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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 development failure can results in albinism
NC migration
Albinism
Abduct the fingers
Phosphate is liberated from the myosin head

2. What antibodies is diffuse scleroderma associated with
Making fist with a proximal median nerve lesion
McCune - Albright syndrome
Allopurinaol - uricosurics (probenicid)
Anti Scl70 - anti DNA topoisomerase I antibody

3. What is the classic presentation of osteoarthritis
Cervical disk lesion
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Ulnar nerve - intrinsic muscles of hand
Pain in weight bearing joints at the end of the day and improving with rest

4. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Corneum - lucidum - granulosum - spinosum - basalis
Abduct the fingers
Keloid

5. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Ulnar
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Verrucae
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

6. What does subscapularis do
Squamous cell carcinoma
Medially rotates and adducts arm
Integrin binds laminin in BM
Macule

7. blister containing pus
Bulla
Erythema nodosum
Pustule
Fibrinoid necrosis surrounded by palisading histiocytes

8. hyperpigmentation associated with pregnancy or OCP
Melasma (chloasma)
Rheumatoid arthritis
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

9. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Osteoid osteoma
Squamous cell carcinoma
Pemphigus vulgaris
Actinic keratosis - risk proportional to epithelial dysplasia

10. loss of what muscles in Erbs causes the medial rotation
Expansile glistening mass within the medullary cavity
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Paralysis of lateral rotators
Basophilic - rhomboid crystals - weakly birefringent

11. How does the radial nerve in the spiral groove become injured
Type 2
Lesioned by midshaft fracture of humerus
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Plaque

12. What kind of jxn is the zona occludens andw What is is composed of...
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Rigor mortis
Papule
Trauma

13. Where is C7 dermatome
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Connects cells to underlying extracellular - bullous pemphigoid
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
3rd finger

14. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Seborrheic keratosis
Large goints (knee)
Ulnar
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

15. What are the subQ rheumatoid nodules made of...
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Fibrinoid necrosis surrounded by palisading histiocytes
Keloid
Adductor policis brevis

16. What is the defect in Paget's disease
Biceps
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Elevated ESR and nl CK - prednisone
Increase in both osteoblast and osteoclast activity

17. What other muscle in the thenar eminence adducts the thumb
Obturator - thigh adduction - medial thigh
Adductor policis brevis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

18. What kind of jxn is in the zona adherens and Where is it - What is it composed of - and what ion does it does it depend on...
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
NC migration
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

19. freckle - normal number of melanocytes - inc melanin pigment
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Ephelis
Ulnar nerve
Median nerve - same fingers but not on the hand

20. What signal initiates a muscle contraction
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ulnar
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
AP depol opens voltage gated Ca channels - inducing NT release

21. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Renal - pulm - CV - GI - 75% female
Ulnar nerve
Down T tubule
Polymyositis - shoulders - perifasicular inflammation

22. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Xeropthalmia - xerostomia - arthritis
Urticaria
Albinism
Serum ca - phos - alk phos are NL

23. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Mesenchymal stem cells in periosteum
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Female between 14 and 45 - mostly black
Keratoacanthoma

24. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Osteopetrosis - abnl fxn of osteoclasts
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Polymyositis - shoulders - perifasicular inflammation

25. What are the common perpetrating infections for Reiters syndrome
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Adduct the fingers
Post GI infxn or chlamydia
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

26. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Myosin releases bound ADP and is displaced on the actin filament
Polyostotic fibrous dysplasia
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
TB from dissemination and lyme dz

27. 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
Down T tubule
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

28. What medication is contraindicated in osteoporosis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Erythema nodosum
Glucocorticoids

29. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Abduct the fingers
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Glucocorticoids
Men and women > 70 - senile osteporosis

30. Who does osteoporosis type 2 effect
Verrucae
Men and women > 70 - senile osteporosis
Medial finger flexion - wrist flexion
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

31. What associations go along with sarcoidosis

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32. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Calmodulin - complex activates myosin light chain kinase
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

33. What happens in the power stroke of skeletal muscle contraction
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Phosphate is liberated from the myosin head
Cherry hemangioma
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

34. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

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35. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Endochondroma
Median nerve - lunate bone
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Verrucae

36. What nerve is compressed by supracondylar fracture of humerus
Deep branch of radial nerve
Biceps
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Median nerve

37. dried exudates from a vesicle - bulla or pustule seen impetigo
Wheal
Rigor mortis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Crust

38. What do the branches of the deep ulnar nerve innervate
Rheumatoid arthritis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Interossei and adductor policis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

39. What do dorsal interosseous muscles do
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Abduct the fingers
Expansile glistening mass within the medullary cavity
Muslce use - nerve stim/compound muscle test

40. 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
Increase in both osteoblast and osteoclast activity
Median nerve - same fingers but not on the hand
Plaque
Female between 14 and 45 - mostly black

41. What causes a lesion in the upper trunk of the brachial plexus
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Trauma
Nl - decreased bone mass
Medial 1.5 fingers - hypothenar eminence

42. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Lichen planus
Thymoma
Polymyositis - shoulders - perifasicular inflammation
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

43. Which type of muscle fiber is hypertrophied during weight training
Expansile glistening mass within the medullary cavity
Condyloma acuminatum - caused by HPV
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Type 2

44. What are the thin lines along the Z line
Actin
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Ulnar
Carbonic anhydrase II

45. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Myosin releases bound ADP and is displaced on the actin filament
Adduct the fingers
Rheumatoid arthritis
Erythema nodosum

46. What does MLCK do in smooth muscle contraction
Rheumatoid arthritis
NC migration
Interossei and adductor policis
Phosphorylates myosin light chain which leads to cross bridge formation

47. papule > 1cm seen psoriasis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Plaque
HI shrinks - A stays same
Medial 1.5 fingers - hypothenar eminence

48. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
ANA - sensitive but not specific
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

49. yellow when parallel and blue when perpendicular
Connects cells to underlying extracellular - bullous pemphigoid
Gout
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

50. mechanical wear and tear of joints leading to destruction of articular cartilage
Osteoarthritis
Sites of tibial attachment
Keloid
Hyperkeratosis