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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 lesions causes Erb's palsy
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Scleroderma
Upper trunk of brachial plexus
Medially rotates and adducts arm

2. What does subscapularis do
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Medially rotates and adducts arm
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Recurrent branch of the median nerve

3. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Osteoblastoma
Nevocellular nevus
Obturator - thigh adduction - medial thigh
Type 2

4. What supplies innervation to the thenar muscles
Mesenchymal stem cells in periosteum
Recurrent branch of the median nerve
Osteoarthritis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

5. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Lesioned by midshaft fracture of humerus
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Xeropthalmia - xerostomia - arthritis
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

6. What does I'M DAMN SHARP stand for
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

7. What does ATP do in skeletal muscle contraction
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Medial finger flexion - wrist flexion
Corneum - lucidum - granulosum - spinosum - basalis

8. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
MCP - PIP - no DIP
Verrucae
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

9. What is below the epidermis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
The dermis
Ligand binding leads to muscle depol
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

10. What happens at the gap jxn and what molecules create them
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Polyostotic fibrous dysplasia
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Parakeratosis

11. which muscle type is fast twitch and why are fibers white
AP depol opens voltage gated Ca channels - inducing NT release
Interossei and adductor policis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Head - trunk - extremities - common benign neoplasm in older persons

12. interlacing trabeculae of woven bone surrounded by osteoblasts
In psoriasis - bleeding spots when scales are scraped off
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Osteoid osteoma
Over deltoid

13. hypothenar eminence - nerve and muscles
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Plaque

14. elevated skin lesion <1cm seen in acne vulgaris
Papule
Medial aspect
Connects cells to underlying extracellular - bullous pemphigoid
Radial nerve becomes compressed in axilla

15. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Viral - maybe paramyxovirus
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Type III - RF
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

16. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Erythema multiforme - can be macules - papules vesicles - target lesions -
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

17. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Lichen planus

18. Who does osteoporosis type 2 effect
AP depol opens voltage gated Ca channels - inducing NT release
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Crust
Men and women > 70 - senile osteporosis

19. What are the lab findings in osteomalacia/rickets
Female between 14 and 45 - mostly black
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Dermatomyositis
Iliac crest

20. Through what pathway does NO work and What is the downstream effect
4th and 5th finger
GC and cGMP and inhibition of MLCK
Melasma (chloasma)
Allopurinaol - uricosurics (probenicid)

21. What lesion causes total claw (klumpke's hand)
Lower trunk of brachial plexus
Type 2
Viral - maybe paramyxovirus
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign

22. Sarcoid TX
Anti - CCP - HLA- DR4
Verrucae
Vesicle
Steroids

23. mechanical wear and tear of joints leading to destruction of articular cartilage
Torn MCL
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Osteoarthritis
Lung

24. What does acantholysis show in pemphigus vulgaris
Acantholysis
Paralysis of lateral rotators
Intraepidermal bullae involving the skin and oral mucosa
McCune - Albright syndrome

25. What do lumbricals do
Flex the MCP joints and extend both the DIP and PIP joints
Phosphate is liberated from the myosin head
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Ulnar

26. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Inc alk phos - abnl bone architecture
Corneum - lucidum - granulosum - spinosum - basalis
Connects cells to underlying extracellular - bullous pemphigoid

27. What kind of jxn is the zona occludens andw What is is composed of...
Widespread skin involvment - rapid progression - early visceral involvement
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Myosin
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

28. What is the classic presentation of RA
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Adduct the fingers
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

29. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Hyperkeratosis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

30. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Inc spinosum - dec granulosum
Xeropthalmia - xerostomia - arthritis
Ulnar nerve - fracture of hook of hamate
Osteoblastoma

31. What do xray show in osteopetrosis and What do potential CN abnl result from
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Erlenmeyer flask bones that flare out - narrowed foramina
ANA - sensitive but not specific
Infraspinatus - laterally rotates arm

32. What nerve is injured by a superficial laceration of the hand
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Recurrent branch of the medain nerve
Renal - pulm - CV - GI - 75% female
Axillary - deltoid - skin over deltoid - flattened deltoid

33. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Connects cells to underlying extracellular - bullous pemphigoid
Recurrent branch of the median nerve
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Parotid enlargement - inc risk of B cell lymphoma - dental caries

34. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
TB from dissemination and lyme dz
Connects cells to underlying extracellular - bullous pemphigoid
Verrucae
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

35. separation of epidermal cells
Acantholysis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Hairy leukoplakia - HIV population - EBV mediated
Nevocellular nevus

36. How is the lower trunk of the brachia plexus injured and what results from it

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37. What autoantibodies are formed in sjogrens syndrome
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Glucocorticoids

38. Loss of what muscles in Erbs causes the forearm to be pronated
Dysplastic nevus
Biceps
Medially rotates and adducts arm
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

39. epi of SLE
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
McCune - Albright syndrome
Crust
Female between 14 and 45 - mostly black

40. thickened - dense bones that are prone to fracture - dz and primary defect
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Osteopetrosis - abnl fxn of osteoclasts
Pemphigus vulgaris

41. What is CREST syndrome and What antibody is it associated with
Anterior interosseous nerve
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
ANA - sensitive but not specific
Osteogenic carcinoma

42. Flat discloration <1cm seen in tinea versicolor
85% - advanced paternal age - or auto dominant inheritance
Crohns and ulcerative colitis
Macule
Medial 1.5 fingers - hypothenar eminence

43. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Keloid
Acanthosis
McCune - Albright syndrome

44. How does the radial nerve in the spiral groove become injured
Lesioned by midshaft fracture of humerus
Down T tubule
Cervical disk lesion
Intraepidermal bullae involving the skin and oral mucosa

45. What are the lab findings in osteopetrosis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Calmodulin - complex activates myosin light chain kinase
Nl - thickened dense bones
Paralysis of abductors

46. osteochondrosis has rare malignant transformation into what cancer
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Chondrosarcoma
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Melasma (chloasma)

47. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Obturator - thigh adduction - medial thigh
Osteogenic carcinoma
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Acanthosis

48. What are the classic fractures in pts with osteoporosis

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49. What nerve become injured in the incorrect use of a crutch
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Radial nerve becomes compressed in axilla
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

50. What is a very specific test for lupus
Medial forearm and arm to just under the axilla
Rigor mortis
Gout
Anti ds DNA - poor prognosis