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 happens in the power stroke of skeletal muscle contraction
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Chondrosarcoma
Phosphate is liberated from the myosin head
Basophilic - rhomboid crystals - weakly birefringent

2. Where does cartilage loss begin in osteoarthritis
Osteochondroma - exostosis
Medial aspect
Connects cells to underlying extracellular - bullous pemphigoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

3. warts on genitals
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Nl - thickened dense bones
Large goints (knee)
Condyloma acuminatum - caused by HPV

4. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Muslce use - nerve stim/compound muscle test
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Renal - pulm - CV - GI - 75% female

5. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Acanthosis nigcricans
Osteogenic carcinoma
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

6. What is the TX for acute gout
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Myosin releases bound ADP and is displaced on the actin filament
NSAIDs (indomethacin) colchicine

7. What enzyme is necessary for smooth muscle relaxation after contraction
Basophilic - rhomboid crystals - weakly birefringent
Hyperkeratosis
Myosin light chain phosphotase
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

8. What do palmar interosseous muscles do
Myosin
Adduct the fingers
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Anti ds DNA - poor prognosis

9. Achondroplasia is a failure of what process which results in which characteristic findings
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Plaque
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Trauma

10. Where is C7 dermatome
Sites of tibial attachment
Osteoarthritis
Connects cells to underlying extracellular - bullous pemphigoid
3rd finger

11. What does injury to the distal median nerve cause

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12. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
NSAIDs (indomethacin) colchicine
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

13. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
McCune - Albright syndrome
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

14. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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15. What is the TX for chronic gout
Musculocutaneous
Allopurinaol - uricosurics (probenicid)
Inc spinosum - dec granulosum
Deep branch of radial nerve

16. What enzyme defect in responsible for osteopetrosis
Down T tubule
Carbonic anhydrase II
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Intraepidermal bullae involving the skin and oral mucosa

17. What do the lumbrical muscles do
Elevated ESR and nl CK - prednisone
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Flex at the MCP

18. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

19. What are the classic fractures in pts with osteoporosis

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20. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Phosphorylates myosin light chain which leads to cross bridge formation
Ulnar nerve

21. Which muscle is the pitching injury and What does it do
Muslce use - nerve stim/compound muscle test
Actinic keratosis - risk proportional to epithelial dysplasia
Dermatomyositis
Infraspinatus - laterally rotates arm

22. What is the source of osteoblast cells
Mesenchymal stem cells in periosteum
Pseudogout
4th and 5th finger
Flex the MCP joints and extend both the DIP and PIP joints

23. mechanical wear and tear of joints leading to destruction of articular cartilage
Osteochondroma - exostosis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Osteoarthritis
Bulla

24. What are the characteristic bone findings in paget's disease
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Phosphate is liberated from the myosin head
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

25. When does membranous ossification occur and What is the difference between membranous and endochondrial
Ligand binding leads to muscle depol
Osteoblastoma
Anti Smith
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

26. What do xray show in osteopetrosis and What do potential CN abnl result from
Erlenmeyer flask bones that flare out - narrowed foramina
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Rigor mortis

27. blister containing pus
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Osteoid osteoma
Pustule
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

28. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Actin
Seborrheic keratosis
Paralysis of lateral rotators
Medial 1.5 fingers - hypothenar eminence

29. Where do sebhorrheic keratosis lesions occur and in who
Dysplastic nevus
Dermatitis
Dermatomyositis
Head - trunk - extremities - common benign neoplasm in older persons

30. What are the layers of of the epidermis from surface to base
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Lower trunk of brachial plexus
Corneum - lucidum - granulosum - spinosum - basalis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

31. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Staph scalded skin syndrome
Nevocellular nevus
Ewings sarcoma - aggressive with early mets - but responsive to chemo

32. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Vesicle

33. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Lesioned by midshaft fracture of humerus
Dermatitis herpetiformis
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Mesenchymal stem cells in periosteum

34. When do acute attacks of gout typically occur
After a large meal or EtOH conspumption
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Axillary nerve
Cherry hemangioma

35. In smooth muscle contraction - What does Ca bind and What is the purpose
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Calmodulin - complex activates myosin light chain kinase
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Radial nerve

36. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Medially rotates and adducts arm
Axillary - deltoid - skin over deltoid - flattened deltoid

37. What runs the distance of the A band
Medial aspect
Keloid
Myosin
Osteoblastoma

38. What does the positive anterior drawer sign test indicate
Tear of the ACL
Parakeratosis
Over deltoid
Osteogenic carcinoma

39. inflammation of the skin
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Dermatitis
Crust
Wheal

40. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Verrucae
Iliac crest

41. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Staph scalded skin syndrome
Musculocutaneous
McCune - Albright syndrome

42. What are the signs of ulnar nerve injury

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43. What kind of endocrine abnl are associated with McCune Albright
NSAIDs (indomethacin) colchicine
Pustule
Precocious puberty
Erlenmeyer flask bones that flare out - narrowed foramina

44. What are defining lab findings for polymyalgia rheumatica and What is the TX
Anti ds DNA - poor prognosis
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Elevated ESR and nl CK - prednisone
Glucocorticoids

45. What other lesion can cause the appearnce of the ulnar claw
Making fist with a proximal median nerve lesion
Renal - pulm - CV - GI - 75% female
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Median nerve

46. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Abduct the fingers
Anti Scl70 - anti DNA topoisomerase I antibody
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Cervical disk lesion

47. What do the branches of the deep ulnar nerve innervate
Muslce use - nerve stim/compound muscle test
Interossei and adductor policis
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

48. Which nerve is compressed in deep forearm
Anterior interosseous nerve
Type III - RF
Mesenchymal stem cells in periosteum
Medial aspect

49. What supplies innervation to the thenar muscles
Sarcoidosis - black females - ACE
Flex at the MCP
Recurrent branch of the median nerve
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

50. Through what pathway does NO work and What is the downstream effect
Actinic keratosis - risk proportional to epithelial dysplasia
GC and cGMP and inhibition of MLCK
Torn MCL
Verrucae