivitis and anterior uveitis - urethritis and arthritis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Rigor mortis
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

31. What is the Sicca syndrome
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Pain in weight bearing joints at the end of the day and improving with rest
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Phosphorylated

32. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Basophilic - rhomboid crystals - weakly birefringent
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Impetigo - s aureus - s pyogenes

33. What are characteristic findings of gout
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Osteosarcoma - multiple myeloma
Patch

34. which muscle type is fast twitch and why are fibers white
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Expansile glistening mass within the medullary cavity

35. What is the landmark for an LP
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Supraspinatus - abducts the arm before the deltoid
Iliac crest
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

36. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Anti ds DNA - poor prognosis
Median nerve - lunate bone
Post GI infxn or chlamydia
Hairy leukoplakia - HIV population - EBV mediated

37. What are the the common causes of Erb palsy - and What are the associated findings
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Basal cell carcinoma - pearly papules - commonly with telangiectasias

38. papule > 1cm seen psoriasis
Interossei and adductor policis
Wheal
Plaque
Muslce use - nerve stim/compound muscle test

39. What are the systemic symptoms found in RA
Median nerve
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Ligand binding leads to muscle depol
Fever - fatigue - pleuritis - pericarditis

40. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Xeropthalmia - xerostomia - arthritis
Musculocutaneous
Atopic dermatitis - eczema

41. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Men and women > 70 - senile osteporosis
NC migration
Down T tubule

42. What nerve is injured by a superficial laceration of the hand
The dermis
Recurrent branch of the medain nerve
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Condyloma acuminatum - caused by HPV

43. What medication is contraindicated in osteoporosis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Glucocorticoids
Pityriasis rosea
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

44. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Myosin releases bound ADP and is displaced on the actin filament
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
Psoriasis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

45. hives - intensely pruritic wheals that form after mast cell degranulation
Urticaria
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
Medial aspect
Acute back pain - loss of height - and kyphosis

46. What is the classic traid of sjogrens syndrome
Chondrosarcoma
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Pain in weight bearing joints at the end of the day and improving with rest
Xeropthalmia - xerostomia - arthritis

47. Loss of what muscles in Erbs causes the forearm to be pronated
Radial nerve becomes compressed in axilla
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Biceps

48. What does injury to the distal ulnar nerve cause
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Squamous cell carcinoma
Carbonic anhydrase II
Hairy leukoplakia - HIV population - EBV mediated

49. What causes the symptoms of MG to worsen - and What is used to diagnose
Endochondroma
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Pityriasis rosea
Muslce use - nerve stim/compound muscle test

50. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

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