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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 is the TX for chronic gout
Spindle shaped cells with multinucleated giant cells
Metaphysis of long bones - distal femur
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Allopurinaol - uricosurics (probenicid)

2. What do lumbricals do
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Pain in weight bearing joints at the end of the day and improving with rest
Flex the MCP joints and extend both the DIP and PIP joints
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

3. Where is C8 dermatome
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
4th and 5th finger
Carbonic anhydrase II
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

4. Who does osteoporosis type 2 effect
Osteopetrosis - abnl fxn of osteoclasts
Polymyositis - shoulders - perifasicular inflammation
Men and women > 70 - senile osteporosis
Plaque

5. Dermatomyositis places the pt at inc risk For what malignancy in particular
Xeropthalmia - xerostomia - arthritis
Lung
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Inc spinosum - dec granulosum

6. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Osteopetrosis - abnl fxn of osteoclasts
Osteoarthritis
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

7. Flat discloration <1cm seen in tinea versicolor
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Macule
NC migration
Precocious puberty

8. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Pustule
Osteoarthritis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

9. Where is T1 dermatome
Large goints (knee)
Medial forearm and arm to just under the axilla
Fibrinoid necrosis surrounded by palisading histiocytes
Antibodies around cells of the epidermis in a reticular or netlike pattern

10. On the palmar side of the hand - what dermatone covers the most of the thumb - 2nd - 3rd - and medial half of the 4th digits and What does it cover on the dorsal side
Median nerve - same fingers but not on the hand
Pseudogout
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Palisading

11. loss of what muscles in Erbs causes the medial rotation
Lichen planus
Paralysis of lateral rotators
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Glucocorticoids

12. What does ATP do in skeletal muscle contraction
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Acanthosis nigcricans
Down T tubule
Acantholysis

13. What lesion causes total claw (klumpke's hand)
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Lower trunk of brachial plexus
Interossei and adductor policis
Verrucae vulgaris

14. pruritic papules and vesicles - deposits of IgA a the tips of dermal papillae - associated with celiac
Dermatitis herpetiformis
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Calmodulin - complex activates myosin light chain kinase
Xeropthalmia - xerostomia - arthritis

15. What is the sensory def of an ulnar nerve injury
Medial 1.5 fingers - hypothenar eminence
Dermatitis herpetiformis
Nl - decreased bone mass
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

16. What are the lab findings in osteoporosis
Nl - decreased bone mass
Thymoma
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Ulnar nerve

17. What are the characteristic bone findings in paget's disease
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Viral - maybe paramyxovirus
Verrucae

18. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Precocious puberty
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

19. Which muscle is the most common rotator cuff injury and What does it do
Integrin binds laminin in BM
Inc alk phos - abnl bone architecture
In psoriasis - bleeding spots when scales are scraped off
Supraspinatus - abducts the arm before the deltoid

20. Damage to what 3 structures is common for the unhappy triad
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
MCL - ACL - lateral meniscus (esp in athletes)
Pseudogout
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

21. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
Over deltoid
Macule
Actin

22. What does acantholysis show in pemphigus vulgaris
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Intraepidermal bullae involving the skin and oral mucosa
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Dec estrogen causes inc bone resorption - postmenopausal

23. inflammatory disorder affective synovial joints with pannus formation in joints
Rheumatoid arthritis
Allopurinaol - uricosurics (probenicid)
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

24. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Radial nerve
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Exercise and Ca ingestion before age 30
Basal cell carcinoma - pearly papules - commonly with telangiectasias

25. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Nevocellular nevus
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

26. freckle - normal number of melanocytes - inc melanin pigment
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Ephelis
Xeropthalmia - xerostomia - arthritis
Infraspinatus - laterally rotates arm

27. Where is osteosarcoma found in the bone
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Metaphysis of long bones - distal femur
Lung
Lichen planus

28. Which muscle is the pitching injury and What does it do
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Infraspinatus - laterally rotates arm
Ulnar nerve
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture

29. Where is C4 dermatome
Over deltoid
Palisading
Patch
Condyloma acuminatum - caused by HPV

30. What do the lumbrical muscles do
Osteoblastoma
Flex at the MCP
Viral - maybe paramyxovirus
Staph scalded skin syndrome

31. What is the classic traid of sjogrens syndrome
Xeropthalmia - xerostomia - arthritis
Dermatomyositis
HI shrinks - A stays same
Inc spinosum - dec granulosum

32. Where is T2 dermatome
Axilla
Parakeratosis
Type III - RF
Acantholysis

33. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Elevated ESR and nl CK - prednisone
Median nerve
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

34. elevated skin lesion <1cm seen in acne vulgaris
Steroids
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
NC migration
Papule

35. What is the sign of Leser - Trelat
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Atopic dermatitis - eczema

36. What does injury to the distal ulnar nerve cause
Scleroderma
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
NSAIDs (indomethacin) colchicine
Cellulitis - s aureus - s pyogenes

37. 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...
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

38. progressive symmetric proximal muscle weakness cause by CD8+ T cell induced injury to myofibers - dz - most common area of involvement and pathgnomonic histological finding
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Polymyositis - shoulders - perifasicular inflammation
Phosphate is liberated from the myosin head
Rigor mortis

39. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Viral - maybe paramyxovirus
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
Type III - RF
Medial 1.5 fingers - hypothenar eminence

40. Very superfiicial skin infection - honey colored crusting - very contagious - condition and organisms
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Median nerve - lunate bone
Impetigo - s aureus - s pyogenes
Tear of the ACL

41. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Axillary - deltoid - skin over deltoid - flattened deltoid
Age - obesity and joint deformity
Erythema nodosum
Median nerve - same fingers but not on the hand

42. MG is associated with what neoplasm
Ulnar nerve
Thymoma
Flex at the MCP
Age - obesity and joint deformity

43. What do dorsal interosseous muscles do
Abduct the fingers
Medial forearm and arm to just under the axilla
Patch
Wheal

44. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Nl - decreased bone mass
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Psoriasis

45. What are the lab findings and TX in dermatomyositis
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Expansile glistening mass within the medullary cavity
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Type 2

46. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Men and women > 70 - senile osteporosis
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Ulnar deviation - subluxation - bakers cysts (behind knee)

47. separation of epidermal cells
Acantholysis
Chondrosarcoma
Recurrent branch of the median nerve
Inc blood flow from AV shunts can cause high output heart failure

48. What signal initiates a muscle contraction
Phosphate is liberated from the myosin head
AP depol opens voltage gated Ca channels - inducing NT release
Medial 1.5 fingers - hypothenar eminence
Osteopetrosis - abnl fxn of osteoclasts

49. What is CREST syndrome and What antibody is it associated with
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Interossei and adductor policis
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions

50. Where is C5 dermatome
3rd finger
Nevocellular nevus
Gout
Outer arm