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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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1. What does injury to the distal ulnar nerve cause
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Anti Smith
Metaphysis of long bones - distal femur
< 2mc found in proximal tibia and femur - men < 25

2. What are the lab findings in osteoporosis
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Medial finger flexion - wrist flexion
Erythema multiforme - can be macules - papules vesicles - target lesions -
Nl - decreased bone mass

3. What does IM reveal in pemphigus vulgaris
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Antibodies around cells of the epidermis in a reticular or netlike pattern
Rigor mortis
AP depol opens voltage gated Ca channels - inducing NT release

4. What do lupus pts falsely test positive for syphillis
Hairy leukoplakia - HIV population - EBV mediated
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Condyloma acuminatum - caused by HPV

5. What does lack of ATP cause
Rigor mortis
MCL - ACL - lateral meniscus (esp in athletes)
Paralysis of lateral rotators
Precocious puberty

6. which muscle type is fast twitch and why are fibers white
Phosphate is liberated from the myosin head
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Actinic keratosis - risk proportional to epithelial dysplasia
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

7. What is the source of osteoblast cells
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Mesenchymal stem cells in periosteum
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Lesioned by midshaft fracture of humerus

8. What is a precursor to squamous cell carcinoma
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Flex the MCP joints and extend both the DIP and PIP joints
Actinic keratosis
Paralysis of abductors

9. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Fever - fatigue - pleuritis - pericarditis
Keloid
Macule
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages

10. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
GC and cGMP and inhibition of MLCK
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Osteoid osteoma

11. What receptor is constitutively activated in achondroplasia and What does it do
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Acanthosis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

12. What causes total claw
Dec estrogen causes inc bone resorption - postmenopausal
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

13. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
TB from dissemination and lyme dz
Myosin
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

14. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Large goints (knee)
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Connects cells to underlying extracellular - bullous pemphigoid

15. What are the most common symtpoms of SLE
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Cherry hemangioma
Ligand binding leads to muscle depol
Verrucae vulgaris

16. What kind of nuclei do basal cell tumors have
Palisading
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Calmodulin - complex activates myosin light chain kinase
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign

17. What is below the epidermis
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Carbonic anhydrase II
TB from dissemination and lyme dz
The dermis

18. small fluid containing blister seen in chickenpox
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Wheal
85% - advanced paternal age - or auto dominant inheritance
Vesicle

19. Decrease marrow space in osteopetrosis leads to what?
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Radial nerve
Men and women > 70 - senile osteporosis

20. What causes the symptoms of MG to worsen - and What is used to diagnose
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Muslce use - nerve stim/compound muscle test
Nl - thickened dense bones
Pemphigus vulgaris

21. What clinical features in vertebral crush fractures
Ulnar
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Erythema multiforme - can be macules - papules vesicles - target lesions -
Acute back pain - loss of height - and kyphosis

22. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Lesioned by midshaft fracture of humerus
Exercise and Ca ingestion before age 30
Osteochondroma - exostosis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

23. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Fibrinoid necrosis surrounded by palisading histiocytes
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Papule

24. What are the classic fractures in pts with osteoporosis

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25. mechanical wear and tear of joints leading to destruction of articular cartilage
Inc blood flow from AV shunts can cause high output heart failure
Seborrheic keratosis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Osteoarthritis

26. Where is McBurney's point and What is there
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Acanthosis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

27. 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
Verrucae vulgaris
Median nerve - lunate bone
Trauma

28. What is the defect in Paget's disease
Integrin binds laminin in BM
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Increase in both osteoblast and osteoclast activity
Myosin releases bound ADP and is displaced on the actin filament

29. Who does osteoporosis type 2 effect
Men and women > 70 - senile osteporosis
4th and 5th finger
Mesenchymal stem cells in periosteum
TB from dissemination and lyme dz

30. Which muscle is the pitching injury and What does it do
< 2mc found in proximal tibia and femur - men < 25
Serum ca - phos - PTH are nl alk phos elevated
Adduct the fingers
Infraspinatus - laterally rotates arm

31. yellow when perpendicular and blue when parallel
Pseudogout
Abduct the fingers
Nevocellular nevus
Carbonic anhydrase II

32. What lesion causes Saturday night wrist drop
Radial nerve
Endochondroma
Actin
Flex the MCP joints and extend both the DIP and PIP joints

33. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Sarcoidosis - black females - ACE
Ulnar nerve
Hairy leukoplakia - HIV population - EBV mediated

34. What are characteristic findings of gout
Staph scalded skin syndrome
Pustule
Steroids
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon

35. What do palmar interosseous muscles do
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Adduct the fingers
After a large meal or EtOH conspumption

36. What nerve and branch are stretche by subluxation of the radius
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
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
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Deep branch of radial nerve

37. What kind of bone tumor is associated with FAP and What is the finding
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

38. What TX prophylax against osteoporisi
Exercise and Ca ingestion before age 30
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Pain in weight bearing joints at the end of the day and improving with rest

39. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Obturator - thigh adduction - medial thigh
Ulnar nerve
Increase in both osteoblast and osteoclast activity
Radial nerve becomes compressed in axilla

40. What causes ape hand
Inc blood flow from AV shunts can cause high output heart failure
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Exercise and Ca ingestion before age 30

41. Sarcoid TX
Myosin releases bound ADP and is displaced on the actin filament
Adductor policis brevis
Steroids
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

42. What do the lumbrical muscles do
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Flex at the MCP
Papule

43. What do dorsal interosseous muscles do
Nl - decreased bone mass
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Abduct the fingers
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

44. What are predisposing factors for osteosarcoma - xray finding

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45. What does acantholysis show in pemphigus vulgaris
Melasma (chloasma)
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Intraepidermal bullae involving the skin and oral mucosa
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

46. epidermal hyperplasia (inc spinosum)
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Acanthosis
Basal cell carcinoma - pearly papules - commonly with telangiectasias

47. What muscles of the shoulder form the rotator cuff
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Expansile glistening mass within the medullary cavity
Cherry hemangioma

48. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Large goints (knee)
Integrin binds laminin in BM
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

49. What is the TX for chronic gout
Anti Smith
Allopurinaol - uricosurics (probenicid)
Vitiligo - dec number in melanocytes
Men and women > 70 - senile osteporosis

50. Through what pathway does NO work and What is the downstream effect
Pseudogout
Expansile glistening mass within the medullary cavity
GC and cGMP and inhibition of MLCK
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis