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Musculoskeletal

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

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2. What are defining lab findings for polymyalgia rheumatica and What is the TX
Fibrinoid necrosis surrounded by palisading histiocytes
Condyloma acuminatum - caused by HPV
Seborrheic keratosis
Elevated ESR and nl CK - prednisone

3. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Precocious puberty
AP depol opens voltage gated Ca channels - inducing NT release
Osteoporosis
Acanthosis nigcricans

4. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Osteosarcoma - multiple myeloma
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Myosin

5. How does the radial nerve in the spiral groove become injured
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Inc blood flow from AV shunts can cause high output heart failure
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Lesioned by midshaft fracture of humerus

6. yellow when parallel and blue when perpendicular
Gout
Acute back pain - loss of height - and kyphosis
Sarcoidosis - black females - ACE
< 2mc found in proximal tibia and femur - men < 25

7. What molecule maintatins integrity of basement membrane and What does it bind
Crohns and ulcerative colitis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Paralysis of abductors
Integrin binds laminin in BM

8. What antibodies is diffuse scleroderma associated with
Anti Scl70 - anti DNA topoisomerase I antibody
Osteopetrosis - abnl fxn of osteoclasts
Lung
Inc alk phos - abnl bone architecture

9. What is the sensory def of an ulnar nerve injury
Polymyositis - shoulders - perifasicular inflammation
Xeropthalmia - xerostomia - arthritis
Medial 1.5 fingers - hypothenar eminence
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

10. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Sarcoidosis - black females - ACE
Inc spinosum - dec granulosum
Axillary nerve
Posterior cord

11. What percent of these mutations occur sporadically and what parental feature are they associated with
Anti - histone
Flex the MCP joints and extend both the DIP and PIP joints
Keloid
85% - advanced paternal age - or auto dominant inheritance

12. What are the thin lines along the Z line
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Actin
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

13. What are the signs of ulnar nerve injury

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14. papule > 1cm seen psoriasis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Plaque

15. Other than N. gono - what organisms can cause infectious - septic arthritis
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
S. aureus - streptococcus
Head - trunk - extremities - common benign neoplasm in older persons

16. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
AP depol opens voltage gated Ca channels - inducing NT release
Antibodies around cells of the epidermis in a reticular or netlike pattern

17. What is TX for osteoporosis
Pseudogout
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

18. What does injury to the distal median nerve cause

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19. knee trauma - nerve - motor and sensory def
Medial forearm and arm to just under the axilla
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

20. What enzyme defect in responsible for osteopetrosis
Carbonic anhydrase II
Axillary - deltoid - skin over deltoid - flattened deltoid
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

21. What happens at the gap jxn and what molecules create them
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Hyperkeratosis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

22. hypothenar eminence - nerve and muscles
Myosin light chain phosphotase
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Urticaria

23. What lesion causes total claw (klumpke's hand)
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Pustule
Median nerve
Lower trunk of brachial plexus

24. What happens at the postsynaptic motor end plate
Ligand binding leads to muscle depol
Head - trunk - extremities - common benign neoplasm in older persons
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Fibrinoid necrosis surrounded by palisading histiocytes

25. Through what pathway does NO work and What is the downstream effect
Condyloma acuminatum - caused by HPV
GC and cGMP and inhibition of MLCK
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
AP depol opens voltage gated Ca channels - inducing NT release

26. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Lung
ANA - sensitive but not specific
Serum ca - phos - alk phos are NL

27. In which joints does pseudogout typically occur
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Large goints (knee)
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

28. What is below the epidermis
Erythema multiforme - can be macules - papules vesicles - target lesions -
Medially rotates and adducts arm
Xeropthalmia - xerostomia - arthritis
The dermis

29. Where is C8 dermatome
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
4th and 5th finger
Connects cells to underlying extracellular - bullous pemphigoid
Gout

30. What are the lab findings and TX in dermatomyositis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Median nerve
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

31. interlacing trabeculae of woven bone surrounded by osteoblasts
Renal - pulm - CV - GI - 75% female
Acanthosis nigcricans
Osteoid osteoma
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

32. What do anterior and posterior in ACL and PCL refer to...
Osteogenic carcinoma
GC and cGMP and inhibition of MLCK
Cellulitis - s aureus - s pyogenes
Sites of tibial attachment

33. What is the Auspitz sign
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Squamous cell carcinoma
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
In psoriasis - bleeding spots when scales are scraped off

34. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Anterior interosseous nerve
Inc blood flow from AV shunts can cause high output heart failure
MCL - ACL - lateral meniscus (esp in athletes)

35. What is the TX for chronic gout
Lichen planus
Pseudogout
Allopurinaol - uricosurics (probenicid)
Nl - decreased bone mass

36. How does gonococcal arthritis present
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Acute back pain - loss of height - and kyphosis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Ulnar nerve

37. What are the predisposing factors for osteoarthritis
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Recurrent branch of the medain nerve
Age - obesity and joint deformity
Myosin

38. What supplies innervation to the thenar muscles
Recurrent branch of the median nerve
Phosphate is liberated from the myosin head
Calmodulin - complex activates myosin light chain kinase
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

39. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Medially rotates and adducts arm
Crust
Impetigo - s aureus - s pyogenes
Posterior cord

40. What does injury to the distal ulnar nerve cause
Calmodulin - complex activates myosin light chain kinase
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Basophilic - rhomboid crystals - weakly birefringent

41. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Thymoma
Pemphigus vulgaris
MCP - PIP - no DIP

42. What is the power stroke of muscle contraction
Myosin releases bound ADP and is displaced on the actin filament
TB from dissemination and lyme dz
Biceps
Pustule

43. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Patch
Serum ca - phos - alk phos are NL

44. Patients with pagets disease can develop what cancer
Polyostotic fibrous dysplasia
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Osteogenic carcinoma
Conjunctivitis and anterior uveitis - urethritis and arthritis

45. What causes total claw
Median nerve - lunate bone
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Intraepidermal bullae involving the skin and oral mucosa
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

46. 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...
McCune - Albright syndrome
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Metaphysis of long bones - distal femur

47. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Lichen planus
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Crohns and ulcerative colitis
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

48. How is diffuse scleroderma characterized
Vesicle
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Anti - histone
Widespread skin involvment - rapid progression - early visceral involvement

49. What runs the distance of the A band
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Pseudogout
Median nerve - same fingers but not on the hand
Myosin

50. What causes heart failure in with Paget's disease
Inc blood flow from AV shunts can cause high output heart failure
Sarcoidosis - black females - ACE
Dermatitis
Median nerve - lunate bone

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Musculoskeletal

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