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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 injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Over deltoid
Erythema multiforme - can be macules - papules vesicles - target lesions -
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Ephelis

2. What do dorsal interosseous muscles do
ANA - sensitive but not specific
Median nerve - same fingers but not on the hand
Abduct the fingers
Erythema nodosum

3. What are characteristic findings of gout
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
In psoriasis - bleeding spots when scales are scraped off
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Renal - pulm - CV - GI - 75% female

4. malignant cartilaginous tumor in men 30 to 60 - Name and common location
3rd finger
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Teres minor

5. What nerve is compressed in carpal tunnel syndrome or a disclocation of this bone
Verrucae
Median nerve - lunate bone
Supraspinatus - abducts the arm before the deltoid
Actinic keratosis - risk proportional to epithelial dysplasia

6. hives - intensely pruritic wheals that form after mast cell degranulation
Serum ca - phos - PTH are nl alk phos elevated
Dermatitis
Urticaria
Pustule

7. What happens at the gap jxn and what molecules create them
Allows adjacent cells to communicate for electric and metabolic fxns - connexons
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Phosphate is liberated from the myosin head

8. 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
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Glucocorticoids
Ulnar deviation - subluxation - bakers cysts (behind knee)

9. large fluid containing blisters seen in bullous pemphigoid
Bulla
Actin
B27 - no RF - males
3rd finger

10. hyperkeratosis with retention of nuclei in stratum corneum seen in psoriasis
Large goints (knee)
Parakeratosis
Iliac crest
Pagets dz - bone infarcts - radiation - familial retinoblastoma - codman's triangle or sunburst pattern from elevation of periosteum - poor prognsosis

11. What autoantibodies are formed in sjogrens syndrome
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Exercise and Ca ingestion before age 30
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Inc alk phos - abnl bone architecture

12. dried exudates from a vesicle - bulla or pustule seen impetigo
3rd finger
Crust
Albinism
Crohns and ulcerative colitis

13. Where is C7 dermatome
Anti - CCP - HLA- DR4
3rd finger
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Increase in both osteoblast and osteoclast activity

14. What lesion causes winged scapula
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Verrucae vulgaris
Long thoracic nerve

15. Where is C8 dermatome
GC and cGMP and inhibition of MLCK
Serum ca - phos - alk phos are NL
4th and 5th finger
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns

16. In which joints does pseudogout typically occur
Actinic keratosis
Ligand binding leads to muscle depol
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Large goints (knee)

17. What are the lab findings in osteoporosis
Inc Ca - dec phos - inc alk phos - inc PTH - brown tumors
Nl - decreased bone mass
Gout
Medial forearm and arm to just under the axilla

18. pruritic - purple - polygonal papules - sawtooth infiltrate of lymphocytes at dermal - epidermal jxn - associated with hep C
Parakeratosis
Pseudogout
Nl - thickened dense bones
Lichen planus

19. Where is C6 dermatome
Osteoarthritis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

20. Associated with M. pneumonia - HSV - sulfa drugs - B lactams - phenytoin - cancers and autoimmune dz - skin disorder and description
Immunoglobulins - malar rash - discoid rash - ANA - mucositis (oropharyngeal ulcers) - neurologic disorders - serositis (pleuritis - pericarditis) - hematologic disorders - arthritis - renal - photosensitivity
Erythema multiforme - can be macules - papules vesicles - target lesions -
Inc blood flow from AV shunts can cause high output heart failure
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head

21. What antibodies is diffuse scleroderma associated with
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Basophilic - rhomboid crystals - weakly birefringent
Anti Scl70 - anti DNA topoisomerase I antibody
Inc blood flow from AV shunts can cause high output heart failure

22. Who does osteoporosis type 2 effect
Steroids
Medial finger flexion - wrist flexion
Making fist with a proximal median nerve lesion
Men and women > 70 - senile osteporosis

23. What is contained within epithelial granulomas of pts with sarcoid
Basophilic - rhomboid crystals - weakly birefringent
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Basal cell carcinoma - pearly papules - commonly with telangiectasias

24. immune mediated - widespread - non - caseating granulomas - dz - affected population and elevated serum level
Sarcoidosis - black females - ACE
Medial 1.5 fingers - hypothenar eminence
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Dermatomyositis

25. What do palmar interosseous muscles do
Ulnar deviation - subluxation - bakers cysts (behind knee)
Adduct the fingers
Female between 14 and 45 - mostly black
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend

