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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. Tumor occuring mostly at epiphyseal end of long bones - occuring btw 20 and 40 - locally aggressive bening tumor around distal femur and proximal tibia - tumor and characteristic xray findings
Rheumatoid arthritis
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Long thoracic nerve

2. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Cellulitis - s aureus - s pyogenes
MCL - ACL - lateral meniscus (esp in athletes)
Torn MCL
Seborrheic keratosis

3. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Iliac crest
Psoriasis
Large goints (knee)
Osteosarcoma - multiple myeloma

4. What lesion causes difficulty flexing elbow with variable sensory loss
Impetigo - s aureus - s pyogenes
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Making fist with a proximal median nerve lesion
Musculocutaneous

5. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Cherry hemangioma
In psoriasis - bleeding spots when scales are scraped off
B27 - no RF - males
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

6. What is the primary screening test for lupus
ANA - sensitive but not specific
Torn MCL
Urticaria
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

7. interlacing trabeculae of woven bone surrounded by osteoblasts
Osteoid osteoma
Type III - RF
Erlenmeyer flask bones that flare out - narrowed foramina
Over deltoid

8. What are the causes of inferior trunk plexus compression and What are the findings
Female between 14 and 45 - mostly black
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Ewings sarcoma - aggressive with early mets - but responsive to chemo
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

9. What are the histo findings in an osteoclastoma
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Spindle shaped cells with multinucleated giant cells
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

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

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11. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Biceps
Bulla
Impetigo - s aureus - s pyogenes
Gout

12. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Medial aspect
Polyostotic fibrous dysplasia
Renal - pulm - CV - GI - 75% female
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

13. What lesion causes total claw (klumpke's hand)
Ulnar nerve
Lower trunk of brachial plexus
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Axillary - deltoid - skin over deltoid - flattened deltoid

14. What molecule maintatins integrity of basement membrane and What does it bind
Median nerve
Integrin binds laminin in BM
B27 - no RF - males
Parotid enlargement - inc risk of B cell lymphoma - dental caries

15. What causes a lesion in the axillary nerve
Integrin binds laminin in BM
NSAIDs (indomethacin) colchicine
Medial aspect
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

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...
NSAIDs (indomethacin) colchicine
Adduct the fingers
Anti - CCP - HLA- DR4
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

17. Where does cartilage loss begin in osteoarthritis
Dermatitis herpetiformis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Dermatomyositis
Medial aspect

18. Which type of muscle fiber is hypertrophied during weight training
Median nerve - same fingers but not on the hand
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Type 2
Expansile glistening mass within the medullary cavity

19. What causes golf or tennis elbow
Osteogenic carcinoma
Carbonic anhydrase II
Papule
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

20. What do the lumbrical muscles do
Verrucae vulgaris
85% - advanced paternal age - or auto dominant inheritance
Flex at the MCP
Keratoacanthoma

21. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Ulnar nerve - fracture of hook of hamate
Type III - RF
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

22. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Obturator - thigh adduction - medial thigh
Serum ca - phos - alk phos are NL
Torn MCL

23. What causes osteoporosis type 1 and When does it typically occur
Dec estrogen causes inc bone resorption - postmenopausal
Hyperkeratosis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Phosphorylates myosin light chain which leads to cross bridge formation

24. What do palmar interosseous muscles do
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Adduct the fingers
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

25. What lesion causes claw hand and What are the muscles involved
Median nerve
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Ulnar nerve - intrinsic muscles of hand
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

26. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Verrucae
Subclavius
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

27. Where is C6 dermatome
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Flex the MCP joints and extend both the DIP and PIP joints
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

28. What is the precursor to melanom
Dysplastic nevus
Anti - CCP - HLA- DR4
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Making fist with a proximal median nerve lesion

29. loss of what muscles in Erbs causes the medial rotation
Infraspinatus - laterally rotates arm
Paralysis of lateral rotators
Crust
Supraspinatus - abducts the arm before the deltoid

30. What kind of jxn is the zona occludens andw What is is composed of...
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Obturator - thigh adduction - medial thigh
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Inc alk phos - abnl bone architecture

31. warts on genitals
Condyloma acuminatum - caused by HPV
Flex the MCP joints and extend both the DIP and PIP joints
Subclavius
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

32. Decrease marrow space in osteopetrosis leads to what?
Over deltoid
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Vesicle
Axilla

33. What are the bone mineralization lab findings in osteopetrosis
Serum ca - phos - alk phos are NL
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Subclavius
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

34. When do acute attacks of gout typically occur
B27 - no RF - males
Mesenchymal stem cells in periosteum
After a large meal or EtOH conspumption
Osteosarcoma - multiple myeloma

35. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Anti Scl70 - anti DNA topoisomerase I antibody
Type III - RF
Outer arm
Median nerve - lunate bone

36. What is the power stroke of muscle contraction
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Osteosarcoma - multiple myeloma
Myosin releases bound ADP and is displaced on the actin filament
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

37. What do pseudogout crystals appear like microscopically
Integrin binds laminin in BM
Connects cells to underlying extracellular - bullous pemphigoid
Abduct the fingers
Basophilic - rhomboid crystals - weakly birefringent

38. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Osteosarcoma - multiple myeloma
Acute back pain - loss of height - and kyphosis
Osteochondroma - exostosis

39. MG is associated with what neoplasm
Rheumatoid arthritis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Thymoma

40. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Ulnar
Biceps
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Osteoblastoma

41. What is the Sicca syndrome
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Female between 14 and 45 - mostly black
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis

42. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Crohns and ulcerative colitis
Medial aspect
Connects cells to underlying extracellular - bullous pemphigoid
Radial nerve becomes compressed in axilla

43. IBS - 2 dz's
Crohns and ulcerative colitis
Nl - thickened dense bones
Sarcoidosis - black females - ACE
Morning stiffness for > 30 min improving with use - symmetry - systemic sx

44. What is below the epidermis
TB from dissemination and lyme dz
Ulnar deviation - subluxation - bakers cysts (behind knee)
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
The dermis

45. Patients with pagets disease can develop what cancer
Medially rotates and adducts arm
Osteogenic carcinoma
Sites of tibial attachment
Metaphysis of long bones - distal femur

46. What are the predisposing factors for osteoarthritis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Age - obesity and joint deformity
Erythema nodosum
Dermatitis

47. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Acanthosis
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Erythema multiforme - can be macules - papules vesicles - target lesions -
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

48. What are the possible origins of the paget's disease
MCP - PIP - no DIP
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Viral - maybe paramyxovirus

49. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Fibrinoid necrosis surrounded by palisading histiocytes
Osteoid osteoma
Recurrent branch of the medain nerve

50. How is diffuse scleroderma characterized
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Widespread skin involvment - rapid progression - early visceral involvement
Radial nerve
Hyperkeratosis