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Musculoskeletal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What are the systemic symptoms found in RA
Chondrosarcoma
Xeropthalmia - xerostomia - arthritis
Fever - fatigue - pleuritis - pericarditis
Iliac crest

2. What variant of squamous cells carcinoma of the skin grows rapidly and regresses spontaneously
The dermis
Anti Smith
Keratoacanthoma
Acantholysis

3. In a fracture of the midshaft of the humerus - or extended compression of axilla - nerve - motor - sensory - sign
ANA - sensitive but not specific
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Radial - BEST extensors - posterior arm and dorsal hand/thumb - wrist drop
Plaque

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

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5. Dermatomyositis places the pt at inc risk For what malignancy in particular
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Lung
Corneum - lucidum - granulosum - spinosum - basalis
Crohns and ulcerative colitis

6. What causes osteoporosis type 1 and When does it typically occur
Dec estrogen causes inc bone resorption - postmenopausal
Paralysis of abductors
Strawberry hemangioma
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated

7. separation of epidermal cells
Ischial spine - relieve pain during delivery
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Acantholysis
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

8. What antibodies is diffuse scleroderma associated with
Adduct the fingers
Anti Scl70 - anti DNA topoisomerase I antibody
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Nevocellular nevus

9. deep tissue injury - crepitus from methane and CO2 production 'flesh eating bacteria' - condition and orgs
Boutonniere - swan neck - zthumb
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Osteoid osteoma

10. Where is McBurney's point and What is there
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Elevated ESR and nl CK - prednisone
Increase in both osteoblast and osteoclast activity
Crohns and ulcerative colitis

11. dried exudates from a vesicle - bulla or pustule seen impetigo
Inc alk phos - abnl bone architecture
Crust
Ulnar
Integrin binds laminin in BM

12. Loss of what muscles in Erbs causes the forearm to be pronated
Biceps
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Atopic dermatitis - eczema
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)

13. hypothenar eminence - nerve and muscles
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Keloid
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy

14. osteochondrosis has rare malignant transformation into what cancer
Ulnar nerve - adduction of thumb - extension of 4th and 5th fingers (lumbricals)
Ulnar nerve
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Chondrosarcoma

15. warts on hands
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Verrucae vulgaris
MCP - PIP - no DIP
Polyostotic fibrous dysplasia

16. What receptor is constitutively activated in achondroplasia and What does it do
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Rheumatoid arthritis
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Osteoid osteoma

17. What does injury to the distal median nerve cause

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18. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Ulnar nerve
Proximal median nerve lesion - loss of opponens pollicis muscle fxn leading to unopposoble thumb
Pain in weight bearing joints at the end of the day and improving with rest

19. What clinical features in vertebral crush fractures
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes
Acute back pain - loss of height - and kyphosis
Inc blood flow from AV shunts can cause high output heart failure
Expansile glistening mass within the medullary cavity

20. What are the classic fractures in pts with osteoporosis

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21. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf
2/3 of the way from the umbilicus to the anterior superior iliac spine - appendix
Inc spinosum - dec granulosum

22. What kind of bone tumor is associated with FAP and What is the finding
Medial forearm and arm to just under the axilla
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins

23. common mole - benign
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Crust
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Nevocellular nevus

24. Depolarizaition causes what voltage sensitive receptor coupled to what other receptor to induce a conformational change In what structure - releasing what?
Parakeratosis
Phosphorylated
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Chondrosarcoma

25. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
Post GI infxn or chlamydia
Psoriasis
Steroids
Metaphysis of long bones - distal femur

26. What does acantholysis show in pemphigus vulgaris
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Intraepidermal bullae involving the skin and oral mucosa
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Upper trunk of brachial plexus

27. In smooth muscle contraction - What does Ca bind and What is the purpose
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Calmodulin - complex activates myosin light chain kinase

28. What are the lab findings in osteoporosis
Iliac crest
Nl - decreased bone mass
Calmodulin - complex activates myosin light chain kinase
Biceps

