Test your basic knowledge |

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 are the lab findings and TX in dermatomyositis
Actinic keratosis
Fever - fatigue - pleuritis - pericarditis
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids
Making fist with a proximal median nerve lesion

2. What TX prophylax against osteoporisi
Dec estrogen causes inc bone resorption - postmenopausal
Wheal
Viral - maybe paramyxovirus
Exercise and Ca ingestion before age 30

3. What enzyme is necessary for smooth muscle relaxation after contraction
Myosin light chain phosphotase
Osteosarcoma - multiple myeloma
Endochondroma
Chondrosarcoma

4. What are the classic fractures in pts with osteoporosis

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5. What happens in the power stroke of skeletal muscle contraction
Interossei and adductor policis
Phosphate is liberated from the myosin head
Outer arm
Binds myosin head and releases actin filament allowing cross - bridge cycling and shortening to occur

6. yellow when parallel and blue when perpendicular
Gout
Wheal
Anti Smith
Ulnar deviation - subluxation - bakers cysts (behind knee)

7. What is the Sicca syndrome
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Gout
Impetigo - s aureus - s pyogenes

8. What are common features of lupus
Dec estrogen causes inc bone resorption - postmenopausal
Age - obesity and joint deformity
Wire - loop lesions in kidney with immune complex deposition - death from renal failure and infxns
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody

9. What causes osteoporosis type 1 and When does it typically occur
Pseudogout
Dec Ca - dec phos - nl alk phos - inc PTH - soft bones
Median - lateral finger and wrist flexion - dorsal palmar aspects of lateral 3.5 fingers/thenar eminence - ape hand - carpal tunnel syndrome
Dec estrogen causes inc bone resorption - postmenopausal

10. Which muscle is the pitching injury and What does it do
Radial deviation of wrist upon flexion - ulnar claw hand - pope's blessing
Loss of lateral lumbrical fxn - 2nd and 3d digits are clawed and can't extend
Lesion to lower trunk of brachial plexus - loss of fxn of all lumbricals - forearm finger flexors - finger extensors are unopposed (radial nerve)
Infraspinatus - laterally rotates arm

11. freckle - normal number of melanocytes - inc melanin pigment
Making fist with a proximal median nerve lesion
Albinism
Exercise and Ca ingestion before age 30
Ephelis

12. What do dorsal interosseous muscles do
Anti - histone
Abduct the fingers
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Median - opponens pollicis - abductors pollicis brevis - flexor pollicis brevis

13. first few weeks of life - grows rapidly and regresses spontaneously at 5 to 8 yrs of age
Gout
Phosphate is liberated from the myosin head
Phosphorylates myosin light chain which leads to cross bridge formation
Strawberry hemangioma

14. When does membranous ossification occur and What is the difference between membranous and endochondrial
McCune - Albright syndrome
Flat bone (skul - facial bones - axial skeleton) woven directly formed - no cartilage - later remodeled to lamellar
Polymyositis - shoulders - perifasicular inflammation
Viral - maybe paramyxovirus

15. appreas in 30s to 40s - does not regress
Cherry hemangioma
4th and 5th finger
Fibroblast growth factor receptor (FGFR3) inhibits chondrocyte proliferation
Median nerve

16. herald path followed by days later christmas tree distribution - multiple papular eruptions; remits spontaneously
Men - needle shaped and negatively birefringent = yellow crystals under parallel light
Pityriasis rosea
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Osteoarthritis

17. What is the classic traid of sjogrens syndrome
Verrucae vulgaris
Widespread skin involvment - rapid progression - early visceral involvement
Xeropthalmia - xerostomia - arthritis
Keloid

18. Deposition of calcium pyrophosphate cyrstals within the joint space
Osteoid osteoma
Cherry hemangioma
Widespread skin involvment - rapid progression - early visceral involvement
Pseudogout

