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Musculoskeletal

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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 lab findings in osteopetrosis
Endochondroma
Condyloma acuminatum - caused by HPV
Axillary - deltoid - skin over deltoid - flattened deltoid
Nl - thickened dense bones

2. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Ewings sarcoma - aggressive with early mets - but responsive to chemo
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

3. What do xray show in osteopetrosis and What do potential CN abnl result from
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Bulla
Erlenmeyer flask bones that flare out - narrowed foramina
Fever - fatigue - pleuritis - pericarditis

4. What is the defect in Paget's disease
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Increase in both osteoblast and osteoclast activity

5. What are predisposing factors for osteosarcoma - xray finding

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6. What are the characterstic joints affected in RA
MCL - ACL - lateral meniscus (esp in athletes)
Squamous cell carcinoma
Recurrent branch of the medain nerve
MCP - PIP - no DIP

7. What are common features of lupus
MCL - ACL - lateral meniscus (esp in athletes)
Phosphate is liberated from the myosin head
Elevated ESR and nl CK - prednisone
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

8. In which gender is gout more common and What does the crystals appear like microscopically
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Macule
Medial finger flexion - wrist flexion

9. separation of epidermal cells
Acantholysis
Dermatomyositis
Medial 1.5 fingers - hypothenar eminence
Urticaria

10. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Parakeratosis
Obturator - thigh adduction - medial thigh
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

11. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Pemphigus vulgaris
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Supraspinatus - abducts the arm before the deltoid
Seborrheic keratosis

12. What are the associations for sjogrens syndrome
Anti ds DNA - poor prognosis
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Type 2
Parotid enlargement - inc risk of B cell lymphoma - dental caries

13. In which form is myosin light chain active
Hairy leukoplakia - HIV population - EBV mediated
Phosphorylated
Precocious puberty
Type III - RF

14. What are the histo findings in an osteoclastoma
Osteosarcoma - multiple myeloma
Connects cells to underlying extracellular - bullous pemphigoid
Hairy leukoplakia - HIV population - EBV mediated
Spindle shaped cells with multinucleated giant cells

15. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Making fist with a proximal median nerve lesion
Dermatomyositis
Xeropthalmia - xerostomia - arthritis
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

16. Ca2+ released from the SR binds what structure and What does it cause
Osteoid osteoma
Flex at the MCP
Making fist with a proximal median nerve lesion
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

17. What are the lab findings in osteomalacia/rickets
Axilla
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Inc blood flow from AV shunts can cause high output heart failure
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

18. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Adduct the fingers
Hairy leukoplakia - HIV population - EBV mediated
Thymoma

19. What causes compression of the C7 nerve root
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Cervical disk lesion
Adductor policis brevis
Deep branch of radial nerve

20. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Verrucae
Upper trunk of brachial plexus
Basal cell carcinoma - pearly papules - commonly with telangiectasias

21. What other lesion can cause the appearnce of the ulnar claw
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Papule
Making fist with a proximal median nerve lesion
Ischial spine - relieve pain during delivery

22. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Osteogenic carcinoma
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Osteosarcoma - multiple myeloma

23. Where does the muscle contraction travel after leaving the motor end plate
Down T tubule
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

24. What organisms can cause chronic infectious arthritis
Men and women > 70 - senile osteporosis
Ulnar nerve
Ulnar nerve - fracture of hook of hamate
TB from dissemination and lyme dz

25. Where is C6 dermatome
Macule
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Tear of the ACL

26. What are the potential causes of gout

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27. Dermatomyositis places the pt at inc risk For what malignancy in particular
Acantholysis
Lung
Phosphorylates myosin light chain which leads to cross bridge formation
Axillary - deltoid - skin over deltoid - flattened deltoid

28. 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
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Median nerve - same fingers but not on the hand
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Albinism

29. What is below the epidermis
Antibodies around cells of the epidermis in a reticular or netlike pattern
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
The dermis
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

30. Contraction results in shortening of what bands - and what band remains the same length
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
HI shrinks - A stays same
Lichen planus
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

31. What causes hypercalcemia in pts with sarcoid
Gout
< 2mc found in proximal tibia and femur - men < 25
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

32. What is the most common NMJ disorder - What causes it and What are common symptoms
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Anti - histone
Lung
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

33. What causes total claw
Dermatitis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
After a large meal or EtOH conspumption
Polymyositis - shoulders - perifasicular inflammation

34. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Palisading
Connects cells to underlying extracellular - bullous pemphigoid
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

35. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Keloid
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

36. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Cervical disk lesion
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

37. What lesion causes Saturday night wrist drop
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Obturator - thigh adduction - medial thigh
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Radial nerve

38. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Ulnar nerve - fracture of hook of hamate
Ligand binding leads to muscle depol
Type 2

39. When do acute attacks of gout typically occur
Myosin releases bound ADP and is displaced on the actin filament
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
After a large meal or EtOH conspumption
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

40. What are the lab findings in pagets disease
Upper trunk of brachial plexus
Osteosarcoma - multiple myeloma
Inc alk phos - abnl bone architecture
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

41. What causes a lesion in the axillary nerve
Osteoid osteoma
Viral - maybe paramyxovirus
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

42. In which joints does pseudogout typically occur
Median nerve - same fingers but not on the hand
3rd finger
Large goints (knee)
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

43. What medication is contraindicated in osteoporosis
Glucocorticoids
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Radial nerve becomes compressed in axilla

44. What are the predisposing factors for osteoarthritis
NSAIDs (indomethacin) colchicine
In psoriasis - bleeding spots when scales are scraped off
Age - obesity and joint deformity
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

45. What antibodies is diffuse scleroderma associated with
Anti Scl70 - anti DNA topoisomerase I antibody
Urticaria
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Median nerve

46. Other than N. gono - what organisms can cause infectious - septic arthritis
Musculocutaneous
S. aureus - streptococcus
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Seborrheic keratosis

47. What are the systemic symptoms found in RA
Type 2
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Fever - fatigue - pleuritis - pericarditis

48. Why does EtOH consumption precipitate gout
Cervical disk lesion
Acanthosis nigcricans
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Inc alk phos - abnl bone architecture

49. thickened - dense bones that are prone to fracture - dz and primary defect
Osteopetrosis - abnl fxn of osteoclasts
B27 - no RF - males
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Medial finger flexion - wrist flexion

50. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Osteoporosis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Median nerve - same fingers but not on the hand
Inc alk phos - abnl bone architecture