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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 does cartilage loss begin in osteoarthritis
Medial aspect
Xeropthalmia - xerostomia - arthritis
Upper trunk of brachial plexus
Mesenchymal stem cells in periosteum

2. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Outer arm
Strawberry hemangioma
Hairy leukoplakia - HIV population - EBV mediated
Wheal

3. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Cellulitis - s aureus - s pyogenes
Chondrosarcoma
Pustule
Pseudogout

4. Where do sebhorrheic keratosis lesions occur and in who
Head - trunk - extremities - common benign neoplasm in older persons
Nl - thickened dense bones
Osteochondroma - exostosis
Crust

5. dried exudates from a vesicle - bulla or pustule seen impetigo
Paralysis of abductors
Renal - pulm - CV - GI - 75% female
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Crust

6. 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...
Palisading
Urticaria
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Calmodulin - complex activates myosin light chain kinase

7. What do anterior and posterior in ACL and PCL refer to...
Sites of tibial attachment
Obturator - thigh adduction - medial thigh
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

8. What is CREST syndrome and What antibody is it associated with
Radial nerve
Large goints (knee)
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Adduct the fingers

9. What development failure can results in albinism
NC migration
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Median nerve
Cellulitis - s aureus - s pyogenes

10. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
85% - advanced paternal age - or auto dominant inheritance
McCune - Albright syndrome
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

11. When do acute attacks of gout typically occur
Down T tubule
Ulnar deviation - subluxation - bakers cysts (behind knee)
Lesioned by midshaft fracture of humerus
After a large meal or EtOH conspumption

12. Which muscle laterally rotates and adducts arm
Teres minor
Acanthosis
Recurrent branch of the medain nerve
Cellulitis - s aureus - s pyogenes

13. 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 - fracture of hook of hamate
Antibodies around cells of the epidermis in a reticular or netlike pattern
Erythema multiforme - can be macules - papules vesicles - target lesions -
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

14. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
Flex the MCP joints and extend both the DIP and PIP joints
Boutonniere - swan neck - zthumb
Vesicle

15. What nerve is compressed by supracondylar fracture of humerus
Median nerve
Posterior cord
Keratoacanthoma
Sites of tibial attachment

16. What are the lab findings in osteomalacia/rickets
Impetigo - s aureus - s pyogenes
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Renal - pulm - CV - GI - 75% female
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

17. What is the Sicca syndrome
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Sarcoidosis - black females - ACE
Anti Scl70 - anti DNA topoisomerase I antibody

18. What other lesion can cause the appearnce of the ulnar claw
Intraepidermal bullae involving the skin and oral mucosa
Outer arm
Making fist with a proximal median nerve lesion
Osteoblastoma

19. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
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
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

20. irregular areas of complete depigmentation - condition and cause
Boutonniere - swan neck - zthumb
Medial finger flexion - wrist flexion
Sarcoidosis - black females - ACE
Vitiligo - dec number in melanocytes

21. What does injury to the distal ulnar nerve cause
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Myosin releases bound ADP and is displaced on the actin filament
Anti Smith

22. What lesion causes difficulty flexing elbow with variable sensory loss
Wheal
Recurrent branch of the medain nerve
Musculocutaneous
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

23. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Axillary nerve
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

24. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Inc spinosum - dec granulosum
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

25. What causes a lesion in the axillary nerve
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Xeropthalmia - xerostomia - arthritis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Ulnar nerve

26. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Exercise and Ca ingestion before age 30
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
85% - advanced paternal age - or auto dominant inheritance

27. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Dermatomyositis
Making fist with a proximal median nerve lesion
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

28. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Recurrent branch of the median nerve
Keloid
Pustule
Hairy leukoplakia - HIV population - EBV mediated

29. What are common features of lupus
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Down T tubule
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

30. What does I'M DAMN SHARP stand for
Post GI infxn or chlamydia
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

31. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Osteoid osteoma
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Tear of the ACL

32. What do lumbricals do
Dec estrogen causes inc bone resorption - postmenopausal
Post GI infxn or chlamydia
Flex the MCP joints and extend both the DIP and PIP joints
MCL - ACL - lateral meniscus (esp in athletes)

33. What is the TX for acute gout
NSAIDs (indomethacin) colchicine
Osteosarcoma - multiple myeloma
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

34. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Thymoma
Lower trunk of brachial plexus
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Pityriasis rosea

35. What does abnl passive abduction of the knee indicate
Osteoblastoma
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Torn MCL

36. epi of SLE
Female between 14 and 45 - mostly black
Impetigo - s aureus - s pyogenes
Serum ca - phos - PTH are nl alk phos elevated
Keloid

37. How does gonococcal arthritis present
Long thoracic nerve
4th and 5th finger
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Widespread skin involvment - rapid progression - early visceral involvement

38. What are the subQ rheumatoid nodules made of...
Fibrinoid necrosis surrounded by palisading histiocytes
Cervical disk lesion
Female between 14 and 45 - mostly black
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

39. What does injury to the distal median nerve cause

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40. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Ulnar nerve - fracture of hook of hamate
Anti Scl70 - anti DNA topoisomerase I antibody
Keloid
Paralysis of lateral rotators

41. What are the characterstic joints affected in RA
MCP - PIP - no DIP
Acantholysis
Abduct the fingers
Thymoma

42. What do dorsal interosseous muscles do
TB from dissemination and lyme dz
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Abduct the fingers

43. What enzyme defect in responsible for osteopetrosis
Carbonic anhydrase II
Atopic dermatitis - eczema
Axilla
Nevocellular nevus

44. What is a positive Nikolsky's sign
Nl - decreased bone mass
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Renal - pulm - CV - GI - 75% female
Axilla

45. What are the causes of inferior trunk plexus compression and What are the findings
Squamous cell carcinoma
Paralysis of abductors
Lichen planus
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

46. What are the lab findings in osteitis fibrosa cystica
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Sites of tibial attachment
Anti ds DNA - poor prognosis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

47. What does lack of ATP cause
Papule
Rigor mortis
Outer arm
Integrin binds laminin in BM

48. transiet vesicle seen in hives
NC migration
Wheal
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ephelis

49. Achondroplasia is a failure of what process which results in which characteristic findings
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Condyloma acuminatum - caused by HPV
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Pain in weight bearing joints at the end of the day and improving with rest

50. What does PED and Tip stand for

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