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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. What is the defect in Paget's disease
Lower trunk of brachial plexus
Rheumatoid arthritis
Increase in both osteoblast and osteoclast activity
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

2. What lesion causes wrist drop
Pemphigus vulgaris
Posterior cord
Anti ds DNA - poor prognosis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

3. What does MLCK do in smooth muscle contraction
Phosphorylates myosin light chain which leads to cross bridge formation
Thymoma
Inc spinosum - dec granulosum
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

4. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Medial forearm and arm to just under the axilla
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Psoriasis

5. Where does the muscle contraction travel after leaving the motor end plate
Paralysis of abductors
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Strawberry hemangioma
Down T tubule

6. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Posterior cord
Acute back pain - loss of height - and kyphosis
Myosin releases bound ADP and is displaced on the actin filament

7. What is the sign of Leser - Trelat
After a large meal or EtOH conspumption
Osteoarthritis
Pain in weight bearing joints at the end of the day and improving with rest
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

8. What antibody is less sensitive than RF but more specific and What is the HLA association
Anterior interosseous nerve
Female between 14 and 45 - mostly black
Anti - CCP - HLA- DR4
Erythema multiforme - can be macules - papules vesicles - target lesions -

9. What are the bone mineral lab findings in paget's disease
< 2mc found in proximal tibia and femur - men < 25
Osteoid osteoma
Serum ca - phos - PTH are nl alk phos elevated
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

10. Sarcoid TX
Parotid enlargement - inc risk of B cell lymphoma - dental caries
S. aureus - streptococcus
< 2mc found in proximal tibia and femur - men < 25
Steroids

11. What are the classic fractures in pts with osteoporosis

12. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Nl - thickened dense bones
Pemphigus vulgaris
Obturator - thigh adduction - medial thigh
Dec estrogen causes inc bone resorption - postmenopausal

13. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Pityriasis rosea
Adductor policis brevis
Condyloma acuminatum - caused by HPV
4th and 5th finger

14. What other lesion can cause the appearnce of the ulnar claw
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Making fist with a proximal median nerve lesion
Polymyositis - shoulders - perifasicular inflammation

15. What is the source of osteoblast cells
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Mesenchymal stem cells in periosteum
Vitiligo - dec number in melanocytes
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

16. What is a precursor to squamous cell carcinoma
Infraspinatus - laterally rotates arm
Actinic keratosis
Median nerve - lunate bone
Biceps

17. What do palmar interosseous muscles do
S. aureus - streptococcus
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Adduct the fingers
Palisading

18. What test if specific for lupus but doesn't indicate prognosis
Anti Smith
Head - trunk - extremities - common benign neoplasm in older persons
Paralysis of abductors
Pseudogout

19. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Type III - RF
Supraspinatus - abducts the arm before the deltoid
Chondrosarcoma

20. What medication is contraindicated in osteoporosis
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Corneum - lucidum - granulosum - spinosum - basalis
Chondrosarcoma
Glucocorticoids

21. What are common features of lupus
Anti - histone
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
S. aureus - streptococcus

22. How does the radial nerve in the spiral groove become injured
Type III - RF
Large goints (knee)
Lesioned by midshaft fracture of humerus
Plaque

23. What kind of bone tumor is associated with FAP and What is the finding
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Medially rotates and adducts arm
Inc alk phos - abnl bone architecture

24. What supplies innervation to the thenar muscles
Paralysis of lateral rotators
Recurrent branch of the median nerve
Radial nerve
Nevocellular nevus

25. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Acanthosis
Gout
Serum ca - phos - PTH are nl alk phos elevated

26. What happens at the postsynaptic motor end plate
Ligand binding leads to muscle depol
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Musculocutaneous
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

27. Loss of what muslces in Erbs causes the limb to hang by side
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Paralysis of abductors
Recurrent branch of the medain nerve
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

28. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Osteosarcoma - multiple myeloma
Calmodulin - complex activates myosin light chain kinase
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Urticaria

29. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
McCune - Albright syndrome
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
4th and 5th finger
Dermatitis

30. What are the associations for sjogrens syndrome
Torn MCL
Biceps
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Condyloma acuminatum - caused by HPV

31. inc thickness of stratum corneum seen in psoriasis
Integrin binds laminin in BM
Flex at the MCP
Hyperkeratosis
Dermatomyositis

32. What is the classic triad of reactive arthritis
Axilla
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Conjunctivitis and anterior uveitis - urethritis and arthritis

33. What are the lab findings and TX in dermatomyositis
Anti Scl70 - anti DNA topoisomerase I antibody
Ischial spine - relieve pain during delivery
Vitiligo - dec number in melanocytes
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

34. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Axillary - deltoid - skin over deltoid - flattened deltoid
Phosphorylated
Trauma

35. What causes a lesion in the axillary nerve
Anti Smith
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Fever - fatigue - pleuritis - pericarditis
Osteopetrosis - abnl fxn of osteoclasts

36. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Elevated ESR and nl CK - prednisone
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

37. What do pseudogout crystals appear like microscopically
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Basophilic - rhomboid crystals - weakly birefringent
GC and cGMP and inhibition of MLCK
Anti Smith

38. Where is C8 dermatome
Abduct the fingers
Corneum - lucidum - granulosum - spinosum - basalis
4th and 5th finger
Staph scalded skin syndrome

39. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Medially rotates and adducts arm
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Scleroderma
Osteoid osteoma

40. What do lupus pts falsely test positive for syphillis
Deep branch of radial nerve
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
The dermis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

41. What organisms can cause chronic infectious arthritis
Ulnar nerve
Adductor policis brevis
Iliac crest
TB from dissemination and lyme dz

42. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

43. What are predisposing factors for osteosarcoma - xray finding

44. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Long thoracic nerve
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Exercise and Ca ingestion before age 30

45. What does subscapularis do
Osteoarthritis
Medially rotates and adducts arm
Widespread skin involvment - rapid progression - early visceral involvement
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

46. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Median nerve - same fingers but not on the hand
Expansile glistening mass within the medullary cavity
Precocious puberty
Polymyositis - shoulders - perifasicular inflammation

47. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
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)
Pseudogout
3rd finger

48. warts on hands
B27 - no RF - males
Verrucae vulgaris
Chondrosarcoma
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

49. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Rheumatoid arthritis
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Papule
Acanthosis nigcricans

50. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Erythema multiforme - can be macules - papules vesicles - target lesions -
4th and 5th finger
Median nerve - lunate bone
Staph scalded skin syndrome