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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 are the causes of inferior trunk plexus compression and What are the findings
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
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

2. irregular areas of complete depigmentation - condition and cause
Osteoid osteoma
Vitiligo - dec number in melanocytes
Erlenmeyer flask bones that flare out - narrowed foramina
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

3. What is the defect in Paget's disease
Increase in both osteoblast and osteoclast activity
3rd finger
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Serum ca - phos - alk phos are NL

4. Decrease marrow space in osteopetrosis leads to what?
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Age - obesity and joint deformity
Fibrinoid necrosis surrounded by palisading histiocytes

5. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Hyperkeratosis
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Lesioned by midshaft fracture of humerus
Staph scalded skin syndrome

6. Loss of what muscles in Erbs causes the forearm to be pronated
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Ephelis
Biceps
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

7. In which joints does pseudogout typically occur
Large goints (knee)
Expansile glistening mass within the medullary cavity
Pseudogout
Lesioned by midshaft fracture of humerus

8. What are the the common causes of Erb palsy - and What are the associated findings
Polymyositis - shoulders - perifasicular inflammation
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Osteoid osteoma
Musculocutaneous

9. What are the signs of ulnar nerve injury

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10. Patients with pagets disease can develop what cancer
< 2mc found in proximal tibia and femur - men < 25
Osteogenic carcinoma
Nevocellular nevus
Hyperkeratosis

11. What is below the epidermis
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
The dermis
Type 2
Inc blood flow from AV shunts can cause high output heart failure

12. Sarcoid TX
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Patch
Steroids
Myosin

13. What is the source of osteoblast cells
Spindle shaped cells with multinucleated giant cells
Mesenchymal stem cells in periosteum
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Vesicle

14. What do dorsal interosseous muscles do
Median nerve
Abduct the fingers
Over deltoid
Scleroderma

15. What does injury to the distal median nerve cause

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16. What do lupus pts falsely test positive for syphillis
Over deltoid
Muslce use - nerve stim/compound muscle test
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Carbonic anhydrase II

17. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
Allopurinaol - uricosurics (probenicid)
MCL - ACL - lateral meniscus (esp in athletes)
Osteosarcoma - multiple myeloma
Interossei and adductor policis

18. inc thickness of stratum corneum seen in psoriasis
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Acanthosis
Hyperkeratosis
Hairy leukoplakia - HIV population - EBV mediated

19. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Down T tubule
Atopic dermatitis - eczema
Torn MCL

20. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Anti ds DNA - poor prognosis
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
< 2mc found in proximal tibia and femur - men < 25

21. Through what pathway does NO work and What is the downstream effect
GC and cGMP and inhibition of MLCK
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Pemphigus vulgaris
Anterior interosseous nerve

22. appreas in 30s to 40s - does not regress
Cherry hemangioma
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Exercise and Ca ingestion before age 30
MCP - PIP - no DIP

23. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Steroids
Squamous cell carcinoma
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Compressed by cervical rib or pancoasts tumor - leads to klumpke's

24. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
HI shrinks - A stays same
Osteochondroma - exostosis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Over deltoid

25. What kind of bone tumor is associated with FAP and What is the finding
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Acantholysis

26. What do pseudogout crystals appear like microscopically
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Basophilic - rhomboid crystals - weakly birefringent
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
Glucocorticoids

27. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies

28. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Abduct the fingers
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Palisading

29. What lesion causes claw hand and What are the muscles involved
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Tear of the ACL
Ulnar nerve - intrinsic muscles of hand

30. fracture of a supracondylar humerus - nerve - motor - sensory - sign and more distal lesion causing the same nerve
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Median nerve - lunate bone
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Lichen planus

31. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Axillary nerve
Actinic keratosis - risk proportional to epithelial dysplasia
Acanthosis

32. What is the sensory def of an ulnar nerve injury
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Medial 1.5 fingers - hypothenar eminence
Polymyositis - shoulders - perifasicular inflammation
In psoriasis - bleeding spots when scales are scraped off

33. separation of epidermal cells
Paralysis of lateral rotators
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Acantholysis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+

34. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Psoriasis
Infraspinatus - laterally rotates arm
Head - trunk - extremities - common benign neoplasm in older persons
Endochondroma

35. What disease is caused by autoantibodies to desomosmes - What area of the cell would it occur - and what molecules are connecting
Radial nerve
Widespread skin involvment - rapid progression - early visceral involvement
Gout
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

36. What lesion causes dec in thumb fxn 'ape hand'
Iliac crest
Elevated ESR and nl CK - prednisone
Interossei and adductor policis
Median nerve

37. What are the lab findings in osteopetrosis
Long thoracic nerve
Nl - thickened dense bones
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Polymyositis - shoulders - perifasicular inflammation

38. Loss of what muslces in Erbs causes the limb to hang by side
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Trauma
Paralysis of abductors
Post GI infxn or chlamydia

39. What is a precursor to squamous cell carcinoma
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Actinic keratosis
Posterior cord

40. What are the characteristic bone findings in paget's disease
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Endochondroma
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Osteochondroma - exostosis

41. What is the TX for acute gout
Carbonic anhydrase II
Elevated ESR and nl CK - prednisone
NSAIDs (indomethacin) colchicine
Viral - maybe paramyxovirus

42. potentially fatal autoimmune disorder with IgG antibody against desmosomes
Pemphigus vulgaris
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Age - obesity and joint deformity
Xeropthalmia - xerostomia - arthritis

43. Flat discloration <1cm seen in tinea versicolor
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Macule
Post GI infxn or chlamydia
Biceps

44. What protects the brachial plexus in clavicle fracture
Subclavius
Calmodulin - complex activates myosin light chain kinase
Erlenmeyer flask bones that flare out - narrowed foramina
Actinic keratosis - risk proportional to epithelial dysplasia

45. Where is osteosarcoma found in the bone
Metaphysis of long bones - distal femur
Recurrent branch of the medain nerve
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Adduct the fingers

46. MG is associated with what neoplasm
Precocious puberty
Thymoma
Palisading
Pityriasis rosea

47. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

48. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
Mesenchymal stem cells in periosteum
Anterior interosseous nerve
Ulnar deviation - subluxation - bakers cysts (behind knee)

49. Deposition of calcium pyrophosphate cyrstals within the joint space
Polymyositis - shoulders - perifasicular inflammation
Large goints (knee)
Pseudogout
Head - trunk - extremities - common benign neoplasm in older persons

50. What lesion causes difficulty flexing elbow with variable sensory loss
Melasma (chloasma)
Musculocutaneous
McCune - Albright syndrome
Atopic dermatitis - eczema