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. What percent of these mutations occur sporadically and what parental feature are they associated with
85% - advanced paternal age - or auto dominant inheritance
Osteosarcoma - multiple myeloma
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

2. What lesion causes wrist drop
Plaque
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Connects cells to underlying extracellular - bullous pemphigoid
Posterior cord

3. What nerve is injured in a fracutre of the hook of hamate
Dermatitis
Ephelis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Ulnar nerve

4. What is the classic presentation of RA
Ulnar nerve - intrinsic muscles of hand
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Inc spinosum - dec granulosum
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

5. What does lack of ATP cause
Rigor mortis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Keloid
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

6. Ca2+ released from the SR binds what structure and What does it cause
Psoriasis
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Female between 14 and 45 - mostly black
Acanthosis nigcricans

7. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Cellulitis - s aureus - s pyogenes
3rd finger
Acanthosis nigcricans
Dermatitis herpetiformis

8. warts on hands
Verrucae vulgaris
Type 2
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
After a large meal or EtOH conspumption

9. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Bulla
Intraepidermal bullae involving the skin and oral mucosa
Down T tubule

10. What are the classic fractures in pts with osteoporosis

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11. MG is associated with what neoplasm
Thymoma
Inc spinosum - dec granulosum
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

12. Which muscle is the pitching injury and What does it do
Seborrheic keratosis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Infraspinatus - laterally rotates arm
Obturator - thigh adduction - medial thigh

13. which muscle type is fast twitch and why are fibers white
Osteopetrosis - abnl fxn of osteoclasts
Adductor policis brevis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

14. larger osteoid osteoma found in vertebral column
Connects cells to underlying extracellular - bullous pemphigoid
Lung
Osteoblastoma
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

15. What causes total claw
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Pityriasis rosea
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

16. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Recurrent branch of the medain nerve
Interossei and adductor policis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

17. What are the motor defs of a proximal ulnar nerve injury
Endochondroma
Dec estrogen causes inc bone resorption - postmenopausal
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Medial finger flexion - wrist flexion

18. small fluid containing blister seen in chickenpox
Axillary - deltoid - skin over deltoid - flattened deltoid
Vesicle
Anterior interosseous nerve
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis

19. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Anti Scl70 - anti DNA topoisomerase I antibody
Osteochondroma - exostosis
Albinism
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

20. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Erythema multiforme - can be macules - papules vesicles - target lesions -
Type 2
Femoral - thing flexion and leg extension - anterior thigh and medial leg

21. inflammation of the skin
Dermatomyositis
Infraspinatus - laterally rotates arm
Plaque
Dermatitis

22. thickened - dense bones that are prone to fracture - dz and primary defect
Down T tubule
Anti ds DNA - poor prognosis
Osteopetrosis - abnl fxn of osteoclasts
Phosphorylated

23. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Ligand binding leads to muscle depol
Psoriasis
Thymoma
Osteoarthritis

24. What nerve is compressed by supracondylar fracture of humerus
Median nerve
Lichen planus
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

25. What is the source of osteoblast cells
Ulnar deviation - subluxation - bakers cysts (behind knee)
Pustule
Mesenchymal stem cells in periosteum
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

26. What are the most common symtpoms of SLE
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Inc blood flow from AV shunts can cause high output heart failure
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Expansile glistening mass within the medullary cavity

27. What are characteristic findings of gout
Phosphorylated
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

28. What are common features of lupus
Upper trunk of brachial plexus
Pseudogout
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Femoral - thing flexion and leg extension - anterior thigh and medial leg

29. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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30. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Polyostotic fibrous dysplasia
Staph scalded skin syndrome
Upper trunk of brachial plexus

31. What is the classic triad of reactive arthritis
Conjunctivitis and anterior uveitis - urethritis and arthritis
In psoriasis - bleeding spots when scales are scraped off
Female between 14 and 45 - mostly black
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

32. What causes ape hand
Interossei and adductor policis
Actinic keratosis
Radial nerve becomes compressed in axilla
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb

33. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Axilla
Down T tubule

34. epi of SLE
Female between 14 and 45 - mostly black
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

35. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Ulnar nerve - fracture of hook of hamate
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Medial aspect

36. What is the power stroke of muscle contraction
Myosin releases bound ADP and is displaced on the actin filament
Pityriasis rosea
Mesenchymal stem cells in periosteum
Ewings sarcoma - aggressive with early mets - but responsive to chemo

37. What is TX for osteoporosis
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Conjunctivitis and anterior uveitis - urethritis and arthritis
Osteosarcoma - multiple myeloma
Antibodies around cells of the epidermis in a reticular or netlike pattern

38. What kind of endocrine abnl are associated with McCune Albright
Fever - fatigue - pleuritis - pericarditis
Seborrheic keratosis
Melasma (chloasma)
Precocious puberty

39. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Keratoacanthoma
Verrucae vulgaris

40. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Parakeratosis
Female between 14 and 45 - mostly black
Dermatomyositis
Acanthosis

41. What antibody is less sensitive than RF but more specific and What is the HLA association
Medial aspect
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Anti - CCP - HLA- DR4

42. Where does the muscle contraction travel after leaving the motor end plate
Down T tubule
Dermatitis
Basophilic - rhomboid crystals - weakly birefringent
Spindle shaped cells with multinucleated giant cells

43. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Infraspinatus - laterally rotates arm
Dec estrogen causes inc bone resorption - postmenopausal
Cellulitis - s aureus - s pyogenes
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

44. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Crust
Seborrheic keratosis
Cherry hemangioma
Parakeratosis

45. When do acute attacks of gout typically occur
Impetigo - s aureus - s pyogenes
Post GI infxn or chlamydia
Dec estrogen causes inc bone resorption - postmenopausal
After a large meal or EtOH conspumption

46. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Lesioned by midshaft fracture of humerus
Axilla
Verrucae

47. What is the most common NMJ disorder - What causes it and What are common symptoms
Osteoarthritis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

48. What causes heart failure in with Paget's disease
Medially rotates and adducts arm
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Inc blood flow from AV shunts can cause high output heart failure

49. What are the lab findings in osteomalacia/rickets
Adductor policis brevis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Adduct the fingers

50. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Wheal
Palisading
Erythema multiforme - can be macules - papules vesicles - target lesions -
Keratoacanthoma