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Musculoskeletal

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Answer 50 questions in 15 minutes.
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1. Which muscle is the pitching injury and What does it do
Phosphorylated
Deep branch of radial nerve
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Infraspinatus - laterally rotates arm

2. inflammation of the skin
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Dermatitis
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Inc blood flow from AV shunts can cause high output heart failure

3. What do lumbricals do
Ephelis
Flex the MCP joints and extend both the DIP and PIP joints
Large goints (knee)
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

4. What do dorsal interosseous muscles do
Anti Smith
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Abduct the fingers

5. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Nl - thickened dense bones
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Medially rotates and adducts arm

6. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Thymoma
Iliac crest
Melasma (chloasma)

7. separation of epidermal cells
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Long thoracic nerve
Acantholysis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

8. What is the classic triad of reactive arthritis
Osteosarcoma - multiple myeloma
Inc alk phos - abnl bone architecture
Glucocorticoids
Conjunctivitis and anterior uveitis - urethritis and arthritis

9. What is a precursor to squamous cell carcinoma
Actinic keratosis
Medially rotates and adducts arm
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Cellulitis - s aureus - s pyogenes

10. What are the possible origins of the paget's disease
Head - trunk - extremities - common benign neoplasm in older persons
Bulla
Viral - maybe paramyxovirus
Pain in weight bearing joints at the end of the day and improving with rest

11. What are the lab findings and TX in dermatomyositis
Inc spinosum - dec granulosum
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Posterior cord
Gout

12. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Hairy leukoplakia - HIV population - EBV mediated
Widespread skin involvment - rapid progression - early visceral involvement

13. What is the TX for acute gout
NSAIDs (indomethacin) colchicine
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Inc blood flow from AV shunts can cause high output heart failure

14. What is the sign of Leser - Trelat
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Verrucae vulgaris
Basophilic - rhomboid crystals - weakly birefringent
Rheumatoid arthritis

15. What TX prophylax against osteoporisi
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Corneum - lucidum - granulosum - spinosum - basalis
Exercise and Ca ingestion before age 30
Phosphate is liberated from the myosin head

16. What kind of bone tumor is associated with FAP and What is the finding
Biceps
Age - obesity and joint deformity
Infraspinatus - laterally rotates arm
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

17. In smooth muscle contraction - What does Ca bind and What is the purpose
Pemphigus vulgaris
Calmodulin - complex activates myosin light chain kinase
Osteoarthritis
Dermatitis

18. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Osteoarthritis
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Exercise and Ca ingestion before age 30
Anterior interosseous nerve

19. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Dysplastic nevus
Keratoacanthoma
4th and 5th finger

20. thickened - dense bones that are prone to fracture - dz and primary defect
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Osteoblastoma
Anti - histone
Osteopetrosis - abnl fxn of osteoclasts

21. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Obturator - thigh adduction - medial thigh
Osteoblastoma
Albinism

22. What is the classic presentation of osteoarthritis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Pain in weight bearing joints at the end of the day and improving with rest
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Papule

23. What is below the epidermis
Erythema nodosum
The dermis
Radial nerve becomes compressed in axilla
Parakeratosis

24. What is the Auspitz sign
Female between 14 and 45 - mostly black
In psoriasis - bleeding spots when scales are scraped off
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Ulnar deviation - subluxation - bakers cysts (behind knee)

25. Where is C6 dermatome
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Widespread skin involvment - rapid progression - early visceral involvement
Medial finger flexion - wrist flexion

26. What are the the common causes of Erb palsy - and What are the associated findings
Myosin
Type III - RF
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction

27. 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
MCL - ACL - lateral meniscus (esp in athletes)
< 2mc found in proximal tibia and femur - men < 25
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

28. What is the landmark for an LP
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Iliac crest
Antibodies around cells of the epidermis in a reticular or netlike pattern
Endochondroma

29. What nerve is injured by a superficial laceration of the hand
HI shrinks - A stays same
Head - trunk - extremities - common benign neoplasm in older persons
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Recurrent branch of the medain nerve

30. What signal initiates a muscle contraction
Wheal
Over deltoid
AP depol opens voltage gated Ca channels - inducing NT release
Phosphorylates myosin light chain which leads to cross bridge formation

31. What does MLCK do in smooth muscle contraction
Phosphorylates myosin light chain which leads to cross bridge formation
Increase in both osteoblast and osteoclast activity
Corneum - lucidum - granulosum - spinosum - basalis
Renal - pulm - CV - GI - 75% female

32. Where is T1 dermatome
Medial forearm and arm to just under the axilla
Patch
Polymyositis - shoulders - perifasicular inflammation
Basal cell carcinoma - pearly papules - commonly with telangiectasias

33. What lesion causes Saturday night wrist drop
Radial nerve
MCL - ACL - lateral meniscus (esp in athletes)
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Osteoporosis

34. transiet vesicle seen in hives
Axillary nerve
Adduct the fingers
Wheal
Interossei and adductor policis

35. What are the lab findings in osteopetrosis
Adductor policis brevis
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Nl - thickened dense bones
Axilla

36. How is chondrosarcoma described
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Large goints (knee)
Expansile glistening mass within the medullary cavity
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

37. hypothenar eminence - nerve and muscles
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Median nerve
Axilla
Median nerve

38. What associations go along with sarcoidosis

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39. What is contained within epithelial granulomas of pts with sarcoid
Pseudogout
Interossei and adductor policis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

40. IBS - 2 dz's
Cervical disk lesion
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Crohns and ulcerative colitis
AP depol opens voltage gated Ca channels - inducing NT release

41. What autoantibodies are formed in sjogrens syndrome
Men and women > 70 - senile osteporosis
Anti Scl70 - anti DNA topoisomerase I antibody
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

42. Why does EtOH consumption precipitate gout
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Glucocorticoids
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

43. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Phosphorylates myosin light chain which leads to cross bridge formation
Thymoma
Torn MCL

44. What causes total claw
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
3rd finger
Steroids
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

45. What is the test for drug induced lupus
Osteoid osteoma
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Anti - histone
Glucocorticoids

46. Which muscle is the most common rotator cuff injury and What does it do
Supraspinatus - abducts the arm before the deltoid
Lung
Ephelis
AP depol opens voltage gated Ca channels - inducing NT release

47. What development failure can results in albinism
Verrucae vulgaris
Acanthosis
NC migration
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

48. What deformities of the hand are common in RA
Boutonniere - swan neck - zthumb
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Flex at the MCP
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

49. Thenar eminence - nerve and muscles
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Nl - decreased bone mass

50. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Seborrheic keratosis
Vesicle
Scleroderma
Acanthosis

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Musculoskeletal

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