Test your basic knowledge |

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. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Osteoarthritis
Ischial spine - relieve pain during delivery
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Interossei and adductor policis

2. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Female between 14 and 45 - mostly black
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Axillary nerve

3. elevated skin lesion <1cm seen in acne vulgaris
Vesicle
Condyloma acuminatum - caused by HPV
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Papule

4. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Type III - RF
Ligand binding leads to muscle depol
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Radial nerve becomes compressed in axilla

5. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Iliac crest
Viral - maybe paramyxovirus
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

6. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Verrucae
Cervical disk lesion
Anti - CCP - HLA- DR4
Dec estrogen causes inc bone resorption - postmenopausal

7. loss of what muscles in Erbs causes the medial rotation
Anti Scl70 - anti DNA topoisomerase I antibody
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Rheumatoid arthritis
Paralysis of lateral rotators

8. MG is associated with what neoplasm
Thymoma
Serum ca - phos - PTH are nl alk phos elevated
McCune - Albright syndrome
Calmodulin - complex activates myosin light chain kinase

9. Decrease marrow space in osteopetrosis leads to what?
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Axilla
Increase in both osteoblast and osteoclast activity

10. What nerve become injured in the incorrect use of a crutch
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Supraspinatus - abducts the arm before the deltoid
Radial nerve becomes compressed in axilla
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

11. Which muscle is the most common rotator cuff injury and What does it do
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Female between 14 and 45 - mostly black
Supraspinatus - abducts the arm before the deltoid
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

12. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Large goints (knee)
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
MCP - PIP - no DIP
McCune - Albright syndrome

13. Autoimmune disorder with IgG antibody against hemidesmosomes - dz - IM - other findings

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14. What are the common perpetrating infections for Reiters syndrome
Allopurinaol - uricosurics (probenicid)
Impetigo - s aureus - s pyogenes
Post GI infxn or chlamydia
Female between 14 and 45 - mostly black

15. What lesion causes Saturday night wrist drop
Median nerve - same fingers but not on the hand
Lower trunk of brachial plexus
Radial nerve
Urticaria

16. What nerve is compressed by supracondylar fracture of humerus
Staph scalded skin syndrome
Pseudogout
Median nerve
Macule

17. What lesion causes total claw (klumpke's hand)
NC migration
Lower trunk of brachial plexus
ANA - sensitive but not specific
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

18. What does subscapularis do
Type III - RF
Adduct the fingers
Medially rotates and adducts arm
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

19. Where is C6 dermatome
Deep branch of radial nerve
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Female between 14 and 45 - mostly black
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

20. 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
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Verrucae
Dec estrogen causes inc bone resorption - postmenopausal
Lesioned by midshaft fracture of humerus

21. What are the classic fractures in pts with osteoporosis

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22. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Anti ds DNA - poor prognosis
Pustule
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

23. normal melanocyte number with dec melanin production due to inactivity of tyrosine
Albinism
Bulla
Pustule
Polymyositis - shoulders - perifasicular inflammation

24. Where is C5 dermatome
Outer arm
MCP - PIP - no DIP
Papule
Posterior cord

25. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

26. epidermal hyperplasia (inc spinosum)
Vitiligo - dec number in melanocytes
Acanthosis
Myosin light chain phosphotase
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

27. What is the classic presentation of osteoarthritis
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Rigor mortis
Pain in weight bearing joints at the end of the day and improving with rest
Xeropthalmia - xerostomia - arthritis

28. What nerve is injured in a fracutre of the hook of hamate
Ulnar nerve
Teres minor
Upper trunk of brachial plexus
Medial forearm and arm to just under the axilla

29. What enzyme is necessary for smooth muscle relaxation after contraction
Head - trunk - extremities - common benign neoplasm in older persons
Anti - histone
Myosin light chain phosphotase
Axillary nerve

30. knee trauma - nerve - motor and sensory def
NC migration
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Fracture of surgical neck - dislocation of the humerus - intramuscular injections

31. What does the hemidesmosome do and what disease is caused by autoantibodies to it
Expansile glistening mass within the medullary cavity
Ligand binding leads to muscle depol
Outer arm
Connects cells to underlying extracellular - bullous pemphigoid

32. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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33. What is TX for osteoporosis
Expansile glistening mass within the medullary cavity
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+

34. Sarcoid TX
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Steroids
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Fever - fatigue - pleuritis - pericarditis

35. What causes the symptoms of MG to worsen - and What is used to diagnose
Down T tubule
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Flex the MCP joints and extend both the DIP and PIP joints
Muslce use - nerve stim/compound muscle test

36. small fluid containing blister seen in chickenpox
Vesicle
Biceps
Over deltoid
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

37. Where is C7 dermatome
Spindle shaped cells with multinucleated giant cells
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Parakeratosis
3rd finger

38. What happens in the power stroke of skeletal muscle contraction
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Biceps
Cellulitis - s aureus - s pyogenes
Phosphate is liberated from the myosin head

39. yellow when parallel and blue when perpendicular
Erythema multiforme - can be macules - papules vesicles - target lesions -
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Gout
Median nerve

40. What are the bone mineralization lab findings in osteopetrosis
Dysplastic nevus
Actinic keratosis
Age - obesity and joint deformity
Serum ca - phos - alk phos are NL

41. What is the precursor to melanom
Recurrent branch of the median nerve
Subclavius
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Dysplastic nevus

42. What is below the epidermis
The dermis
Vesicle
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
Anti Smith

43. What do lupus pts falsely test positive for syphillis
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Female between 14 and 45 - mostly black
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

44. What is the primary screening test for lupus
4th and 5th finger
ANA - sensitive but not specific
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Men and women > 70 - senile osteporosis

45. What antibody is less sensitive than RF but more specific and What is the HLA association
Median nerve - lunate bone
Myosin light chain phosphotase
Type III - RF
Anti - CCP - HLA- DR4

46. What is the sign of Leser - Trelat
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Papule
Hyperkeratosis
Polyostotic fibrous dysplasia

47. Contraction results in shortening of what bands - and what band remains the same length
Atopic dermatitis - eczema
HI shrinks - A stays same
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

48. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Polymyositis - shoulders - perifasicular inflammation
Pain in weight bearing joints at the end of the day and improving with rest
Anti - histone
Deep branch of radial nerve

49. What other muscle in the thenar eminence adducts the thumb
Long thoracic nerve
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Adductor policis brevis
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

50. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Strawberry hemangioma
Nl - decreased bone mass
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Ulnar nerve - intrinsic muscles of hand