19. What do xray show in osteopetrosis and What do potential CN abnl result from
Erlenmeyer flask bones that flare out - narrowed foramina
Dry eyes - dry mouth - nasal and vaginal dryness - chronic bronchitis - reflux esophagitis and No arthritis
Pseudogout
Viral - maybe paramyxovirus

20. What do anterior and posterior in ACL and PCL refer to...
Axillary - deltoid - skin over deltoid - flattened deltoid
Boutonniere - swan neck - zthumb
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Sites of tibial attachment

21. What muscles of the shoulder form the rotator cuff
Metaphysis of long bones - distal femur
Radial nerve becomes compressed in axilla
Supraspinatus - infraspinatus - teres minor - subscapularis - SItS
EtOH metabolites compete for same excretion site in kidney as uric acid - causing dec uric acid secretion and subsequent buildup

22. What syndrome of the NMJ is a paraneoplastic syndrome and What are the antibodies directed against
Peroneal everts and dorsiflexes - foot dropPED; tibial inverts and plantarflexes - can't stand on Tip toes
Basal cell carcinoma - pearly papules - commonly with telangiectasias
Widespread skin involvment - rapid progression - early visceral involvement
Lamber eaton - presynaptic Ca channels - dec ACH release leading to proximal muscle weakness

23. hives - intensely pruritic wheals that form after mast cell degranulation
Inc alk phos - abnl bone architecture
Head - trunk - extremities - common benign neoplasm in older persons
Biceps
Urticaria

24. Where do sebhorrheic keratosis lesions occur and in who
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory
Paralysis of lateral rotators
Ribonucleoprotein antigents - SS- A and SS- B (Ro and La)
Head - trunk - extremities - common benign neoplasm in older persons

25. inc thickness of stratum corneum seen in psoriasis
Ulnar nerve - fracture of hook of hamate
Medial finger flexion - wrist flexion
Hyperkeratosis
Medial 1.5 fingers - hypothenar eminence

26. inflammatory lesions of subQ fat - usually on anterior shins - associated with coccidioidomycosis - histoplasmosis - TB - leprosy - streptoccocal infxn - sarcoid
Anemia - thrombocytopenia - infection - extramedullary hematopoiesis
Calmodulin - complex activates myosin light chain kinase
Anterior interosseous nerve
Erythema nodosum

27. What does injury to the distal ulnar nerve cause
Parakeratosis
Scleroderma
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Loss of medial lumbrical fxn; 4th and 5th digits are clawed - when try to open hand - pinky and ring finger stay clawed

28. Which muscle fiber type is slow twitch and why are fibers red
Ulnar nerve
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts
Interossei and adductor policis

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

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30. What antibody is less sensitive than RF but more specific and What is the HLA association
Polyostotic fibrous dysplasia
Thymoma
Outer arm
Anti - CCP - HLA- DR4

31. interlacing trabeculae of woven bone surrounded by osteoblasts
Osteoid osteoma
Vesicle
Over deltoid
Plaque

32. What kind of bone tumor is associated with FAP and What is the finding
Osteopetrosis - abnl fxn of osteoclasts
Osteoma (gardners syndrome) - new piece of bone grows on another bone - often skull
Polymyaglia rheumatica associated with temporal (giant cell) arteritis
Cellulitis - s aureus - s pyogenes

33. hyperpigmentation associated with pregnancy or OCP
Myosin
Rheumatoid arthritis
Inc alk phos - abnl bone architecture
Melasma (chloasma)

34. What are the signs of ulnar nerve injury

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35. Flat discloration <1cm seen in tinea versicolor
Ligand binding leads to muscle depol
Cherry hemangioma
Macule
Defective mineralization/calcification of osteoid - osteomalacia in adults and ricketts in kids

36. Dermatomyositis places the pt at inc risk For what malignancy in particular
Type 2
Head - trunk - extremities - common benign neoplasm in older persons
Musculocutaneous
Lung

