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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 do dorsal interosseous muscles do
Abduct the fingers
Rheumatoid arthritis
Bulla
Osteoarthritis

2. What is the precursor to melanom
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Dysplastic nevus
AP depol opens voltage gated Ca channels - inducing NT release
B27 - no RF - males

3. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Atopic dermatitis - eczema
Acantholysis
Impetigo - s aureus - s pyogenes
Anti Scl70 - anti DNA topoisomerase I antibody

4. Patients with pagets disease can develop what cancer
GC and cGMP and inhibition of MLCK
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Polyostotic fibrous dysplasia
Osteogenic carcinoma

5. What is contained within epithelial granulomas of pts with sarcoid
Axillary - deltoid - skin over deltoid - flattened deltoid
Papule
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Ischial spine - relieve pain during delivery

6. 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...
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
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
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

7. What deformities of the hand are common in RA
Boutonniere - swan neck - zthumb
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Actinic keratosis

8. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Dermatitis
Seborrheic keratosis
Anti ds DNA - poor prognosis
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

9. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Squamous cell carcinoma
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Age - obesity and joint deformity
Medial forearm and arm to just under the axilla

10. large fluid containing blisters seen in bullous pemphigoid
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Acute back pain - loss of height - and kyphosis
Serum ca - phos - alk phos are NL
Bulla

11. Damage to what 3 structures is common for the unhappy triad
MCL - ACL - lateral meniscus (esp in athletes)
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Plaque
Anti - CCP - HLA- DR4

12. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Osteoporosis
Ephelis
Ligand binding leads to muscle depol
Deep branch of radial nerve

13. What form of polyostotic fibrous dysplasia has multiple unilateral bones lesions associated with endocrine abnl and unilateral pigmented skin lesions - caf
Type III - RF
McCune - Albright syndrome
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Ligand binding leads to muscle depol

14. What nerve is injured by a superficial laceration of the hand
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Crohns and ulcerative colitis
Recurrent branch of the medain nerve
Axillary - deltoid - skin over deltoid - flattened deltoid

15. What is TX for osteoporosis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Deep branch of radial nerve
Staph scalded skin syndrome
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

16. What is the Auspitz sign
Steroids
Infraspinatus - laterally rotates arm
Dysplastic nevus
In psoriasis - bleeding spots when scales are scraped off

17. transiet vesicle seen in hives
Wheal
Muslce use - nerve stim/compound muscle test
In psoriasis - bleeding spots when scales are scraped off
Verrucae

18. What receptor is constitutively activated in achondroplasia and What does it do
Nl - decreased bone mass
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Bulla
Ephelis

19. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Vitiligo - dec number in melanocytes
Medial aspect
Pityriasis rosea

20. What supplies innervation to the thenar muscles
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Recurrent branch of the median nerve
Down T tubule

21. What does soft bones result from and What is the dz called in adults and children
Osteoid osteoma
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Scleroderma

22. What are the signs of ulnar nerve injury

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23. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Obturator - thigh adduction - medial thigh
Post GI infxn or chlamydia
Seborrheic keratosis
Wheal

24. What autoantibodies are formed in sjogrens syndrome
Inc alk phos - abnl bone architecture
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Myosin releases bound ADP and is displaced on the actin filament
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

25. What is below the epidermis
The dermis
MCP - PIP - no DIP
Large goints (knee)
Phosphate is liberated from the myosin head

26. Thenar eminence - nerve and muscles
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Bulla

27. small fluid containing blister seen in chickenpox
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Vesicle
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Interossei and adductor policis

28. What lesion causes total claw (klumpke's hand)
Myosin
Ephelis
Dysplastic nevus
Lower trunk of brachial plexus

29. What is the power stroke of muscle contraction
Sarcoidosis - black females - ACE
Serum ca - phos - alk phos are NL
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Myosin releases bound ADP and is displaced on the actin filament

30. papule > 1cm seen psoriasis
Anti Smith
Plaque
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Cervical disk lesion

31. 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
Age - obesity and joint deformity
Gout
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

32. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Erythema nodosum
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

33. Where does cartilage loss begin in osteoarthritis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Erythema multiforme - can be macules - papules vesicles - target lesions -
Medial aspect

34. What do palmar interosseous muscles do
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Adduct the fingers
Albinism
Myosin releases bound ADP and is displaced on the actin filament

35. What molecule maintatins integrity of basement membrane and What does it bind
Flex the MCP joints and extend both the DIP and PIP joints
B27 - no RF - males
Integrin binds laminin in BM
Phosphorylated

36. larger osteoid osteoma found in vertebral column
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Melasma (chloasma)
Osteoblastoma
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

37. What happens in the power stroke of skeletal muscle contraction
Cellulitis - s aureus - s pyogenes
Phosphate is liberated from the myosin head
Rheumatoid arthritis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

38. What are the borders of the superficial branch of the radial nerve dermatone
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits
Osteogenic carcinoma
Patch
Atopic dermatitis - eczema

39. What causes a lesion in the axillary nerve
Torn MCL
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Flex at the MCP

40. What is CREST syndrome and What antibody is it associated with
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Increase in both osteoblast and osteoclast activity

41. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Actinic keratosis - risk proportional to epithelial dysplasia
Vitiligo - dec number in melanocytes
In psoriasis - bleeding spots when scales are scraped off

42. What kind of nuclei do basal cell tumors have
Palisading
Vitiligo - dec number in melanocytes
Staph scalded skin syndrome
Inc blood flow from AV shunts can cause high output heart failure

43. What is the Sicca syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Widespread skin involvment - rapid progression - early visceral involvement
Ischial spine - relieve pain during delivery
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

44. What are the potential causes of gout

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45. What causes compression of the C7 nerve root
Seborrheic keratosis
Cervical disk lesion
Melasma (chloasma)
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

46. How does the radial nerve in the spiral groove become injured
Medial forearm and arm to just under the axilla
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Nl - thickened dense bones
Lesioned by midshaft fracture of humerus

47. What are the layers of of the epidermis from surface to base
Corneum - lucidum - granulosum - spinosum - basalis
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Fibrinoid necrosis surrounded by palisading histiocytes
Men - needle shaped and negatively birefringent = yellow crystals under parallel light

48. What are predisposing factors for osteosarcoma - xray finding

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49. What are the predisposing factors for osteoarthritis
Myosin light chain phosphotase
Men and women > 70 - senile osteporosis
Age - obesity and joint deformity
HI shrinks - A stays same

50. Where is C4 dermatome
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Over deltoid
Actin