26. What does lack of ATP cause
Rigor mortis
Middle bicep down - cuts lateral at cuboidal foass and runs distally to include the thumb and 2nd digit
Vitiligo - dec number in melanocytes
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

27. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Subclavius
Cellulitis - s aureus - s pyogenes
Scleroderma

28. What is the clinically important landmark for pubendal nerve block and When is it used
Lesioned by midshaft fracture of humerus
GC and cGMP and inhibition of MLCK
Ischial spine - relieve pain during delivery
Femoral - thing flexion and leg extension - anterior thigh and medial leg

29. Where is T1 dermatome
Pseudogout
Ulnar nerve
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Medial forearm and arm to just under the axilla

30. What lesion causes Saturday night wrist drop
Verrucae
Polyostotic fibrous dysplasia
Radial nerve becomes compressed in axilla
Radial nerve

31. What are common features of lupus
Adductor policis brevis
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Muslce use - nerve stim/compound muscle test
Hyperkeratosis

32. warts on genitals
Verrucae vulgaris
Anti ds DNA - poor prognosis
Condyloma acuminatum - caused by HPV
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed

33. What are the characterstic joints affected in RA
MCL - ACL - lateral meniscus (esp in athletes)
Phosphate is liberated from the myosin head
MCP - PIP - no DIP
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs

34. What lesion causes wrist drop
Median nerve - lunate bone
Ischial spine - relieve pain during delivery
Posterior cord
Polyostotic fibrous dysplasia

35. What are the signs of ulnar nerve injury

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36. What nerve is injured in a fracture of the medial epicondyle of humerus - and What is a more distal lesion injuring the same nerve
Osteosarcoma - multiple myeloma
Torn MCL
Ulnar nerve - fracture of hook of hamate
ANA - sensitive but not specific

37. Macule greater than 1cm
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Scleroderma
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Patch

38. In smooth muscle contraction - What does Ca bind and What is the purpose
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
S. aureus - streptococcus
Spindle shaped cells with multinucleated giant cells
Calmodulin - complex activates myosin light chain kinase

39. In longitudinal bone growth - what model is made first (and By what cell) and What is it later replaced by (and By what cells) - process name
Fever - fatigue - pleuritis - pericarditis
In psoriasis - bleeding spots when scales are scraped off
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Cartilaginous by chondrocytes first - osteoclasts and osteoblasts later replace with women bone and remodel to lamellar bone - endochondrial ossification

40. How is chondrosarcoma described
Expansile glistening mass within the medullary cavity
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Fever - fatigue - pleuritis - pericarditis

41. Where are most osteoid osteoma found and In what population
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Female between 14 and 45 - mostly black
Intraepidermal bullae involving the skin and oral mucosa
< 2mc found in proximal tibia and femur - men < 25

42. Besides the skin - what other organ systems are commonly affected by scleroderma and who is primarily affected
The dermis
Renal - pulm - CV - GI - 75% female
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Ligand binding leads to muscle depol

43. Anterior hip dislocation causes injury to what nerve and What are the motor and sensory defs
Deep branch of radial nerve
Polymyositis - shoulders - perifasicular inflammation
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Obturator - thigh adduction - medial thigh

44. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Osteochondroma - exostosis
Torn MCL
Seborrheic keratosis
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix

45. heliotrope rash 'shawl and face' rash - Gotton's papules - 'mechanic's hands'
Impetigo - s aureus - s pyogenes
Dermatomyositis
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
4th and 5th finger

46. What happens at the postsynaptic motor end plate
Ligand binding leads to muscle depol
Ulnar nerve - fracture of hook of hamate
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments

47. How does gonococcal arthritis present
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen
Medial finger flexion - wrist flexion
Fibrinoid necrosis surrounded by palisading histiocytes
Rheumatoid arthritis

48. In which gender is gout more common and What does the crystals appear like microscopically
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Flex the MCP joints and extend both the DIP and PIP joints
Patch

49. subchondreal cysts - sclerosis - osteophytes - joint space narrowing - eburnation - hebereden's nodes (DIP) bouchard nodes (PIP) - characteristic findings of this dz
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Fever - fatigue - pleuritis - pericarditis
Melasma (chloasma)
Osteoarthritis

50. What is the precursor to melanom
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Dysplastic nevus
Bullous pemphigoid - linear immunofluorescence - eosinphils within blisters - similar to but less severed thatn pemphigus vulgaris - spares oral mucosa - negaitve nikolsky's sign
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf