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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. common mole - benign
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Nevocellular nevus

2. irregular areas of complete depigmentation - condition and cause
Psoriasis
Vitiligo - dec number in melanocytes
Integrin binds laminin in BM
Femoral - thing flexion and leg extension - anterior thigh and medial leg

3. What causes osteoporosis type 1 and When does it typically occur
Gout
Calmodulin - complex activates myosin light chain kinase
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Dec estrogen causes inc bone resorption - postmenopausal

4. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Nevocellular nevus
Median nerve - lunate bone
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Erlenmeyer flask bones that flare out - narrowed foramina

5. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Musculocutaneous
Squamous cell carcinoma
Parakeratosis

6. What is the classic traid of sjogrens syndrome
Widespread skin involvment - rapid progression - early visceral involvement
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
Xeropthalmia - xerostomia - arthritis
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

7. What are common features of lupus
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Cervical disk lesion
Posterior cord

8. In which joints does pseudogout typically occur
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
Age - obesity and joint deformity
Large goints (knee)

9. larger osteoid osteoma found in vertebral column
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Osteoblastoma
Dysplastic nevus

10. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Basophilic - rhomboid crystals - weakly birefringent
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Osteochondroma - exostosis
Spindle shaped cells with multinucleated giant cells

11. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Pain in weight bearing joints at the end of the day and improving with rest
Keratoacanthoma
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

12. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Biceps
Recurrent branch of the medain nerve
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)

13. Where is C4 dermatome
Head - trunk - extremities - common benign neoplasm in older persons
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Over deltoid
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

14. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Ephelis
Abduct the fingers
Staph scalded skin syndrome
Verrucae

15. Where is C8 dermatome
Corneum - lucidum - granulosum - spinosum - basalis
4th and 5th finger
Type III - RF
Thymoma

16. What other muscle in the thenar eminence adducts the thumb
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
In psoriasis - bleeding spots when scales are scraped off
Adductor policis brevis
Pustule

17. papule > 1cm seen psoriasis
Plaque
Female between 14 and 45 - mostly black
Medial 1.5 fingers - hypothenar eminence
Type III - RF

18. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Xeropthalmia - xerostomia - arthritis
< 2mc found in proximal tibia and femur - men < 25
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced

19. What is below the epidermis
Osteosarcoma - multiple myeloma
Phosphorylated
The dermis
Rheumatoid arthritis

20. What protects the brachial plexus in clavicle fracture
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Subclavius
Dermatitis herpetiformis

21. 2nd most malignant tumor of bone - men 10-20 - cancer - and primary malignant tumor bone
In psoriasis - bleeding spots when scales are scraped off
Osteosarcoma - multiple myeloma
Deep branch of radial nerve
Wheal

22. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Median nerve

23. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Actin
Ewings sarcoma - aggressive with early mets - but responsive to chemo
Type III - RF
Outer arm

24. What are the classic fractures in pts with osteoporosis

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25. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Strawberry hemangioma
ANA - sensitive but not specific
Ulnar nerve - intrinsic muscles of hand
Teres minor

26. Why does EtOH consumption precipitate gout
Gout
The dermis
Pityriasis rosea
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

27. What are the common perpetrating infections for Reiters syndrome
Chondrosarcoma
Post GI infxn or chlamydia
Upper trunk of brachial plexus
Expansile glistening mass within the medullary cavity

28. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Wheal
Connects cells to underlying extracellular - bullous pemphigoid
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Polymyaglia rheumatica associated with temporal (giant cell) arteritis

29. hives - intensely pruritic wheals that form after mast cell degranulation
Gout
Fever - fatigue - pleuritis - pericarditis
Urticaria
MCP - PIP - no DIP

30. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Axillary - deltoid - skin over deltoid - flattened deltoid
Median nerve - same fingers but not on the hand
Serum ca - phos - PTH are nl alk phos elevated
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling

31. Seronegative spondyloarthropathis have what HLA association - and why are they seronegative - and who do they more often occur in
B27 - no RF - males
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Thymoma
NSAIDs (indomethacin) colchicine

32. What is the precursor to melanom
Dysplastic nevus
Median nerve
Osteopetrosis - abnl fxn of osteoclasts
Myosin

33. How is the lower trunk of the brachia plexus injured and what results from it

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34. white painless plaques on the tongue that cannot be scraped off - dz - population - implicated virus
Squamous cell carcinoma
Dermatitis herpetiformis
Hairy leukoplakia - HIV population - EBV mediated
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction

35. What are predisposing factors for osteosarcoma - xray finding

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36. What are the layers of of the epidermis from surface to base
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Corneum - lucidum - granulosum - spinosum - basalis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Crust

37. What kind of nuclei do basal cell tumors have
Men and women > 70 - senile osteporosis
Gout
Palisading
Fever - fatigue - pleuritis - pericarditis

38. What are the lab findings in osteitis fibrosa cystica
Cellulitis - s aureus - s pyogenes
NC migration
Axilla
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors

39. What signal initiates a muscle contraction
AP depol opens voltage gated Ca channels - inducing NT release
Acanthosis nigcricans
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Basal cell carcinoma - pearly papules - commonly with telangiectasias

40. What lesions causes Erb's palsy
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
Upper trunk of brachial plexus
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

41. What do the lumbrical muscles do
Hyperkeratosis
Fever - fatigue - pleuritis - pericarditis
Flex at the MCP
NC migration

42. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
NC migration
The dermis
Osteoporosis
Over deltoid

43. What is TX for osteoporosis
Median nerve
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
McCune - Albright syndrome

44. What is the clinically important landmark for pubendal nerve block and When is it used
Anti ds DNA - poor prognosis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Ischial spine - relieve pain during delivery

45. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
Wheal
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Nl - thickened dense bones

46. thickened - dense bones that are prone to fracture - dz and primary defect
Osteopetrosis - abnl fxn of osteoclasts
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Paralysis of abductors
Adductor policis brevis

47. Where are most osteoid osteoma found and In what population
Integrin binds laminin in BM
< 2mc found in proximal tibia and femur - men < 25
Myosin
Anti Smith

48. What lesion causes Saturday night wrist drop
Median nerve
Cellulitis - s aureus - s pyogenes
Radial nerve
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

49. What are the potential causes of gout

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50. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Condyloma acuminatum - caused by HPV
Atopic dermatitis - eczema
Pain in weight bearing joints at the end of the day and improving with rest
Metaphysis of long bones - distal femur