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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. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Atopic dermatitis - eczema
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Median nerve

2. What nerve is injured in a posterior hip dislocation or polio and What are the motor defs
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Superior glut - thigh abduction - pos trendelenburg - hip drops when standing on the opposite foot (standing on the side of the lesion)
Myosin light chain phosphotase
Dermatomyositis

3. What is below the epidermis
MCL - ACL - lateral meniscus (esp in athletes)
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Keloid
The dermis

4. What runs the distance of the A band
Scleroderma
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Myosin

5. What are the lab findings in osteomalacia/rickets
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Carbonic anhydrase II
After a large meal or EtOH conspumption

6. papule > 1cm seen psoriasis
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Plaque
Rigor mortis
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -

7. What causes osteoporosis type 1 and When does it typically occur
Dec estrogen causes inc bone resorption - postmenopausal
Integrin binds laminin in BM
Pustule
Carbonic anhydrase II

8. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop

9. appreas in 30s to 40s - does not regress
ANA - sensitive but not specific
Widespread skin involvment - rapid progression - early visceral involvement
Cherry hemangioma
Myosin

10. What lesions causes Erb's palsy
Psoriasis
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Phosphorylated
Upper trunk of brachial plexus

11. dried exudates from a vesicle - bulla or pustule seen impetigo
Medial forearm and arm to just under the axilla
Flex the MCP joints and extend both the DIP and PIP joints
Crust
In pemphis vulgaris - separation of epidermis upon manual stroking of skin

12. Which muscle is the most common rotator cuff injury and What does it do
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Anti Scl70 - anti DNA topoisomerase I antibody
Supraspinatus - abducts the arm before the deltoid
Inc spinosum - dec granulosum

13. What is the test for drug induced lupus
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Acanthosis
Anti - histone
Osteochondroma - exostosis

14. What lesion causes deltoid paralysis
Myosin
Axillary nerve
Allopurinaol - uricosurics (probenicid)
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

15. bone replaced by fibroblasts and irregular bony trabeculae affecting many bones
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Polyostotic fibrous dysplasia
Psoriasis
Sites of tibial attachment

16. What does the positive anterior drawer sign test indicate
Radial nerve becomes compressed in axilla
Actinic keratosis - risk proportional to epithelial dysplasia
Corneum - lucidum - granulosum - spinosum - basalis
Tear of the ACL

17. What lesion causes total claw (klumpke's hand)
MCP - PIP - no DIP
After a large meal or EtOH conspumption
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases
Lower trunk of brachial plexus

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

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19. In a fractured surgical neck of humerus or dislocation of humeral head - What is the nerve injury - motor deficit - sensory deficit
Papule
Posterior cord
Ulnar deviation - subluxation - bakers cysts (behind knee)
Axillary - deltoid - skin over deltoid - flattened deltoid

20. Patients with pagets disease can develop what cancer
Radial nerve becomes compressed in axilla
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Osteogenic carcinoma
Phosphorylates myosin light chain which leads to cross bridge formation

21. What does abnl passive abduction of the knee indicate
Metaphysis of long bones - distal femur
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Actinic keratosis - risk proportional to epithelial dysplasia
Torn MCL

22. chronic inflammatory disease of sacroiliac joints and spine - dz - associations
Post GI infxn or chlamydia
Antibodies around cells of the epidermis in a reticular or netlike pattern
Ankylosing spondylitis - uveitis - aortic regurg and bamboo spine
Polyostotic fibrous dysplasia

23. What nerve controls ab and adduction of the interossei muscles and What does it for the thumb and 4th and 5th lumbricals
Long thoracic nerve
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)

24. 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
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Iliac crest

25. What do anterior and posterior in ACL and PCL refer to...
Ischial spine - relieve pain during delivery
Gout
Sites of tibial attachment
Serum ca - phos - PTH are nl alk phos elevated

26. fever - bulla formation and necrosis - sloughing of skin and high mortality - syndrome and associations
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Medial 1.5 fingers - hypothenar eminence
Keratoacanthoma

27. What is the source of osteoblast cells
Urticaria
< 2mc found in proximal tibia and femur - men < 25
Mesenchymal stem cells in periosteum
3rd finger

28. inc thickness of stratum corneum seen in psoriasis
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Hyperkeratosis
Medially rotates and adducts arm
SERMs - calcitonin - bisphosphates or pulsatile PTH for severe cases

29. What lesion causes Saturday night wrist drop
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Integrin binds laminin in BM
Radial nerve

30. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Chondrosarcoma
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes

31. Damage to what 3 structures is common for the unhappy triad
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Nevocellular nevus
Connects cells to underlying extracellular - bullous pemphigoid
MCL - ACL - lateral meniscus (esp in athletes)

32. What protects the brachial plexus in clavicle fracture
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification
Keratoacanthoma
Subclavius

33. What does PED and Tip stand for

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34. What are the classic fractures in pts with osteoporosis

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35. What muscles of the shoulder form the rotator cuff
Osteosarcoma - multiple myeloma
Myosin releases bound ADP and is displaced on the actin filament
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Large goints (knee)

36. What is CREST syndrome and What antibody is it associated with
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Carbonic anhydrase II
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

37. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Ulnar nerve - fracture of hook of hamate
Verrucae
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Interossei and adductor policis

38. Pain and stiffness in shoulders and hips - fever malaise and weight loss - no weakness - pts over 50 - associated with HA and jaw pain
Ligand binding leads to muscle depol
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Ischial spine - relieve pain during delivery

39. hyperpigmentation associated with pregnancy or OCP
Gout
Melasma (chloasma)
Dec estrogen causes inc bone resorption - postmenopausal
Connects cells to underlying extracellular - bullous pemphigoid

40. transiet vesicle seen in hives
Wheal
Nl - decreased bone mass
Myosin releases bound ADP and is displaced on the actin filament
Dermatitis

41. What are the associations for sjogrens syndrome
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Parotid enlargement - inc risk of B cell lymphoma - dental caries
Type III - RF
Anti ds DNA - poor prognosis

42. Why does EtOH consumption precipitate gout
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Osteoporosis
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

43. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Rheumatoid arthritis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Gout
Sarcoidosis - black females - ACE

44. Deposition of calcium pyrophosphate cyrstals within the joint space
Troponin C - conformational change that moves tropomyosin out the myosin binding groove on actin filaments
Patch
Pseudogout
Erlenmeyer flask bones that flare out - narrowed foramina

45. On the palmar and dorsal sides of the hand - what dermatome covers the 5th finger and the lateral 1/2 of the 4th finger
Ulnar nerve - fracture of hook of hamate
Subclavius
Actinic keratosis
Ulnar

46. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Keratoacanthoma

47. What causes osteomalacia/ricketts - why - and What therapy can reverse the symptoms
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Inc blood flow from AV shunts can cause high output heart failure
Increase in both osteoblast and osteoclast activity
Xeropthalmia - xerostomia - arthritis

48. What causes compression of the C7 nerve root
Cervical disk lesion
Interossei and adductor policis
Medial finger flexion - wrist flexion
Increase in both osteoblast and osteoclast activity

49. What are the signs of ulnar nerve injury

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50. IBS - 2 dz's
Crohns and ulcerative colitis
Anti Scl70 - anti DNA topoisomerase I antibody
In psoriasis - bleeding spots when scales are scraped off
Nevocellular nevus