Test your basic knowledge |

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. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Medially rotates and adducts arm
Antibodies around cells of the epidermis in a reticular or netlike pattern
Dermatomyositis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

2. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Axillary nerve
Increase in both osteoblast and osteoclast activity
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Anti Scl70 - anti DNA topoisomerase I antibody

3. warts on hands
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Verrucae vulgaris
NC migration
Endochondroma

4. What autoantibodies are formed in sjogrens syndrome
Ulnar deviation - subluxation - bakers cysts (behind knee)
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Median nerve
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin

5. Why does EtOH consumption precipitate gout
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Ulnar nerve
Axillary nerve
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

6. Sarcoid TX
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Steroids
Medially rotates and adducts arm
Intraepidermal bullae involving the skin and oral mucosa

7. Deposition of calcium pyrophosphate cyrstals within the joint space
Dermatitis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
NSAIDs (indomethacin) colchicine
Pseudogout

8. What is the landmark for an LP
B27 - no RF - males
Iliac crest
Age - obesity and joint deformity
Medial forearm and arm to just under the axilla

9. interlacing trabeculae of woven bone surrounded by osteoblasts
Erythema multiforme - can be macules - papules vesicles - target lesions -
Crohns and ulcerative colitis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Osteoid osteoma

10. What causes ape hand
Xeropthalmia - xerostomia - arthritis
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

11. What are the lab findings in pagets disease
Vesicle
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Inc alk phos - abnl bone architecture
Inc spinosum - dec granulosum

12. What is the most common NMJ disorder - What causes it and What are common symptoms
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

13. What are the possible origins of the paget's disease
Bulla
Post GI infxn or chlamydia
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Viral - maybe paramyxovirus

14. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Ulnar nerve
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Impetigo - s aureus - s pyogenes

15. What are the motor defs of a proximal ulnar nerve injury
Medial finger flexion - wrist flexion
Dermatomyositis
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Expansile glistening mass within the medullary cavity

16. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Polyostotic fibrous dysplasia
Osteoporosis
Axilla

17. What are the common perpetrating infections for Reiters syndrome
Polyostotic fibrous dysplasia
Post GI infxn or chlamydia
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Fibrinoid necrosis surrounded by palisading histiocytes

18. What is the Auspitz sign
In psoriasis - bleeding spots when scales are scraped off
Head - trunk - extremities - common benign neoplasm in older persons
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Ephelis

19. When do acute attacks of gout typically occur
Verrucae
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Medially rotates and adducts arm
After a large meal or EtOH conspumption

20. hyperpigmentation associated with pregnancy or OCP
Precocious puberty
Melasma (chloasma)
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Lichen planus

21. What enzyme defect in responsible for osteopetrosis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Connects cells to underlying extracellular - bullous pemphigoid
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Carbonic anhydrase II

22. loss of what muscles in Erbs causes the medial rotation
Glucocorticoids
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Paralysis of lateral rotators
Dysplastic nevus

23. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Lesioned by midshaft fracture of humerus
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Muslce use - nerve stim/compound muscle test
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

24. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Posterior cord
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Inc blood flow from AV shunts can cause high output heart failure
Tear of the ACL

25. Ca2+ released from the SR binds what structure and What does it cause
Serum ca - phos - PTH are nl alk phos elevated
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
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

26. How is diffuse scleroderma characterized
Cervical disk lesion
Down T tubule
Widespread skin involvment - rapid progression - early visceral involvement
Nl - decreased bone mass

27. What do anterior and posterior in ACL and PCL refer to...
Sites of tibial attachment
Torn MCL
Conjunctivitis and anterior uveitis - urethritis and arthritis
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

28. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Conjunctivitis and anterior uveitis - urethritis and arthritis
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

29. What do the branches of the deep ulnar nerve innervate
Wheal
Subclavius
Staph scalded skin syndrome
Interossei and adductor policis

30. thickened - dense bones that are prone to fracture - dz and primary defect
Pityriasis rosea
Fever - fatigue - pleuritis - pericarditis
Osteopetrosis - abnl fxn of osteoclasts
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

31. What does acantholysis show in pemphigus vulgaris
Intraepidermal bullae involving the skin and oral mucosa
3rd finger
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

32. What runs the distance of the A band
Wheal
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Myosin
Erythema nodosum

33. What do pseudogout crystals appear like microscopically
Basophilic - rhomboid crystals - weakly birefringent
Pseudogout
Flex the MCP joints and extend both the DIP and PIP joints
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

34. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Parakeratosis
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Melasma (chloasma)

35. 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
Keloid
MCL - ACL - lateral meniscus (esp in athletes)
Osteoid osteoma

36. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Pityriasis rosea
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
85% - advanced paternal age - or auto dominant inheritance

37. What are the subQ rheumatoid nodules made of...
Axillary nerve
Fibrinoid necrosis surrounded by palisading histiocytes
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Actin

38. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Endochondroma
Keratoacanthoma
Nl - thickened dense bones
Tear of the ACL

39. What are the characteristic bone findings in paget's disease
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Age - obesity and joint deformity

40. 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
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Expansile glistening mass within the medullary cavity
Polymyositis - shoulders - perifasicular inflammation
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

41. hives - intensely pruritic wheals that form after mast cell degranulation
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Viral - maybe paramyxovirus
Urticaria
Anti ds DNA - poor prognosis

42. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Anterior interosseous nerve
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Fibrinoid necrosis surrounded by palisading histiocytes

43. freckle - normal number of melanocytes - inc melanin pigment
Erythema nodosum
Sites of tibial attachment
Ephelis
Recurrent branch of the median nerve

44. what changes are seen in stratum spinosum and granulosum in psoriasis
Posterior cord
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Inc spinosum - dec granulosum

45. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Recurrent branch of the medain nerve
Axillary - deltoid - skin over deltoid - flattened deltoid

46. What nerve is injured in a fracutre of the hook of hamate
Erythema multiforme - can be macules - papules vesicles - target lesions -
Palisading
Ligand binding leads to muscle depol
Ulnar nerve

47. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Calmodulin - complex activates myosin light chain kinase
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

48. Where is C6 dermatome
Lung
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Tear of the ACL

49. Where is osteosarcoma found in the bone
Ulnar nerve
Viral - maybe paramyxovirus
Osteoblastoma
Metaphysis of long bones - distal femur

50. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Osteoarthritis
Erythema multiforme - can be macules - papules vesicles - target lesions -
Renal - pulm - CV - GI - 75% female
Phosphorylates myosin light chain which leads to cross bridge formation