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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 lesion causes Saturday night wrist drop
Radial nerve
Ulnar nerve
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Radial nerve becomes compressed in axilla

2. Where is osteosarcoma found in the bone
Adduct the fingers
Dermatitis
Infraspinatus - laterally rotates arm
Metaphysis of long bones - distal femur

3. What lesion causes wrist drop
Lesch - nyhan - PRPP excess - dec exretion of uric acid (thiazide) inc cell turnover - von Gierke's dz - 90% due to underexcretion - 10% to overproduction
Posterior cord
Calmodulin - complex activates myosin light chain kinase
Sarcoidosis - black females - ACE

4. What injury causes injury to the MC nerve and what motor and sensory defs dose it cause
Posterior cord
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Adduct the fingers
Upper trunk compression - biceps - brachialis - corachobrachialis - flexion of arm at elbow - sensory = lateraly forearm

5. What does PED and Tip stand for

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6. What other muscle in the thenar eminence adducts the thumb
AP depol opens voltage gated Ca channels - inducing NT release
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Stevens johnson syndrome - associated with adverse drug reactions - more severe version called toxic epidermal necrolysis
Adductor policis brevis

7. what changes are seen in stratum spinosum and granulosum in psoriasis
Hairy leukoplakia - HIV population - EBV mediated
Cervical disk lesion
Inc spinosum - dec granulosum
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar

8. What is the source of osteoblast cells
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Ephelis
Mesenchymal stem cells in periosteum
Psoriasis

9. What happens at the gap jxn and what molecules create them
B27 - no RF - males
Acantholysis
ACH esterase inhibitors - edrophonium test - improvement of sx after edro means the patient is underdosed
Allows adjacent cells to communicate for electric and metabolic fxns - connexons

10. papules and plaques with silvery scaling - especially on knees and elbows - acanthosis with parakeratotic scaling (nuclei sill in stratun corneum - nail pitting and arthritis
4th and 5th finger
Osteoblastoma
Polyostotic fibrous dysplasia
Psoriasis

11. dried exudates from a vesicle - bulla or pustule seen impetigo
Cervical disk lesion
In psoriasis - bleeding spots when scales are scraped off
Crust
Allopurinaol - uricosurics (probenicid)

12. What is below the epidermis
Vit D def - dec Ca - inc PTH - dec serum phos - reversible when vit D is replaced
Erythema nodosum
Anti Smith
The dermis

13. osteochondrosis has rare malignant transformation into what cancer
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Chondrosarcoma
Phosphorylates myosin light chain which leads to cross bridge formation

14. What lesion causes claw hand and What are the muscles involved
Anti Scl70 - anti DNA topoisomerase I antibody
Acute back pain - loss of height - and kyphosis
Ulnar nerve - intrinsic muscles of hand
Musculocutaneous

15. pruritic eruption - commonly on skin flexures - of associated with asthma - allergic rhinitis
Crohns and ulcerative colitis
Inc alk phos - abnl bone architecture
Sites of tibial attachment
Atopic dermatitis - eczema

16. What lesion causes difficulty flexing elbow with variable sensory loss
Musculocutaneous
Osteoid osteoma
Serum ca - phos - PTH are nl alk phos elevated
Medial 1.5 fingers - hypothenar eminence

17. Where are most osteoid osteoma found and In what population
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Inc blood flow from AV shunts can cause high output heart failure
Inc spinosum - dec granulosum
< 2mc found in proximal tibia and femur - men < 25

18. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Erythema nodosum
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Osteoarthritis
Cellulitis - s aureus - s pyogenes

19. Warts - soft - tan - colored - cauliflower type lesions - epidermal hyperplasia - hyperkeratosis - koilocytosis
Biceps
Medial 1.5 fingers - hypothenar eminence
Verrucae
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS

20. acute painful spreading infxn of dermis and subQ tissues - condition and orgs
Cellulitis - s aureus - s pyogenes
Corneum - lucidum - granulosum - spinosum - basalis
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
In psoriasis - bleeding spots when scales are scraped off

21. inflammation of the skin
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup
Median nerve - same fingers but not on the hand
MCP - PIP - no DIP
Dermatitis

22. Other than characteristic joints and subQ nodules - What are the other findings classicly in RA
Medially rotates and adducts arm
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Ulnar deviation - subluxation - bakers cysts (behind knee)
Increase in both osteoblast and osteoclast activity

23. What test if specific for lupus but doesn't indicate prognosis
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
Hands and face - ulcerative red lesion - locally invasive bur rare metastasis - associated with chronic draining sinuses and keratin pearls
Morning stiffness for > 30 min improving with use - symmetry - systemic sx
Anti Smith

24. Reduction of primarily trabecular (spongy) bone mass despite nl bone mineralization lab values
Gout
Osteoporosis
Gout
Polymyositis - shoulders - perifasicular inflammation

25. What nerve is injured in a fracutre of the hook of hamate
Osteoblastoma
Ulnar nerve
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)

