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

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2. What do the branches of the deep ulnar nerve innervate
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Interossei and adductor policis
Paralysis of abductors

3. What lesion causes total claw (klumpke's hand)
Hyperkeratosis
< 2mc found in proximal tibia and femur - men < 25
Integrin binds laminin in BM
Lower trunk of brachial plexus

4. What does injury to the distal ulnar nerve cause
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed
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
Bulla
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

5. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Acanthosis nigcricans
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine

6. What are the lab findings in pagets disease
Connects cells to underlying extracellular - bullous pemphigoid
Gout
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Inc alk phos - abnl bone architecture

7. Where is C6 dermatome
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

8. What kind of injury can cause damage to the inferior gluteal nerve and What can it cause

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9. Ca2+ released from the SR binds what structure and What does it cause
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Pustule
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Ewings sarcoma - aggressive with early mets - but responsive to chemo

10. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Ulnar nerve
Acanthosis
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls

11. loss of what muscles in Erbs causes the medial rotation
Wheal
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Biceps
Paralysis of lateral rotators

12. What is TX for osteoporosis
ANA - sensitive but not specific
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
After a large meal or EtOH conspumption

13. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Bulla
Plaque
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Basal cell carcinoma - pearly papules - commonly with telangiectasias

14. Which type of muscle fiber is hypertrophied during weight training
Type 2
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Atopic dermatitis - eczema
S. aureus - streptococcus

15. What does PED and Tip stand for

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16. What causes heart failure in with Paget's disease
Inc blood flow from AV shunts can cause high output heart failure
Phosphorylates myosin light chain which leads to cross bridge formation
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Lichen planus

17. inflammatory disorder affective synovial joints with pannus formation in joints
Increase in both osteoblast and osteoclast activity
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Dermatitis herpetiformis
Rheumatoid arthritis

18. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Rheumatoid arthritis
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Urticaria
Vesicle

19. Patients with pagets disease can develop what cancer
Hyperkeratosis
Pustule
Osteogenic carcinoma
MCL - ACL - lateral meniscus (esp in athletes)

20. osteochondrosis has rare malignant transformation into what cancer
Rigor mortis
Myosin releases bound ADP and is displaced on the actin filament
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Chondrosarcoma

21. hives - intensely pruritic wheals that form after mast cell degranulation
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Urticaria
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit

22. inc thickness of stratum corneum seen in psoriasis
Hyperkeratosis
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Strawberry hemangioma
Antibodies around cells of the epidermis in a reticular or netlike pattern

23. Decrease marrow space in osteopetrosis leads to what?
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Nl - decreased bone mass
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)

24. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Actinic keratosis - risk proportional to epithelial dysplasia
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

25. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Mesenchymal stem cells in periosteum
Osteoarthritis
Lichen planus
Palisading

26. What are the causes of inferior trunk plexus compression and What are the findings
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Spindle shaped cells with multinucleated giant cells
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
Osteopetrosis - abnl fxn of osteoclasts

27. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Keratoacanthoma
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Keloid
Thymoma

28. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Axillary nerve
Steroids
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

29. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Subclavius
Psoriasis
Pseudogout
Anti ds DNA - poor prognosis

30. What is the source of osteoblast cells
Mesenchymal stem cells in periosteum
Anterior interosseous nerve
Ulnar deviation - subluxation - bakers cysts (behind knee)
Anti Scl70 - anti DNA topoisomerase I antibody

31. what changes are seen in stratum spinosum and granulosum in psoriasis
Recurrent branch of the median nerve
Inc spinosum - dec granulosum
Anterior interosseous nerve
Bulla

32. What is below the epidermis
Obturator - thigh adduction - medial thigh
TB from dissemination and lyme dz
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
The dermis

33. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Hyperkeratosis
Osteoporosis
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Impetigo - s aureus - s pyogenes

34. What is a positive Nikolsky's sign
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Basophilic - rhomboid crystals - weakly birefringent
Expansile glistening mass within the medullary cavity

35. What receptor is constitutively activated in achondroplasia and What does it do
Polyostotic fibrous dysplasia
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Seborrheic keratosis
MCL - ACL - lateral meniscus (esp in athletes)

36. What signal initiates a muscle contraction
Polyostotic fibrous dysplasia
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Inc blood flow from AV shunts can cause high output heart failure
AP depol opens voltage gated Ca channels - inducing NT release

37. What are characteristic findings of gout
Actinic keratosis
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Iliac crest
Vitiligo - dec number in melanocytes

38. Macule greater than 1cm
Patch
Dysplastic nevus
GC and cGMP and inhibition of MLCK
Inc blood flow from AV shunts can cause high output heart failure

39. Other than N. gono - what organisms can cause infectious - septic arthritis
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
S. aureus - streptococcus
Giant cell tumor (osteoclastoma) - double bubble or soap bubble

40. What are the borders of the superficial branch of the radial nerve dermatone
Calmodulin - complex activates myosin light chain kinase
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Myosin
Dorsal side of lateral hand - most of lateral surface of the thumb - no digits

41. What are the characterstic joints affected in RA
Rheumatoid arthritis
Calmodulin - complex activates myosin light chain kinase
MCP - PIP - no DIP
Hyperkeratosis

42. Where is osteosarcoma found in the bone
Medial forearm and arm to just under the axilla
3rd finger
Gout
Metaphysis of long bones - distal femur

43. What are the systemic symptoms found in RA
Wheal
The dermis
Fever - fatigue - pleuritis - pericarditis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

44. What are the lab findings in osteoporosis
Staph scalded skin syndrome
Phosphate is liberated from the myosin head
Nl - decreased bone mass
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

45. In which form is myosin light chain active
Increase in both osteoblast and osteoclast activity
NSAIDs (indomethacin) colchicine
Dermatitis
Phosphorylated

46. What causes hypercalcemia in pts with sarcoid
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Corneum - lucidum - granulosum - spinosum - basalis
Medial forearm and arm to just under the axilla

47. What are the motor defs of a proximal ulnar nerve injury
Medial finger flexion - wrist flexion
In psoriasis - bleeding spots when scales are scraped off
Verrucae
Anti - histone

48. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Urticaria
Pain in weight bearing joints at the end of the day and improving with rest
Axillary - deltoid - skin over deltoid - flattened deltoid

49. What are the possible origins of the paget's disease
Ulnar nerve - fracture of hook of hamate
Pseudogout
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Viral - maybe paramyxovirus

50. larger osteoid osteoma found in vertebral column
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Musculocutaneous
Osteoblastoma
Acute back pain - loss of height - and kyphosis