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Musculoskeletal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Widespread skin involvment - rapid progression - early visceral involvement
McCune - Albright syndrome
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

2. What molecule maintatins integrity of basement membrane and What does it bind
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Integrin binds laminin in BM
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Acute back pain - loss of height - and kyphosis

3. What do dorsal interosseous muscles do
Widespread skin involvment - rapid progression - early visceral involvement
Abduct the fingers
MCL - ACL - lateral meniscus (esp in athletes)
Allopurinaol - uricosurics (probenicid)

4. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Squamous cell carcinoma
Acute back pain - loss of height - and kyphosis
Plaque
< 2mc found in proximal tibia and femur - men < 25

5. What do lumbricals do
Osteoporosis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Patch
Flex the MCP joints and extend both the DIP and PIP joints

6. Which muscle fiber type is slow twitch and why are fibers red
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Nevocellular nevus
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Scleroderma

7. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Parakeratosis
Pseudogout
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Impetigo - s aureus - s pyogenes

8. What kind of endocrine abnl are associated with McCune Albright
Precocious puberty
Femoral - thing flexion and leg extension - anterior thigh and medial leg
S. aureus - streptococcus
Plaque

9. What causes ape hand
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Fibrinoid necrosis surrounded by palisading histiocytes
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Biceps

10. Where is McBurney's point and What is there
Phosphorylates myosin light chain which leads to cross bridge formation
Mesenchymal stem cells in periosteum
Sarcoidosis - black females - ACE
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

11. What are common features of lupus
Lower trunk of brachial plexus
Pseudogout
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
The dermis

12. What associations go along with sarcoidosis

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13. thickened - dense bones that are prone to fracture - dz and primary defect
Dec estrogen causes inc bone resorption - postmenopausal
Medially rotates and adducts arm
Ligand binding leads to muscle depol
Osteopetrosis - abnl fxn of osteoclasts

14. What does injury to the distal ulnar nerve cause
Intraepidermal bullae involving the skin and oral mucosa
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

15. What does IM reveal in pemphigus vulgaris
Thymoma
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Antibodies around cells of the epidermis in a reticular or netlike pattern

16. Other than N. gono - what organisms can cause infectious - septic arthritis
S. aureus - streptococcus
Integrin binds laminin in BM
Osteoarthritis
Precocious puberty

17. Where is osteosarcoma found in the bone
Paralysis of abductors
Cherry hemangioma
Metaphysis of long bones - distal femur
Making fist with a proximal median nerve lesion

18. What supplies innervation to the thenar muscles
Xeropthalmia - xerostomia - arthritis
Crohns and ulcerative colitis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Recurrent branch of the median nerve

19. What is the primary screening test for lupus
ANA - sensitive but not specific
Men and women > 70 - senile osteporosis
Sarcoidosis - black females - ACE
Over deltoid

20. What lesion causes wrist drop
Ulnar deviation - subluxation - bakers cysts (behind knee)
Musculocutaneous
Patch
Posterior cord

21. Where is C7 dermatome
Vesicle
3rd finger
Staph scalded skin syndrome
Lesioned by midshaft fracture of humerus

22. What is the Auspitz sign
Albinism
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
In psoriasis - bleeding spots when scales are scraped off
Renal - pulm - CV - GI - 75% female

23. What does subscapularis do
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Medially rotates and adducts arm
Median nerve - same fingers but not on the hand
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

24. What are the characterstic joints affected in RA
MCP - PIP - no DIP
Type 2
Long thoracic nerve
Pseudogout

25. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments

26. What causes a lesion in the upper trunk of the brachial plexus
Medial forearm and arm to just under the axilla
Trauma
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Actinic keratosis

27. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Pityriasis rosea
Biceps
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid

28. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Myosin light chain phosphotase
Median nerve - lunate bone
Corneum - lucidum - granulosum - spinosum - basalis

29. What kind of bone tumor is associated with FAP and What is the finding
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Palisading
Inc blood flow from AV shunts can cause high output heart failure
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

30. What does lack of ATP cause
Rigor mortis
Allopurinaol - uricosurics (probenicid)
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

31. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Female between 14 and 45 - mostly black
Pityriasis rosea
Axillary nerve
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

32. What enzyme is necessary for smooth muscle relaxation after contraction
Ulnar nerve
Myosin light chain phosphotase
Large goints (knee)
Sites of tibial attachment

33. Macule greater than 1cm
Patch
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Ischial spine - relieve pain during delivery
Staph scalded skin syndrome

34. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Anti - histone
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Osteochondroma - exostosis

35. How does gonococcal arthritis present
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Anti Smith
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Erythema multiforme - can be macules - papules vesicles - target lesions -

36. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Axilla
Lower trunk of brachial plexus
Precocious puberty

37. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Type 2
Polymyositis - shoulders - perifasicular inflammation
Erythema nodosum
Ewings sarcoma - aggressive with early mets - but responsive to chemo

38. separation of epidermal cells
The dermis
Outer arm
Cherry hemangioma
Acantholysis

39. What are the subQ rheumatoid nodules made of...
Fibrinoid necrosis surrounded by palisading histiocytes
Radial nerve
Ligand binding leads to muscle depol
Femoral - thing flexion and leg extension - anterior thigh and medial leg

40. What is the source of osteoblast cells
Mesenchymal stem cells in periosteum
Rheumatoid arthritis
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Albinism

41. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Cervical disk lesion
Scleroderma
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Sarcoidosis - black females - ACE

42. What nerve is injured by a superficial laceration of the hand
Long thoracic nerve
Recurrent branch of the medain nerve
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Dermatitis herpetiformis

43. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Outer arm
Muslce use - nerve stim/compound muscle test
Lichen planus
Keratoacanthoma

44. What is below the epidermis
ANA - sensitive but not specific
The dermis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Medial 1.5 fingers - hypothenar eminence

45. hyperpigmentation associated with pregnancy or OCP
Osteosarcoma - multiple myeloma
Osteopetrosis - abnl fxn of osteoclasts
Melasma (chloasma)
Fever - fatigue - pleuritis - pericarditis

46. warts on genitals
Nl - decreased bone mass
Condyloma acuminatum - caused by HPV
Inc alk phos - abnl bone architecture
MCL - ACL - lateral meniscus (esp in athletes)

47. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Patch
TB from dissemination and lyme dz

48. knee trauma - nerve - motor and sensory def
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Hairy leukoplakia - HIV population - EBV mediated
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity

49. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Lower trunk of brachial plexus
Conjunctivitis and anterior uveitis - urethritis and arthritis
Impetigo - s aureus - s pyogenes
Iliac crest

50. What are the lab findings and TX in dermatomyositis
Dermatitis herpetiformis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Cherry hemangioma
S. aureus - streptococcus

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Musculoskeletal

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