26. What are predisposing factors for osteosarcoma - xray finding

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27. Which muscle is the pitching injury and What does it do
Infraspinatus - laterally rotates arm
ANA - sensitive but not specific
Restrictive lung disease - bilateral hilar lymphadenopathy - erythema nodosum - Bell's palsy
Ulnar nerve

28. Sarcoid TX
Steroids
Precocious puberty
Myosin light chain phosphotase
Medial finger flexion - wrist flexion

29. locally invasive but rarely mets skin cancer - rolled edges - with central ulceration - cancer and gross path
Basal cell carcinoma - pearly papules - commonly with telangiectasias
S100 - associated with sunligh exposure - fair skinned at risk - depth of tumor correlates with risk of mets - dark with irregular borders
Asymmetric - swollen - red - painful joint - often MTP (podagra) - tophus formation on external ear - olecranon bursa - achilles tendon
Iliac crest

30. What is the precursor to melanom
Hyperkeratosis
Seborrheic keratosis
Dec estrogen causes inc bone resorption - postmenopausal
Dysplastic nevus

31. What is the landmark for an LP
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Iliac crest
Bulla
Pustule

32. Trauma to lateral aspect of leg or fibula neck fracture - nerve - motor and sens def
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Outer arm
Crohns and ulcerative colitis

33. warts on hands
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Tight jxn - prevents diffusion across paracellular space - composed of claudins and occludins
Intraepidermal bullae involving the skin and oral mucosa
Verrucae vulgaris

34. What is the TX for acute gout
NSAIDs (indomethacin) colchicine
Fever - fatigue - weight loss - nonbacterial verruucous (Liebman - Sacks) endocarditis - hilar adenopathy - Raynauds
HI shrinks - A stays same
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome

35. pelvic fracture can cause injury to which nerve - and What are the motor and sens def
Femoral - thing flexion and leg extension - anterior thigh and medial leg
Wheal
Lesioned by midshaft fracture of humerus
Elevated ESR and nl CK - prednisone

36. What is a precursor to squamous cell carcinoma
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Actinic keratosis
Radial nerve becomes compressed in axilla
NC migration

37. knee trauma - nerve - motor and sensory def
Blow to the shoulder - trauma during delivery; limb hangs by side - medially rotated - forearm is pronated
Nl - decreased bone mass
Dermatomyositis
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory

38. What nerve is injured by a fracture of the epicondyle of humerus or repeated minor traumas
Ulnar nerve
Binds troponin C causing a conformational change leading to tropomyosin to move out of the way allowing for actin/myosin cycling
Median nerve
Adductor policis brevis

39. What does MLCK do in smooth muscle contraction
Paralysis of abductors
Schaumann (calcium and protein inclusions inside Langhans giant cells) and asteroid bodies
Phosphorylates myosin light chain which leads to cross bridge formation
Sarcoidosis - black females - ACE

40. What is a very specific test for lupus
Precocious puberty
Chondrosarcoma - pelvis - spine - scapula - humerus - tibia - or femur
Increase in both osteoblast and osteoclast activity
Anti ds DNA - poor prognosis

41. Which muscle laterally rotates and adducts arm
Dysplastic nevus
Gout
Teres minor
Serum ca - phos - alk phos are NL

42. hypothenar eminence - nerve and muscles
Scleroderma
Tibial - foot inversioon and plantarflexion; toe flexion - sole of foot is sensory
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Ulnar - opponens digiti minimi - abductor digiti minimi - flexor digiti mimini

43. What cancer in particular are associated with LE syndrome - what happens to symptoms with muscle use or ACH esterase inhibs
Pityriasis rosea
Biceps
Small cell cancer of the lung - improve with muscle use - no change with ACHE inhibs
Impetigo - s aureus - s pyogenes

44. most common benign tumor - mature bone with cartilaginous cap - men <25 - origintate froms long metaphysis
Ulnar nerve
Allopurinaol - uricosurics (probenicid)
Osteochondroma - exostosis
Squamous cell carcinoma

45. How does gonococcal arthritis present
Type 2 - dec mitochondria and myoglobin - inc anaerobic glycolysis
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Hyperkeratosis
STD presents as a monarticular - migratory arthritis with an asynmetrical pattern - affected joint is painful - red and swollen

46. What kind of nuclei do basal cell tumors have
AP depol opens voltage gated Ca channels - inducing NT release
Palisading
Ulnar nerve - fracture of hook of hamate
Actin

47. What are the bone mineral lab findings in paget's disease
Basophilic - rhomboid crystals - weakly birefringent
Dermatitis
Serum ca - phos - PTH are nl alk phos elevated
Serum ca - phos - alk phos are NL

48. When does membranous ossification occur and What is the difference between membranous and endochondrial
NC migration
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Osteoid osteoma
Recurrent branch of the median nerve

49. What are the causes of inferior trunk plexus compression and What are the findings
Lesioned by midshaft fracture of humerus
Adductor policis brevis
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

50. Where is C5 dermatome
Vertebral crush fractures - femoral neck fractures - distal radius (Colles') fracture
Outer arm
Elevated 1 alpha hydroxylase mediated vit D activation in epithloid macrophages
Anti - CCP - HLA- DR4