29. What protects the brachial plexus in clavicle fracture
Squamous cell carcinoma
Type III - RF
Subclavius
Iliac crest

30. Where is C4 dermatome
Over deltoid
Upper trunk of brachial plexus
Boutonniere - swan neck - zthumb
Anti Scl70 - anti DNA topoisomerase I antibody

31. What kind of hypersens rxn is RA - and what serum marker is present in 80% of RA pts
Type III - RF
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Medial finger flexion - wrist flexion
Subclavius

32. What lesions causes Erb's palsy
Phosphate is liberated from the myosin head
Voltage sens - dihydropiridine R coupled to ryanodine recpetor - conformational change in the SR - releasing Ca2+
Viral - maybe paramyxovirus
Upper trunk of brachial plexus

33. inflammation of the skin
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
B27 - no RF - males
Dermatitis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

34. Loss of what muslces in Erbs causes the limb to hang by side
Paralysis of abductors
Acantholysis
Myosin releases bound ADP and is displaced on the actin filament
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis

35. appreas in 30s to 40s - does not regress
Cherry hemangioma
Myosin
Giant cell tumor (osteoclastoma) - double bubble or soap bubble
Muslce use - nerve stim/compound muscle test

36. In skeletal and smooth muscle contraction - when Ca2+ enters the cytoplasm - What does it do
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
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
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs

37. What is the sign of Leser - Trelat
Ulnar nerve - intrinsic muscles of hand
Medial 1.5 fingers - hypothenar eminence
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Necrotizing fasciitis - anaerobic bacteria or S. pyogenes

38. What do xray show in osteopetrosis and What do potential CN abnl result from
Psoriasis
Erlenmeyer flask bones that flare out - narrowed foramina
Patch
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis

39. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
3rd finger

40. What TX prophylax against osteoporisi
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Hyperkeratosis
Exercise and Ca ingestion before age 30
Viral - maybe paramyxovirus

41. What enzyme is necessary for smooth muscle relaxation after contraction
Myosin light chain phosphotase
GC and cGMP and inhibition of MLCK
In pemphis vulgaris - separation of epidermis upon manual stroking of skin
Medial 1.5 fingers - hypothenar eminence

42. What autoantibodies are formed in sjogrens syndrome
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
Sudden appearance of multiple sebhorrheic keratosis lesions indicating underlying lesions - GI or lymphoid
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Pseudogout

43. What do the lumbrical muscles do
Osteochondroma - exostosis
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur
The dermis
Flex at the MCP

44. What is contained within epithelial granulomas of pts with sarcoid
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
In psoriasis - bleeding spots when scales are scraped off
Thymoma

45. excessive fibrosis and collagen deposition throughout the body - common in skin manifesting as puffy taut skin with absence of wrinkles
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Recurrent branch of the medain nerve
Lichen planus
Scleroderma

46. Contraction results in shortening of what bands - and what band remains the same length
Osteoarthritis
Phosphorylates myosin light chain which leads to cross bridge formation
HI shrinks - A stays same
Pseudogout

47. What are the motor - sensory deficits and sign of carpal tunnel syndrome
Hyperkeratosis
Seborrheic keratosis
Opposition of thumb - dorsal/palmar 3.5 fingers sensory - ulnar deviation upon wrist flexion
Anti Smith

48. What is the primary screening test for lupus
ANA - sensitive but not specific
Bulla
Men and women > 70 - senile osteporosis
Palisading

49. What kind of jxn is in the zona adherens and Where is it - What is it composed of - and what ion does it does it depend on...
Lesioned by midshaft fracture of humerus
Axillary - deltoid - skin over deltoid - flattened deltoid
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Intraepidermal bullae involving the skin and oral mucosa

50. What do anterior and posterior in ACL and PCL refer to...
Sites of tibial attachment
Ephelis
Torn MCL
Osteoid osteoma