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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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1. Deposition of calcium pyrophosphate cyrstals within the joint space
Ephelis
Pseudogout
Nl - thickened dense bones
Dysplastic nevus

2. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
In psoriasis - bleeding spots when scales are scraped off
Pityriasis rosea
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Long thoracic nerve

3. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Fibrinoid necrosis surrounded by palisading histiocytes
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

4. What are the thin lines along the Z line
Pityriasis rosea
Actin
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Sites of tibial attachment

5. Thenar eminence - nerve and muscles
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Calmodulin - complex activates myosin light chain kinase
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Tear of the ACL

6. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Osteopetrosis - abnl fxn of osteoclasts
Muslce use - nerve stim/compound muscle test
Impetigo - s aureus - s pyogenes
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

7. small fluid containing blister seen in chickenpox
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Sarcoidosis - black females - ACE
Axilla
Vesicle

8. What does soft bones result from and What is the dz called in adults and children
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
AP depol opens voltage gated Ca channels - inducing NT release
Median nerve
Adductor policis brevis

9. thickened - dense bones that are prone to fracture - dz and primary defect
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Bulla
Iliac crest
Osteopetrosis - abnl fxn of osteoclasts

10. freckle - normal number of melanocytes - inc melanin pigment
4th and 5th finger
Widespread skin involvment - rapid progression - early visceral involvement
Ephelis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

11. What is the landmark for an LP
Median nerve
Iliac crest
Type III - RF
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

12. What causes heart failure in with Paget's disease
Biceps
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Inc blood flow from AV shunts can cause high output heart failure
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

13. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Osteochondroma - exostosis
Staph scalded skin syndrome
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Albinism

14. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Acantholysis
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

15. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Patch
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Pemphigus vulgaris
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

16. What are the layers of of the epidermis from surface to base
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Corneum - lucidum - granulosum - spinosum - basalis
Paralysis of abductors
Erlenmeyer flask bones that flare out - narrowed foramina

17. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Keratoacanthoma
Actinic keratosis
Elevated ESR and nl CK - prednisone
McCune - Albright syndrome

18. What are the possible origins of the paget's disease
Staph scalded skin syndrome
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Viral - maybe paramyxovirus
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

19. What associations go along with sarcoidosis

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20. What enzyme is necessary for smooth muscle relaxation after contraction
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Myosin light chain phosphotase
Acute back pain - loss of height - and kyphosis

21. 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
Myosin
Nl - thickened dense bones
Medial 1.5 fingers - hypothenar eminence

22. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Tear of the ACL
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Recurrent branch of the medain nerve
Strawberry hemangioma

23. What lesion causes claw hand and What are the muscles involved
Dysplastic nevus
Serum ca - phos - alk phos are NL
Ulnar nerve - intrinsic muscles of hand
Keratoacanthoma

24. What does injury to the distal ulnar nerve cause
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Lichen planus
4th and 5th finger
Phosphorylated

25. What are defining lab findings for polymyalgia rheumatica and What is the TX
Erlenmeyer flask bones that flare out - narrowed foramina
Medially rotates and adducts arm
Elevated ESR and nl CK - prednisone
Inc spinosum - dec granulosum

26. What causes a lesion in the axillary nerve
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Recurrent branch of the median nerve
Dermatomyositis
Rheumatoid arthritis

27. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

28. What is the primary screening test for lupus
Nevocellular nevus
Obturator - thigh adduction - medial thigh
ANA - sensitive but not specific
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

29. What are the potential causes of gout

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30. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Flex at the MCP
Rigor mortis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Posterior cord

31. 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
Pseudogout
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

32. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Lichen planus
Paralysis of lateral rotators
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

33. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Verrucae vulgaris
Anti - histone
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

34. What is the classic presentation of osteoarthritis
Pain in weight bearing joints at the end of the day and improving with rest
Recurrent branch of the median nerve
Boutonniere - swan neck - zthumb
Ulnar nerve - intrinsic muscles of hand

35. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Pemphigus vulgaris
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Dermatomyositis
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

36. What does injury to the distal median nerve cause

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37. What is TX for osteoporosis
Inc spinosum - dec granulosum
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Fibrinoid necrosis surrounded by palisading histiocytes
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

38. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Atopic dermatitis - eczema
Erythema multiforme - can be macules - papules vesicles - target lesions -
Urticaria
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

39. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Renal - pulm - CV - GI - 75% female
Scleroderma
Obturator - thigh adduction - medial thigh
Ulnar nerve - intrinsic muscles of hand

40. IBS - 2 dz's
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Crohns and ulcerative colitis
Intraepidermal bullae involving the skin and oral mucosa

41. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Erythema nodosum
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Paralysis of abductors

42. What does PED and Tip stand for

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43. Where is T1 dermatome
Carbonic anhydrase II
Medial forearm and arm to just under the axilla
3rd finger
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

44. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Subclavius
Antibodies around cells of the epidermis in a reticular or netlike pattern
Lower trunk of brachial plexus
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

45. Where is C6 dermatome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
4th and 5th finger
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
Parotid enlargement - inc risk of B cell lymphoma - dental caries

46. papule > 1cm seen psoriasis
Crust
Median nerve - lunate bone
Plaque
Chondrosarcoma

47. What kind of endocrine abnl are associated with McCune Albright
Deep branch of radial nerve
Calmodulin - complex activates myosin light chain kinase
Precocious puberty
Hairy leukoplakia - HIV population - EBV mediated

48. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
After a large meal or EtOH conspumption
Dermatitis herpetiformis
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Axilla

49. What is the test for drug induced lupus
Anti - histone
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Precocious puberty
Bulla

50. What is the power stroke of muscle contraction
Myosin releases bound ADP and is displaced on the actin filament
Subclavius
Thymoma
B27 - no RF - males