Test your basic knowledge |

Musculoskeletal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Adductor policis brevis
Dec estrogen causes inc bone resorption - postmenopausal

2. Thenar eminence - nerve and muscles
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
3rd finger
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

3. yellow when perpendicular and blue when parallel
Plaque
Pseudogout
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Chondrosarcoma

4. What is the TX for acute gout
Anti Scl70 - anti DNA topoisomerase I antibody
Post GI infxn or chlamydia
NSAIDs (indomethacin) colchicine
Radial nerve

5. What do lumbricals do
Pseudogout
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Cherry hemangioma
Flex the MCP joints and extend both the DIP and PIP joints

6. What does I'M DAMN SHARP stand for
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Polyostotic fibrous dysplasia
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Musculocutaneous

7. Why does EtOH consumption precipitate gout
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Rigor mortis
Xeropthalmia - xerostomia - arthritis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

8. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Mesenchymal stem cells in periosteum
Recurrent branch of the medain nerve
Supraspinatus - abducts the arm before the deltoid

9. Where is C8 dermatome
Seborrheic keratosis
4th and 5th finger
Thymoma
Flex the MCP joints and extend both the DIP and PIP joints

10. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
TB from dissemination and lyme dz
Median nerve - same fingers but not on the hand
Radial nerve becomes compressed in axilla
Trauma

11. Which nerve is compressed in deep forearm
Dysplastic nevus
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Anterior interosseous nerve

12. What other muscle in the thenar eminence adducts the thumb
Precocious puberty
Obturator - thigh adduction - medial thigh
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Adductor policis brevis

13. What enzyme is necessary for smooth muscle relaxation after contraction
Osteochondroma - exostosis
GC and cGMP and inhibition of MLCK
Flex at the MCP
Myosin light chain phosphotase

14. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Large goints (knee)
Connects cells to underlying extracellular - bullous pemphigoid
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

15. What lesion causes Saturday night wrist drop
Steroids
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Radial nerve
S. aureus - streptococcus

16. What kind of jxn is the zona occludens andw What is is composed of...
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
GC and cGMP and inhibition of MLCK
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

17. papule > 1cm seen psoriasis
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Plaque
Over deltoid

18. What causes ape hand
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Phosphorylated
Antibodies around cells of the epidermis in a reticular or netlike pattern
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

19. What is the landmark for an LP
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Iliac crest
Renal - pulm - CV - GI - 75% female
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

20. In smooth muscle contraction - What does Ca bind and What is the purpose
Calmodulin - complex activates myosin light chain kinase
Ulnar nerve
Ulnar nerve
Paralysis of lateral rotators

21. knee trauma - nerve - motor and sensory def
Down T tubule
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Keratoacanthoma

22. What causes hypercalcemia in pts with sarcoid
Verrucae vulgaris
Anterior interosseous nerve
Median nerve
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

23. What is the Sicca syndrome
Thymoma
Recurrent branch of the median nerve
Crohns and ulcerative colitis
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

24. What happens at the postsynaptic motor end plate
Cherry hemangioma
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Ligand binding leads to muscle depol
Precocious puberty

25. What are the thin lines along the Z line
Type III - RF
Actin
Subclavius
Gout

26. blister containing pus
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Expansile glistening mass within the medullary cavity
Pustule
Inc alk phos - abnl bone architecture

27. What does soft bones result from and What is the dz called in adults and children
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Subclavius
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

28. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
NSAIDs (indomethacin) colchicine
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Ewings sarcoma - aggressive with early mets - but responsive to chemo

29. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Recurrent branch of the medain nerve
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Iliac crest

30. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Medial aspect
Sites of tibial attachment
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Hairy leukoplakia - HIV population - EBV mediated

31. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Verrucae
Carbonic anhydrase II
Nl - decreased bone mass

32. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Allopurinaol - uricosurics (probenicid)
Osteoporosis
Iliac crest

33. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
Metaphysis of long bones - distal femur
Endochondroma
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

34. What are the bone mineralization lab findings in osteopetrosis
Ulnar nerve
Serum ca - phos - alk phos are NL
Ligand binding leads to muscle depol
< 2mc found in proximal tibia and femur - men < 25

35. What do the branches of the deep ulnar nerve innervate
Post GI infxn or chlamydia
Interossei and adductor policis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Recurrent branch of the median nerve

36. What lesion causes deltoid paralysis
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Axillary nerve
Cherry hemangioma

37. What causes the symptoms of MG to worsen - and What is used to diagnose
GC and cGMP and inhibition of MLCK
Median nerve - lunate bone
Muslce use - nerve stim/compound muscle test
Basophilic - rhomboid crystals - weakly birefringent

38. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Psoriasis
Impetigo - s aureus - s pyogenes
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Carbonic anhydrase II

39. What is the test for drug induced lupus
Upper trunk of brachial plexus
Hyperkeratosis
Anti - histone
Ulnar

40. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Vesicle
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Upper trunk of brachial plexus

41. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Ulnar

42. 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
< 2mc found in proximal tibia and femur - men < 25
Acute back pain - loss of height - and kyphosis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

43. 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...
Xeropthalmia - xerostomia - arthritis
McCune - Albright syndrome
Integrin binds laminin in BM
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

44. What does PED and Tip stand for

45. What are the lab findings in osteoporosis
Cellulitis - s aureus - s pyogenes
Bulla
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Nl - decreased bone mass

46. What is a positive Nikolsky's sign
ANA - sensitive but not specific
Post GI infxn or chlamydia
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
85% - advanced paternal age - or auto dominant inheritance

47. What lesion causes winged scapula
Long thoracic nerve
Head - trunk - extremities - common benign neoplasm in older persons
AP depol opens voltage gated Ca channels - inducing NT release
Axillary nerve

48. What are the lab findings in osteomalacia/rickets
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Polyostotic fibrous dysplasia
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

49. What are the layers of of the epidermis from surface to base
Osteopetrosis - abnl fxn of osteoclasts
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Corneum - lucidum - granulosum - spinosum - basalis
Ulnar nerve - fracture of hook of hamate

50. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Precocious puberty
Erythema nodosum
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur