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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. What are the signs of ulnar nerve injury

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2. Which muscle is the pitching injury and What does it do
Flex at the MCP
Infraspinatus - laterally rotates arm
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Supraspinatus - abducts the arm before the deltoid

3. Damage to what 3 structures is common for the unhappy triad
ANA - sensitive but not specific
Medial finger flexion - wrist flexion
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
MCL - ACL - lateral meniscus (esp in athletes)

4. papule > 1cm seen psoriasis
Erythema multiforme - can be macules - papules vesicles - target lesions -
Widespread skin involvment - rapid progression - early visceral involvement
Pityriasis rosea
Plaque

5. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Hairy leukoplakia - HIV population - EBV mediated
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Lung

6. transiet vesicle seen in hives
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Wheal
Abduct the fingers
Osteoarthritis

7. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
< 2mc found in proximal tibia and femur - men < 25
Head - trunk - extremities - common benign neoplasm in older persons
Female between 14 and 45 - mostly black

8. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Expansile glistening mass within the medullary cavity
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Axillary - deltoid - skin over deltoid - flattened deltoid
Impetigo - s aureus - s pyogenes

9. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Ulnar nerve
Lichen planus
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Serum ca - phos - PTH are nl alk phos elevated

10. What kind of endocrine abnl are associated with McCune Albright
Staph scalded skin syndrome
Precocious puberty
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

11. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Pityriasis rosea
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Osteopetrosis - abnl fxn of osteoclasts

12. What are the characterstic joints affected in RA
Posterior cord
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
MCP - PIP - no DIP

13. What is a positive Nikolsky's sign
Verrucae vulgaris
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Paralysis of lateral rotators
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

14. What lesion causes total claw (klumpke's hand)
Keloid
Lichen planus
Lower trunk of brachial plexus
Muslce use - nerve stim/compound muscle test

15. What are the lab findings in pagets disease
MCP - PIP - no DIP
Phosphorylated
Squamous cell carcinoma
Inc alk phos - abnl bone architecture

16. What does subscapularis do
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Dermatitis
Medially rotates and adducts arm
Osteoporosis

17. What are the lab findings and TX in dermatomyositis
Posterior cord
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Xeropthalmia - xerostomia - arthritis
Squamous cell carcinoma

18. What lesion causes deltoid paralysis
Nevocellular nevus
Osteoid osteoma
Axillary nerve
Erlenmeyer flask bones that flare out - narrowed foramina

19. What does MLCK do in smooth 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
Urticaria
The dermis
Phosphorylates myosin light chain which leads to cross bridge formation

20. What deformities of the hand are common in RA
Boutonniere - swan neck - zthumb
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Median nerve - lunate bone
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

21. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Expansile glistening mass within the medullary cavity
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

22. What do lumbricals do
Gout
Flex the MCP joints and extend both the DIP and PIP joints
McCune - Albright syndrome
Vitiligo - dec number in melanocytes

23. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Vitiligo - dec number in melanocytes
Osteosarcoma - multiple myeloma
Fever - fatigue - pleuritis - pericarditis

24. osteochondrosis has rare malignant transformation into what cancer
Chondrosarcoma
Seborrheic keratosis
Plaque
Lichen planus

25. What does injury to the distal median nerve cause

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26. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Connects cells to underlying extracellular - bullous pemphigoid
Flex the MCP joints and extend both the DIP and PIP joints
Viral - maybe paramyxovirus
Expansile glistening mass within the medullary cavity

27. appreas in 30s to 40s - does not regress
Cherry hemangioma
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Pityriasis rosea

28. what changes are seen in stratum spinosum and granulosum in psoriasis
Inc spinosum - dec granulosum
Pain in weight bearing joints at the end of the day and improving with rest
Making fist with a proximal median nerve lesion
Bulla

29. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Anti Smith
Large goints (knee)
Dec estrogen causes inc bone resorption - postmenopausal

30. What does PED and Tip stand for

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31. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Median nerve
Lichen planus
Medial forearm and arm to just under the axilla
Pseudogout

32. Through what pathway does NO work and What is the downstream effect
Ligand binding leads to muscle depol
Albinism
Cellulitis - s aureus - s pyogenes
GC and cGMP and inhibition of MLCK

33. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Carbonic anhydrase II
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Iliac crest
Upper trunk of brachial plexus

34. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Condyloma acuminatum - caused by HPV
Seborrheic keratosis
Osteosarcoma - multiple myeloma

35. dried exudates from a vesicle - bulla or pustule seen impetigo
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Vesicle
Crust

36. What are the characteristic bone findings in paget's disease
Actin
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Widespread skin involvment - rapid progression - early visceral involvement

37. What does soft bones result from and What is the dz called in adults and children
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Thymoma
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

38. What causes a lesion in the axillary nerve
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
NSAIDs (indomethacin) colchicine
Type III - RF

39. What are the motor defs of a proximal ulnar nerve injury
Condyloma acuminatum - caused by HPV
Medial finger flexion - wrist flexion
Lung
Pseudogout

40. Where is T2 dermatome
Pemphigus vulgaris
85% - advanced paternal age - or auto dominant inheritance
HI shrinks - A stays same
Axilla

41. common mole - benign
Nevocellular nevus
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
Median nerve
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

42. What does acantholysis show in pemphigus vulgaris
Gout
Integrin binds laminin in BM
Intraepidermal bullae involving the skin and oral mucosa
Ulnar nerve

43. Where are most osteoid osteoma found and In what population
< 2mc found in proximal tibia and femur - men < 25
Osteochondroma - exostosis
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Median nerve - lunate bone

44. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Dermatitis herpetiformis
Fibrinoid necrosis surrounded by palisading histiocytes
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

45. What is the defect in Paget's disease
Increase in both osteoblast and osteoclast activity
Osteoid osteoma
Female between 14 and 45 - mostly black
Deep branch of radial nerve

46. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Age - obesity and joint deformity
Teres minor
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign

47. Where is C8 dermatome
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
4th and 5th finger
Verrucae
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

48. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Pain in weight bearing joints at the end of the day and improving with rest
Serum ca - phos - alk phos are NL

49. What are the lab findings in osteitis fibrosa cystica
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Biceps

50. What are the layers of of the epidermis from surface to base
Corneum - lucidum - granulosum - spinosum - basalis
Thymoma
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Ligand binding leads to muscle depol