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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. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Phosphate is liberated from the myosin head
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Psoriasis
Acantholysis

2. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Sarcoidosis - black females - ACE
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Dec estrogen causes inc bone resorption - postmenopausal

3. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Lesioned by midshaft fracture of humerus
Upper trunk of brachial plexus
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Dermatomyositis

4. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Ulnar deviation - subluxation - bakers cysts (behind knee)
Thymoma
Trauma
Ulnar nerve - intrinsic muscles of hand

5. Where does the muscle contraction travel after leaving the motor end plate
Medial aspect
Medial forearm and arm to just under the axilla
Dermatitis herpetiformis
Down T tubule

6. What is the power stroke of muscle contraction
Ligand binding leads to muscle depol
Glucocorticoids
Myosin releases bound ADP and is displaced on the actin filament
Radial nerve

7. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Posterior cord
The dermis
Actinic keratosis - risk proportional to epithelial dysplasia

8. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
After a large meal or EtOH conspumption
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Phosphorylates myosin light chain which leads to cross bridge formation
Parakeratosis

9. larger osteoid osteoma found in vertebral column
Gout
Osteoblastoma
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Fibrinoid necrosis surrounded by palisading histiocytes

10. Where does cartilage loss begin in osteoarthritis
Medial aspect
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
NSAIDs (indomethacin) colchicine
Squamous cell carcinoma

11. What do the branches of the deep ulnar nerve innervate
Phosphate is liberated from the myosin head
Female between 14 and 45 - mostly black
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Interossei and adductor policis

12. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Integrin binds laminin in BM
Dysplastic nevus
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Osteoporosis

13. Which type of muscle fiber is hypertrophied during weight training
Medial aspect
Type 2
Dermatitis herpetiformis
Gout

14. Which muscle is the most common rotator cuff injury and What does it do
Age - obesity and joint deformity
The dermis
Supraspinatus - abducts the arm before the deltoid
Adductor policis brevis

15. What organisms can cause chronic infectious arthritis
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
TB from dissemination and lyme dz
Dermatitis herpetiformis

16. What deformities of the hand are common in RA
Type III - RF
Plaque
Boutonniere - swan neck - zthumb
Medial forearm and arm to just under the axilla

17. anaplastic small blue cell malignant tumor - most common in boys < 15 - dz and prognosis
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Increase in both osteoblast and osteoclast activity
Ligand binding leads to muscle depol
Osteogenic carcinoma

18. What are the potential causes of gout

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19. warts on hands
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Condyloma acuminatum - caused by HPV
Sarcoidosis - black females - ACE
Verrucae vulgaris

20. Where is C7 dermatome
Radial nerve
3rd finger
Mesenchymal stem cells in periosteum
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

21. What lesion causes deltoid paralysis
Pseudogout
Axillary nerve
Osteochondroma - exostosis
Crust

22. What does abnl passive abduction of the knee indicate
Torn MCL
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Outer arm

23. What do lumbricals do
Flex the MCP joints and extend both the DIP and PIP joints
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Xeropthalmia - xerostomia - arthritis
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

24. Deposition of calcium pyrophosphate cyrstals within the joint space
Outer arm
Pseudogout
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Increase in both osteoblast and osteoclast activity

25. malignant cartilaginous tumor in men 30 to 60 - Name and common location
Upper trunk of brachial plexus
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur

26. premalignant lesions caused by sun exposure - small rough - erythematous or brownish papules - cutaenous horns - Name and risk of carcinoma
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Ephelis
Actinic keratosis - risk proportional to epithelial dysplasia
Rheumatoid arthritis

27. Why does EtOH consumption precipitate gout
Strawberry hemangioma
Flex the MCP joints and extend both the DIP and PIP joints
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Head - trunk - extremities - common benign neoplasm in older persons

28. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Ulnar nerve - fracture of hook of hamate
Interossei and adductor policis
Iliac crest
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

29. Patients with pagets disease can develop what cancer
Osteogenic carcinoma
Cervical disk lesion
Tear of the ACL
Glucocorticoids

30. exotoxin destroys keratinocyte attachments in the stratum granulosum - fever - generalized erythematous rash with sloughing of the upper layers of the dermis - newborns and children
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis
Staph scalded skin syndrome
Over deltoid
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

31. What are the histo findings in an osteoclastoma
Exercise and Ca ingestion before age 30
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Cellulitis - s aureus - s pyogenes
Spindle shaped cells with multinucleated giant cells

32. What does I'M DAMN SHARP stand for
Median nerve - lunate bone
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Erythema multiforme - can be macules - papules vesicles - target lesions -

33. separation of epidermal cells
Expansile glistening mass within the medullary cavity
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Acantholysis
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

34. papule > 1cm seen psoriasis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Keloid
Subclavius
Plaque

35. What are the predisposing factors for osteoarthritis
Age - obesity and joint deformity
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Ligand binding leads to muscle depol
Recurrent branch of the medain nerve

36. thickened - dense bones that are prone to fracture - dz and primary defect
Gout
Rigor mortis
Osteopetrosis - abnl fxn of osteoclasts
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

37. What causes osteoporosis type 1 and When does it typically occur
Dec estrogen causes inc bone resorption - postmenopausal
Actinic keratosis - risk proportional to epithelial dysplasia
Pseudogout
Ulnar nerve - fracture of hook of hamate

38. What is CREST syndrome and What antibody is it associated with
Recurrent branch of the medain nerve
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Lichen planus

39. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
< 2mc found in proximal tibia and femur - men < 25
Keratoacanthoma
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

40. dried exudates from a vesicle - bulla or pustule seen impetigo
Post GI infxn or chlamydia
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Crust

41. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
Renal - pulm - CV - GI - 75% female
Gout
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull

42. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Anti Smith
Anti - CCP - HLA- DR4
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Deep branch of radial nerve

43. What are the signs of ulnar nerve injury

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44. What do xray show in osteopetrosis and What do potential CN abnl result from
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Erlenmeyer flask bones that flare out - narrowed foramina
Inc spinosum - dec granulosum

45. What is the classic presentation of RA
Medial forearm and arm to just under the axilla
Macule
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Seborrheic keratosis

46. Other than N. gono - what organisms can cause infectious - septic arthritis
Osteopetrosis - abnl fxn of osteoclasts
Osteoarthritis
S. aureus - streptococcus
Outer arm

47. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Adduct the fingers
Pityriasis rosea
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

48. What enzyme defect in responsible for osteopetrosis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Anti Scl70 - anti DNA topoisomerase I antibody
Type 2
Carbonic anhydrase II

49. How does the radial nerve in the spiral groove become injured
Lesioned by midshaft fracture of humerus
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
NSAIDs (indomethacin) colchicine
Basophilic - rhomboid crystals - weakly birefringent

50. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Crust
Keloid
Paralysis of lateral rotators