Test your basic knowledge |

Musculoskeletal

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Macule greater than 1cm
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Thymoma
Post GI infxn or chlamydia
Patch

2. What is the tumor marker for melanoma - who is at risk - what correlates with risk of metastasis and What is the gross path
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Pseudogout
Supraspinatus - abducts the arm before the deltoid
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders

3. What is the classic presentation of RA
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Erythema multiforme - can be macules - papules vesicles - target lesions -
Conjunctivitis and anterior uveitis - urethritis and arthritis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

4. When does membranous ossification occur and What is the difference between membranous and endochondrial
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Fever - fatigue - pleuritis - pericarditis
Crohns and ulcerative colitis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

5. What are the associations for sjogrens syndrome
Nl - thickened dense bones
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Macule

6. Deposition of calcium pyrophosphate cyrstals within the joint space
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Pseudogout
Crohns and ulcerative colitis

7. What nerve become injured in the incorrect use of a crutch
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Radial nerve becomes compressed in axilla
Osteochondroma - exostosis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation

8. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Ulnar deviation - subluxation - bakers cysts (behind knee)
Female between 14 and 45 - mostly black
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Verrucae vulgaris

9. How is the lower trunk of the brachia plexus injured and what results from it

10. What causes a lesion in the upper trunk of the brachial plexus
Basophilic - rhomboid crystals - weakly birefringent
Viral - maybe paramyxovirus
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Trauma

11. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Anti - CCP - HLA- DR4
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Inc spinosum - dec granulosum

12. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Anti Scl70 - anti DNA topoisomerase I antibody
Strawberry hemangioma
Psoriasis

13. warts on genitals
Condyloma acuminatum - caused by HPV
NC migration
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

14. What does abnl passive abduction of the knee indicate
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Supraspinatus - abducts the arm before the deltoid
Basophilic - rhomboid crystals - weakly birefringent
Torn MCL

15. Where is C6 dermatome
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Adductor policis brevis
Exercise and Ca ingestion before age 30

16. What development failure can results in albinism
NC migration
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Macule
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

17. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Medial forearm and arm to just under the axilla
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Staph scalded skin syndrome
Atopic dermatitis - eczema

18. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
B27 - no RF - males
Ulnar nerve - fracture of hook of hamate
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

19. Where is C7 dermatome
B27 - no RF - males
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
3rd finger
Pemphigus vulgaris

20. What antibodies is diffuse scleroderma associated with
Spindle shaped cells with multinucleated giant cells
Anti Scl70 - anti DNA topoisomerase I antibody
Deep branch of radial nerve
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

21. Through what pathway does NO work and What is the downstream effect
Serum ca - phos - PTH are nl alk phos elevated
In psoriasis - bleeding spots when scales are scraped off
GC and cGMP and inhibition of MLCK
Median nerve

22. Where is C5 dermatome
Axillary - deltoid - skin over deltoid - flattened deltoid
Outer arm
Axilla
Condyloma acuminatum - caused by HPV

23. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Erythema nodosum
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

24. What is contained within epithelial granulomas of pts with sarcoid
AP depol opens voltage gated Ca channels - inducing NT release
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Type 2
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

25. What is a very specific test for lupus
Dermatomyositis
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Infraspinatus - laterally rotates arm
Anti ds DNA - poor prognosis

26. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
McCune - Albright syndrome
3rd finger
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Steroids

27. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Inc spinosum - dec granulosum
Melasma (chloasma)

28. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Endochondroma
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Connects cells to underlying extracellular - bullous pemphigoid
Inc blood flow from AV shunts can cause high output heart failure

29. Administration of what kind of compound causes reversal of symptoms and What is used to distringuish under from over dosing
Carbonic anhydrase II
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
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Dysplastic nevus

30. osteochondrosis has rare malignant transformation into what cancer
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
B27 - no RF - males
Chondrosarcoma

31. epi of SLE
Flex the MCP joints and extend both the DIP and PIP joints
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Steroids
Female between 14 and 45 - mostly black

32. What do anterior and posterior in ACL and PCL refer to...
Lower trunk of brachial plexus
Sites of tibial attachment
Abduct the fingers
Intraepidermal bullae involving the skin and oral mucosa

33. Who does osteoporosis type 2 effect
Men and women > 70 - senile osteporosis
Acanthosis
Myosin releases bound ADP and is displaced on the actin filament
TB from dissemination and lyme dz

34. Where is C4 dermatome
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Over deltoid
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Radial nerve

35. 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
MCP - PIP - no DIP
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Medial finger flexion - wrist flexion

36. hyperpigmentation associated with pregnancy or OCP
Musculocutaneous
Melasma (chloasma)
Medially rotates and adducts arm
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

37. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Cherry hemangioma
Osteosarcoma - multiple myeloma
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

38. What are defining lab findings for polymyalgia rheumatica and What is the TX
Elevated ESR and nl CK - prednisone
Carbonic anhydrase II
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Corneum - lucidum - granulosum - spinosum - basalis

39. What are common features of lupus
Erythema nodosum
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Phosphorylated
Medial forearm and arm to just under the axilla

40. precipitation of monosodium urate crystals into joints due to hyperuricemia
Widespread skin involvment - rapid progression - early visceral involvement
Gout
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Medial finger flexion - wrist flexion

41. What are the histo findings in an osteoclastoma
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Seborrheic keratosis
Osteoarthritis
Spindle shaped cells with multinucleated giant cells

42. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Strawberry hemangioma
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Recurrent branch of the median nerve
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

43. Where is C8 dermatome
4th and 5th finger
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Gout

44. Dermatomyositis places the pt at inc risk For what malignancy in particular
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Lung
MCL - ACL - lateral meniscus (esp in athletes)
Inc blood flow from AV shunts can cause high output heart failure

45. What does subscapularis do
Medially rotates and adducts arm
Ephelis
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
< 2mc found in proximal tibia and femur - men < 25

46. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Boutonniere - swan neck - zthumb
Ulnar nerve
Acanthosis

47. What kind of nuclei do basal cell tumors have
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Palisading
Bulla
Seborrheic keratosis

48. How does gonococcal arthritis present
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
TB from dissemination and lyme dz

49. What is the TX for acute gout
HI shrinks - A stays same
NSAIDs (indomethacin) colchicine
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Flex at the MCP

50. What clinical features in vertebral crush fractures
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Actinic keratosis
Lung
Acute back pain - loss of height - and kyphosis