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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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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 are the lab findings in osteomalacia/rickets
Pseudogout
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Paralysis of abductors
Fibrinoid necrosis surrounded by palisading histiocytes

2. 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
MCL - ACL - lateral meniscus (esp in athletes)
Median nerve - same fingers but not on the hand
Ulnar nerve - fracture of hook of hamate
Elevated ESR and nl CK - prednisone

3. what changes are seen in stratum spinosum and granulosum in psoriasis
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Inc spinosum - dec granulosum
Median nerve - same fingers but not on the hand
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

4. Where is osteosarcoma found in the bone
Abduct the fingers
Renal - pulm - CV - GI - 75% female
Inc spinosum - dec granulosum
Metaphysis of long bones - distal femur

5. What is the Auspitz sign
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
In psoriasis - bleeding spots when scales are scraped off
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
Adduct the fingers

6. flat - greasy - pigmented - squamous epithelial proliferation with keratin - filled cyts (horn cysts) - looks pasted on...
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Seborrheic keratosis
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Flex the MCP joints and extend both the DIP and PIP joints

7. What nerve is injured in a fracutre of the hook of hamate
Median nerve - lunate bone
Median nerve - same fingers but not on the hand
Ulnar nerve
Pain in weight bearing joints at the end of the day and improving with rest

8. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Radial nerve becomes compressed in axilla
B27 - no RF - males
TB from dissemination and lyme dz

9. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
4th and 5th finger
Scleroderma
Dermatomyositis
Spindle shaped cells with multinucleated giant cells

10. In which form is myosin light chain active
Fibrinoid necrosis surrounded by palisading histiocytes
Actinic keratosis - risk proportional to epithelial dysplasia
Phosphorylated
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

11. What supplies innervation to the thenar muscles
Palisading
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Recurrent branch of the median nerve

12. What medication is contraindicated in osteoporosis
Glucocorticoids
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
B27 - no RF - males
TB from dissemination and lyme dz

13. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Urticaria
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

14. What are the possible origins of the paget's disease
Ulnar
Men and women > 70 - senile osteporosis
Viral - maybe paramyxovirus
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema

15. yellow when perpendicular and blue when parallel
Calmodulin - complex activates myosin light chain kinase
Hyperkeratosis
Pseudogout
Actinic keratosis

16. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Osteopetrosis - abnl fxn of osteoclasts
Parakeratosis
Seborrheic keratosis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

17. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Renal - pulm - CV - GI - 75% female
Posterior cord
Medially rotates and adducts arm

18. 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
Renal - pulm - CV - GI - 75% female
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Ulnar
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

19. Where do sebhorrheic keratosis lesions occur and in who
Head - trunk - extremities - common benign neoplasm in older persons
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion

20. What does lack of ATP cause
Psoriasis
Upper trunk of brachial plexus
Rigor mortis
Anterior interosseous nerve

21. What is the power stroke of muscle contraction
Pityriasis rosea
Myosin releases bound ADP and is displaced on the actin filament
Actinic keratosis - risk proportional to epithelial dysplasia
Infraspinatus - laterally rotates arm

22. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Median nerve - lunate bone
Ulnar nerve
Pseudogout
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

23. What antibodies is diffuse scleroderma associated with
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Anti Scl70 - anti DNA topoisomerase I antibody
Elevated ESR and nl CK - prednisone
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

24. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Integrin binds laminin in BM
Condyloma acuminatum - caused by HPV
Squamous cell carcinoma

25. What is the sensory def of an ulnar nerve injury
Squamous cell carcinoma
Chondrosarcoma
Medial 1.5 fingers - hypothenar eminence
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

26. What is the classic triad of reactive arthritis
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Lung
Conjunctivitis and anterior uveitis - urethritis and arthritis

27. Damage to what 3 structures is common for the unhappy triad
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Lichen planus
Paralysis of abductors
MCL - ACL - lateral meniscus (esp in athletes)

28. Which muscle laterally rotates and adducts arm
Teres minor
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Recurrent branch of the medain nerve
Hairy leukoplakia - HIV population - EBV mediated

29. What are the subQ rheumatoid nodules made of...
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Post GI infxn or chlamydia
Myosin light chain phosphotase
Fibrinoid necrosis surrounded by palisading histiocytes

30. What are the potential causes of gout

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31. What receptor is constitutively activated in achondroplasia and What does it do
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Medial aspect
Ephelis

32. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Musculocutaneous
ANA - sensitive but not specific
Type III - RF

33. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Posterior cord
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Infraspinatus - laterally rotates arm

34. What causes ape hand
Fibrinoid necrosis surrounded by palisading histiocytes
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Age - obesity and joint deformity

35. Where does cartilage loss begin in osteoarthritis
Medial aspect
AP depol opens voltage gated Ca channels - inducing NT release
Anti - histone
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

36. What is the clinically important landmark for pubendal nerve block and When is it used
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Ischial spine - relieve pain during delivery
Osteoporosis
Paralysis of lateral rotators

37. Deposition of calcium pyrophosphate cyrstals within the joint space
Pemphigus vulgaris
Myosin releases bound ADP and is displaced on the actin filament
Pseudogout
Axilla

38. What is the classic presentation of osteoarthritis
Post GI infxn or chlamydia
Pain in weight bearing joints at the end of the day and improving with rest
Widespread skin involvment - rapid progression - early visceral involvement
Lower trunk of brachial plexus

39. Where is C7 dermatome
Elevated ESR and nl CK - prednisone
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Cervical disk lesion
3rd finger

40. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Actinic keratosis - risk proportional to epithelial dysplasia
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Pemphigus vulgaris

41. appreas in 30s to 40s - does not regress
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Cherry hemangioma
Calmodulin - complex activates myosin light chain kinase
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

42. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Strawberry hemangioma
Precocious puberty

43. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Vitiligo - dec number in melanocytes
Gout
TB from dissemination and lyme dz

44. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
In psoriasis - bleeding spots when scales are scraped off
Osteosarcoma - multiple myeloma
S. aureus - streptococcus

45. What are the lab findings in osteitis fibrosa cystica
Osteoarthritis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Hyperkeratosis
Lesioned by midshaft fracture of humerus

46. What causes hypercalcemia in pts with sarcoid
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Osteoblastoma
Glucocorticoids
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

47. What lesion causes deltoid paralysis
Axillary nerve
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
< 2mc found in proximal tibia and femur - men < 25
Pustule

48. Which muscle is the pitching injury and What does it do
Infraspinatus - laterally rotates arm
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Dermatitis herpetiformis
Median nerve

49. Where does the muscle contraction travel after leaving the motor end plate
TB from dissemination and lyme dz
Carbonic anhydrase II
Down T tubule
B27 - no RF - males

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

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