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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. which muscle type is fast twitch and why are fibers white
Acantholysis
Inc blood flow from AV shunts can cause high output heart failure
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Anti ds DNA - poor prognosis

2. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
Type 2
Ulnar deviation - subluxation - bakers cysts (behind knee)
Lung

3. what changes are seen in stratum spinosum and granulosum in psoriasis
Vesicle
Patch
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Inc spinosum - dec granulosum

4. What are the potential causes of gout

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5. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Papule
Osteoblastoma
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

6. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Paralysis of lateral rotators
Median nerve
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

7. What is the Sicca syndrome
Serum ca - phos - PTH are nl alk phos elevated
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Pseudogout

8. What do dorsal interosseous muscles do
Acute back pain - loss of height - and kyphosis
Impetigo - s aureus - s pyogenes
Abduct the fingers
Widespread skin involvment - rapid progression - early visceral involvement

9. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Iliac crest
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Psoriasis
Seborrheic keratosis

10. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Over deltoid
Erlenmeyer flask bones that flare out - narrowed foramina
Albinism
Corneum - lucidum - granulosum - spinosum - basalis

11. What kind of bone tumor is associated with FAP and What is the finding
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Nl - decreased bone mass
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Long thoracic nerve

12. What is CREST syndrome and What antibody is it associated with
Median nerve - lunate bone
Keratoacanthoma
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Plaque

13. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Inc blood flow from AV shunts can cause high output heart failure
Basophilic - rhomboid crystals - weakly birefringent

14. epi of SLE
Lesioned by midshaft fracture of humerus
Female between 14 and 45 - mostly black
Dermatitis
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

15. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Bulla
Myosin light chain phosphotase
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

16. What is the defect in Paget's disease
In psoriasis - bleeding spots when scales are scraped off
Chondrosarcoma
Increase in both osteoblast and osteoclast activity
Iliac crest

17. What lesion causes Saturday night wrist drop
Radial nerve
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Axillary - deltoid - skin over deltoid - flattened deltoid
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

18. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Rheumatoid arthritis
Widespread skin involvment - rapid progression - early visceral involvement
Polyostotic fibrous dysplasia
Melasma (chloasma)

19. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Anterior interosseous nerve
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

20. Which type of muscle fiber is hypertrophied during weight training
MCP - PIP - no DIP
Type 2
Anti ds DNA - poor prognosis
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

21. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Verrucae vulgaris
B27 - no RF - males
Endochondroma

22. 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
Nl - decreased bone mass
Deep branch of radial nerve
Axilla

23. loss of what muscles in Erbs causes the medial rotation
Paralysis of lateral rotators
GC and cGMP and inhibition of MLCK
Lichen planus
Axillary - deltoid - skin over deltoid - flattened deltoid

24. Where is C4 dermatome
Allopurinaol - uricosurics (probenicid)
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Over deltoid

25. What protects the brachial plexus in clavicle fracture
Xeropthalmia - xerostomia - arthritis
Subclavius
Trauma
Interossei and adductor policis

26. 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...
HI shrinks - A stays same
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Pustule
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

27. What antibodies is diffuse scleroderma associated with
Anti Scl70 - anti DNA topoisomerase I antibody
Teres minor
Osteoblastoma
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

28. Patients with pagets disease can develop what cancer
Medial finger flexion - wrist flexion
Osteogenic carcinoma
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

29. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Ulnar nerve
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Mesenchymal stem cells in periosteum
Musculocutaneous

30. What deformities of the hand are common in RA
Boutonniere - swan neck - zthumb
Acanthosis
Conjunctivitis and anterior uveitis - urethritis and arthritis
Fibrinoid necrosis surrounded by palisading histiocytes

31. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Macule
Atopic dermatitis - eczema
Acantholysis
Fibrinoid necrosis surrounded by palisading histiocytes

32. Where is osteosarcoma found in the bone
Metaphysis of long bones - distal femur
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

33. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Parakeratosis
Obturator - thigh adduction - medial thigh
McCune - Albright syndrome
Ulnar

34. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Erythema multiforme - can be macules - papules vesicles - target lesions -
Hyperkeratosis
Impetigo - s aureus - s pyogenes
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

35. How does gonococcal arthritis present
Phosphorylated
Anti ds DNA - poor prognosis
Ligand binding leads to muscle depol
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

36. What do anterior and posterior in ACL and PCL refer to...
Sites of tibial attachment
Radial nerve
Trauma
Acanthosis

37. hypothenar eminence - nerve and muscles
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Squamous cell carcinoma
Myosin releases bound ADP and is displaced on the actin filament
Nl - decreased bone mass

38. What are predisposing factors for osteosarcoma - xray finding

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39. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Infraspinatus - laterally rotates arm
ANA - sensitive but not specific
Seborrheic keratosis
Sarcoidosis - black females - ACE

40. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Flex at the MCP
Osteosarcoma - multiple myeloma
Fibrinoid necrosis surrounded by palisading histiocytes
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

41. What are characteristic findings of gout
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Verrucae vulgaris

42. Where is C6 dermatome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Obturator - thigh adduction - medial thigh
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Lesioned by midshaft fracture of humerus

43. What does the positive anterior drawer sign test indicate
Anti Scl70 - anti DNA topoisomerase I antibody
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Tear of the ACL
Anti ds DNA - poor prognosis

44. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Nl - thickened dense bones
Ulnar nerve - intrinsic muscles of hand
Dermatomyositis
Recurrent branch of the medain nerve

45. What causes compression of the C7 nerve root
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Cervical disk lesion
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

46. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Seborrheic keratosis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Albinism
Keloid

47. Damage to what 3 structures is common for the unhappy triad
Trauma
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Impetigo - s aureus - s pyogenes
MCL - ACL - lateral meniscus (esp in athletes)

48. 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
Exercise and Ca ingestion before age 30
Median nerve - same fingers but not on the hand
Parakeratosis
Polyostotic fibrous dysplasia

49. Where does cartilage loss begin in osteoarthritis
Supraspinatus - abducts the arm before the deltoid
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Chondrosarcoma
Medial aspect

50. What TX prophylax against osteoporisi
Metaphysis of long bones - distal femur
Exercise and Ca ingestion before age 30
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Medially rotates and adducts arm