37. irregular raised lesion resulting from scar tissue hypertrophy - follows trauma to skin - common to african americans see in T. pertenue (yaws)
Posterior hip dislocation - can't jump - climb stairs or rise from seated positions
Keloid
Antibodies around cells of the epidermis in a reticular or netlike pattern
Actinic keratosis - risk proportional to epithelial dysplasia

38. hyperplasia of stratum spinosum - associated with hyperinsulinemia (cushings - DM) and visceral malignancy
Myasthenia gravis - autoAb against ACH receptors causing ptosis - diplopia - general weakness -
Acanthosis nigcricans
Viral - maybe paramyxovirus
Mosiac bone pattern - long bone chalk stick fractures - increased hat size or hearing loss due to auditory foramen narrowing

39. What is the characteristic appearance of bone - the common translocation - area of - and bones affected
False positives on syphillis test (RPR/VRDL) due to antiphospholipid antibodies - cross react with cardiolipin
Failure of longitudinal growth (endochondrial ossification) leading to short limbs - membranous is unaffected - large head
Onion skin - 11:22 - diaphysis of long bones - pelvis - scapula - ribs
Common peroneal - foot eversion and dorsiflexion - toe extention - foot drop - foot slap - stepped gaint - anterolateral leg and dorsal aspect of foot for sensory

40. dactylitis and pencil in cup deformity on xray - patchy skin rash and joint pain
Lichen planus
Inc alk phos - abnl bone architecture
B27 - no RF - males
Psoriatic arthritis - occurs is less than 1/3 of psoriasis pts

41. What organisms can cause chronic infectious arthritis
TB from dissemination and lyme dz
The dermis
Erythema multiforme - can be macules - papules vesicles - target lesions -
Median nerve - same fingers but not on the hand

42. What antibodies is diffuse scleroderma associated with
Anterior interosseous nerve
Calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasia - anti centromere antibody
Anti Scl70 - anti DNA topoisomerase I antibody
Degenerative injury due to repeated use - tiny tears in the tendons and muscles - may be inflammatory - lateral epicondyle is tennis - medial epicondyle is golf

43. What is the Auspitz sign
In psoriasis - bleeding spots when scales are scraped off
Muslce use - nerve stim/compound muscle test
Hairy leukoplakia - HIV population - EBV mediated
Inc CK - inc aldolase - and positive ANA and anti Jo -1 - steroids

44. What lesion causes claw hand and What are the muscles involved
Infraspinatus - laterally rotates arm
Fracture of surgical neck - dislocation of the humerus - intramuscular injections
Posterior cord
Ulnar nerve - intrinsic muscles of hand

45. What lesion causes wrist drop
Paralysis of lateral rotators
Posterior cord
Type 1 - inc mitochondria and myoglobin conc - inc OXPHOS leading to sustained conctraction
Myosin releases bound ADP and is displaced on the actin filament

46. What medication is contraindicated in osteoporosis
Glucocorticoids
Teres minor
Albinism
Impetigo - s aureus - s pyogenes

47. What lesion causes total claw (klumpke's hand)
Medial 1.5 fingers - hypothenar eminence
Lower trunk of brachial plexus
Pain in weight bearing joints at the end of the day and improving with rest
Patch

48. What does subscapularis do
Serratus anterior - connects scapular to thoracic cage - abduction above horizontal position - injured in mastectomy - winged scapula and lymphedema
Compressed by cervical rib or pancoasts tumor - leads to klumpke's
Men and women > 70 - senile osteporosis
Medially rotates and adducts arm

49. skin cancer associatd associated with excessive exposure to sunlight and arsenic
Keratoacanthoma
Intermediate jxn - just below zona occludens - cadherins and actin filaments - cadherins are dependent on Ca2+
Squamous cell carcinoma
Upper trunk of brachial plexus

50. Loss of what muslces in Erbs causes the limb to hang by side
4th and 5th finger
Pemphigus vulgaris - macula adherens where cadherins attach to intermediate filaments
Paralysis of abductors
Men - needle shaped and negatively birefringent = yellow crystals under parallel light