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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 are the lab findings in osteomalacia/rickets
Ulnar nerve
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
Radial nerve
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones

2. What does PED and Tip stand for

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

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4. What lesion causes deltoid paralysis
Axillary nerve
In psoriasis - bleeding spots when scales are scraped off
Acantholysis
Fibrinoid necrosis surrounded by palisading histiocytes

5. What supplies innervation to the thenar muscles
Scleroderma
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Recurrent branch of the median nerve

6. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Steroids
Adductor policis brevis
Ulnar nerve
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

7. In which form is myosin light chain active
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Chondrosarcoma
Phosphorylated
Mesenchymal stem cells in periosteum

8. What enzyme is necessary for smooth muscle relaxation after contraction
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Myosin light chain phosphotase

9. What causes a lesion in the upper trunk of the brachial plexus
Trauma
Serum ca - phos - PTH are nl alk phos elevated
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Patch

10. What is CREST syndrome and What antibody is it associated with
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Scleroderma
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Actinic keratosis

11. What are the the common causes of Erb palsy - and What are the associated findings
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
McCune - Albright syndrome
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
3rd finger

12. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
Ligand binding leads to muscle depol
Serum ca - phos - PTH are nl alk phos elevated
Osteoarthritis

13. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
In psoriasis - bleeding spots when scales are scraped off
Actinic keratosis
Parakeratosis

14. Which muscle fiber type is slow twitch and why are fibers red
Osteochondroma - exostosis
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Musculocutaneous
Long thoracic nerve

15. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Median nerve
Acanthosis nigcricans
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

16. What does lack of ATP cause
Radial nerve becomes compressed in axilla
Rigor mortis
Ulnar nerve
Adduct the fingers

17. What is the classic presentation of RA
Muslce use - nerve stim/compound muscle test
3rd finger
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Anti ds DNA - poor prognosis

18. warts on genitals
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Cherry hemangioma
Axillary nerve
Condyloma acuminatum - caused by HPV

19. What does abnl passive abduction of the knee indicate
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Exercise and Ca ingestion before age 30
Interossei and adductor policis
Torn MCL

20. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
In psoriasis - bleeding spots when scales are scraped off
Seborrheic keratosis

21. Achondroplasia is a failure of what process which results in which characteristic findings
Biceps
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

22. What muscle the long thoracic nerve innervate - What does it do - and when can it be injured
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Integrin binds laminin in BM
Elevated ESR and nl CK - prednisone
Radial nerve

23. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Erythema nodosum
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Pseudogout

24. What are the most common symtpoms of SLE
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Axillary nerve
Rigor mortis
Elevated ESR and nl CK - prednisone

25. What are the subQ rheumatoid nodules made of...
Anterior interosseous nerve
Fibrinoid necrosis surrounded by palisading histiocytes
Flex at the MCP
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

26. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Anti - histone
Cellulitis - s aureus - s pyogenes
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Medial forearm and arm to just under the axilla

27. How is chondrosarcoma described
Osteochondroma - exostosis
Myosin releases bound ADP and is displaced on the actin filament
Metaphysis of long bones - distal femur
Expansile glistening mass within the medullary cavity

28. What associations go along with sarcoidosis

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29. Patients with pagets disease can develop what cancer
S. aureus - streptococcus
Osteogenic carcinoma
Anterior interosseous nerve
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing

30. What is a precursor to squamous cell carcinoma
Actinic keratosis
Radial nerve
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Albinism

31. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Pain in weight bearing joints at the end of the day and improving with rest
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Age - obesity and joint deformity

32. Thenar eminence - nerve and muscles
Cherry hemangioma
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Medially rotates and adducts arm
< 2mc found in proximal tibia and femur - men < 25

33. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Adductor policis brevis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Pityriasis rosea

34. Which muscle is the pitching injury and What does it do
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Pseudogout
Infraspinatus - laterally rotates arm
Mesenchymal stem cells in periosteum

35. What is the defect in Paget's disease
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Increase in both osteoblast and osteoclast activity
Thymoma
Outer arm

36. Where are most osteoid osteoma found and In what population
Fever - fatigue - pleuritis - pericarditis
Ischial spine - relieve pain during delivery
< 2mc found in proximal tibia and femur - men < 25
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

37. osteochondrosis has rare malignant transformation into what cancer
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Chondrosarcoma
Expansile glistening mass within the medullary cavity

38. What are the motor defs of a proximal ulnar nerve injury
Medial finger flexion - wrist flexion
Lesioned by midshaft fracture of humerus
Nl - thickened dense bones
Allopurinaol - uricosurics (probenicid)

39. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Calmodulin - complex activates myosin light chain kinase
Strawberry hemangioma
Osteoarthritis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

40. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Post GI infxn or chlamydia
Keloid
Exercise and Ca ingestion before age 30
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

41. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Adductor policis brevis
Macule
Parotid enlargement - inc risk of B cell lymphoma - dental caries

42. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Dermatomyositis
Teres minor
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

43. What nerve is injured in a fracutre of the hook of hamate
Pustule
Posterior cord
Ulnar nerve
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

44. What other muscle in the thenar eminence adducts the thumb
Pityriasis rosea
Adductor policis brevis
Gout
Macule

45. What autoantibodies are formed in sjogrens syndrome
Muslce use - nerve stim/compound muscle test
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Infraspinatus - laterally rotates arm
NC migration

46. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Post GI infxn or chlamydia
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Erlenmeyer flask bones that flare out - narrowed foramina

47. 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
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Erythema nodosum
Acantholysis
Pain in weight bearing joints at the end of the day and improving with rest

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
AP depol opens voltage gated Ca channels - inducing NT release
Impetigo - s aureus - s pyogenes
Deep branch of radial nerve
Median nerve - same fingers but not on the hand

49. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Actinic keratosis
Connects cells to underlying extracellular - bullous pemphigoid
Axillary nerve
Polyostotic fibrous dysplasia

50. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Vitiligo - dec number in melanocytes
Femoral - thing flexion and leg extension - anterior thigh and medial leg
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Antibodies around cells of the epidermis in a reticular or netlike pattern