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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 percent of these mutations occur sporadically and what parental feature are they associated with
Macule
Erythema nodosum
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
85% - advanced paternal age - or auto dominant inheritance

2. Where is C5 dermatome
Crust
Integrin binds laminin in BM
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Outer arm

3. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Median nerve
Keloid
Ulnar
Upper trunk of brachial plexus

4. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Glucocorticoids
Scleroderma
4th and 5th finger
Medially rotates and adducts arm

5. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
McCune - Albright syndrome
Nl - thickened dense bones
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Dermatitis herpetiformis

6. Sarcoid TX
Steroids
Vesicle
Inc alk phos - abnl bone architecture
Lesioned by midshaft fracture of humerus

7. What nerve is injured by a superficial laceration of the hand
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Recurrent branch of the medain nerve
Acanthosis
Osteochondroma - exostosis

8. bening cartilaginous neoplasm found in intramedullary bone - usually distal extremities
TB from dissemination and lyme dz
Endochondroma
Staph scalded skin syndrome
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

9. hypothenar eminence - nerve and muscles
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Ligand binding leads to muscle depol
Musculocutaneous

10. What is the most common NMJ disorder - What causes it and What are common symptoms
Teres minor
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Female between 14 and 45 - mostly black

11. Where does cartilage loss begin in osteoarthritis
Medial aspect
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Lesioned by midshaft fracture of humerus
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

12. What nerve become injured in the incorrect use of a crutch
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Cervical disk lesion
Radial nerve becomes compressed in axilla

13. Where does squamous cell carcinoma of the skin typically appear - What is the histo - prognosis - and associations
Squamous cell carcinoma
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
GC and cGMP and inhibition of MLCK

14. What does I'M DAMN SHARP stand for
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Sites of tibial attachment
Condyloma acuminatum - caused by HPV

15. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Type III - RF
Post GI infxn or chlamydia
Paralysis of lateral rotators
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

16. 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+
Osteoporosis
Trauma
Inc alk phos - abnl bone architecture

17. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Serum ca - phos - alk phos are NL
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

18. What are the bone mineralization lab findings in osteopetrosis
Deep branch of radial nerve
Intraepidermal bullae involving the skin and oral mucosa
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Serum ca - phos - alk phos are NL

19. What does the positive anterior drawer sign test indicate
MCL - ACL - lateral meniscus (esp in athletes)
Median nerve
Tear of the ACL
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

20. What is the defect in Paget's disease
Increase in both osteoblast and osteoclast activity
Sites of tibial attachment
Widespread skin involvment - rapid progression - early visceral involvement
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

21. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Axillary nerve
Medial forearm and arm to just under the axilla
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

22. yellow when perpendicular and blue when parallel
Pseudogout
Nl - thickened dense bones
Serum ca - phos - PTH are nl alk phos elevated
Large goints (knee)

23. What are the associations for sjogrens syndrome
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Connects cells to underlying extracellular - bullous pemphigoid

24. What happens in the power stroke of skeletal muscle contraction
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Osteoarthritis
Phosphate is liberated from the myosin head
Upper trunk of brachial plexus

25. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Lichen planus
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Acanthosis nigcricans

26. irregular areas of complete depigmentation - condition and cause
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Vitiligo - dec number in melanocytes
Ulnar nerve - intrinsic muscles of hand

27. Which muscle fiber type is slow twitch and why are fibers red
Anti - histone
Ulnar nerve - intrinsic muscles of hand
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Femoral - thing flexion and leg extension - anterior thigh and medial leg

28. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Palisading
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

29. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Myosin light chain phosphotase
Pityriasis rosea
Fibrinoid necrosis surrounded by palisading histiocytes
Glucocorticoids

30. What is the classic presentation of RA
Polymyositis - shoulders - perifasicular inflammation
Glucocorticoids
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Keloid

31. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Erythema nodosum
Recurrent branch of the medain nerve

32. IBS - 2 dz's
Crohns and ulcerative colitis
Axillary - deltoid - skin over deltoid - flattened deltoid
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

33. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Osteosarcoma - multiple myeloma
Deep branch of radial nerve
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

34. separation of epidermal cells
Acantholysis
Dysplastic nevus
Patch
Medially rotates and adducts arm

35. What kind of nuclei do basal cell tumors have
Palisading
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Actin
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

36. Macule greater than 1cm
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Anti ds DNA - poor prognosis
Deep branch of radial nerve
Patch

37. inflammation of the skin
Dermatitis
The dermis
Inc spinosum - dec granulosum
Polyostotic fibrous dysplasia

38. What do the lumbrical muscles do
Widespread skin involvment - rapid progression - early visceral involvement
Pseudogout
Flex at the MCP
Staph scalded skin syndrome

39. What are the thin lines along the Z line
Actin
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Ulnar deviation - subluxation - bakers cysts (behind knee)
Pustule

40. What causes hypercalcemia in pts with sarcoid
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Axillary nerve
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
85% - advanced paternal age - or auto dominant inheritance

41. What do lupus pts falsely test positive for syphillis
Keloid
Erythema multiforme - can be macules - papules vesicles - target lesions -
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Recurrent branch of the medain nerve

42. What is a very specific test for lupus
Anti ds DNA - poor prognosis
Anti Smith
Metaphysis of long bones - distal femur
Verrucae vulgaris

43. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Fibrinoid necrosis surrounded by palisading histiocytes
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

44. Where is T1 dermatome
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Thymoma
Urticaria
Medial forearm and arm to just under the axilla

45. Where is C6 dermatome
Exercise and Ca ingestion before age 30
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Acantholysis

46. Loss of what muslces in Erbs causes the limb to hang by side
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Paralysis of abductors
Acantholysis
Phosphorylates myosin light chain which leads to cross bridge formation

47. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Acanthosis nigcricans
Medial forearm and arm to just under the axilla
Exercise and Ca ingestion before age 30

48. elevated skin lesion <1cm seen in acne vulgaris
Nl - decreased bone mass
Papule
HI shrinks - A stays same
Allopurinaol - uricosurics (probenicid)

49. What does PED and Tip stand for

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50. What are the lab findings in osteitis fibrosa cystica
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Torn MCL
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids