MUSCULOSKELETAL

Question 1

what consists of the internal anal sphincter

Answer 1

smooth muscle
under autonomic control

not affected by kagel exercises

Question 2

which muscles do pelvic floor exercises target

Answer 2

puborectalis
pubococcygeous
ileococcygeous

Question 3

spinal osteomyelitis
osteodiscitis
TB

Answer 3

Potts disease

TB of the spine

other extrapulmonary manifestations:
dermatologic TB
meningitis

airbone
often ‘homeless’ for TB in question vingette

Question 4

disorganised woven bone
fractures
lytic/sclerotic lesions
cranial nerve compression

Answer 4

paget disease

disorder osteoclast/blast

Question 5

50yo
malignant
from mesenchymal cells
produce cartilage
axial skeleton - pelvis
pain, neural dysfunction

Answer 5

chondrosarcoma

‘disruption of cortex’
‘diaphysis thickening’
‘cysts, calcification’

lobules
hyaline like cartilage
nests malignant chondrocyte-like cells
disorganised calcifications - rings/arcs

Question 6

posterior calf and dorsolateral foot drain into what LN

Answer 6

popliteal LN

‘pop-lateral’

Question 7

what area drains into superficial inguinal LN

Answer 7

skin below the umbilicus
lower back
perianal region (below pectinate line)
distal vagina, vulva, scrotum, urethra
lower extremity
exception: posterior calf / dorsolateral foot

lower extremity below umbilicus incl up to pectinate line

superficial LN –> deep LN –> external iliac LN

Question 8

internal iliac LN drainage

Answer 8

cervix
proximal vagina
corpus cavernosum
prostate
inferior bladder
lower rectum (above pectinate line)

upper rectum - inf meseneric LN
below pectinate line - sup inguinal LN

lower rectum above pectinate line = ‘middle rectum’

Question 9

internal iliac LN drain what part of the anal canal

Answer 9

above pectinate line
(middle rectum)

superficial inguinal drains below pectinate line

Question 10

cervix
proximal vagina
corpus cavernosum
prostate
inferior bladder
lower rectum (above petinate line)
drain to what LN

Answer 10

internal iliac LN

Question 11

prostate drains to what LN

Answer 11

internal iliac LN

Question 12

where does the inferior vs superior bladder drain (LN)

Answer 12

superior = external iliac
inferior = internal iliac

Question 13

where does the body of uterus, cervix and superior bladder drain (LN)

Answer 13

external iliac LN

Question 14

where does the body vs fundus of uterus drain

Answer 14

body = external iliac
fundus = para-aortic (lumbar)

Question 15

what drains to para-aortic LN

Answer 15

testes
fundus uterus
ovaries
kidneys
fallopian tubes

metastasis

Question 16

what structures drain: celiac LN

Answer 16

liver
stomach
spleen
pancreas
upper dodenum

Question 17

What drains superior mesenteric LN

Answer 17

lower duodenum
jejunum
ileum
colon to splenic flexure

Question 18

what drains inferior mesenteric LN

Answer 18

from splenic flexure (colon) to upper rectum

left colic, sigmoid, superior rectal artery

Question 19

trachea and oeseophagus drain to

Answer 19

mediastinal LN

pulmonary TB (unilateral hilar)
sarcoidosis (bilateral hilar)
lung cancer
granulomatous disease

above also applies to lungs –> hilar LN

Question 20

which areas to left vs right supraclaviulcar LN drain

Answer 20

right: right hemithorax
left: left hemithorax, pelvis, abdomen

Question 21

kawasaki, infectious mononucleosis, URTI and head malignancies affect what LN

Answer 21

deep cervical LN

Question 22

ruptuer of thoracic duct can cause

Answer 22

chylothorax

i.e. central line into L internal jugular vein

Question 23

venous drainage of rectum (above pectinate line)

Answer 23

superior rectal ->
inferior mesenteric ->
splenic ->
hepatic portal

portal HTN can cause internal haemorrhoids

part of portal circulation

first pass metabolism (initial drug metabolism) higher - if drains via superior rectal - hepatic circulation

Question 24

venous drainage of rectum (above pectinate line)

Answer 24

inferior rectal ->
inferior pudendal ->
internal iliac ->
IVC

systemic circulation
external haemarrhoids

Question 25

symmetric proximal ms weakness *anti-nuclear autoantibodies anti-tRNA synthetase (anti-Jo) autoantibodies anti-SRP autoantibodies anti-Mi-2 (helicase) autoantibodies* ms biopsy: **patchy endomysial inflammatory infitrate, CD8 cells**

Answer 25

polymyositis ## Footnote Progressive symmetric proximal muscle weakness, endomysial inflammation with CD8+ T cells. Most often involves shoulders. perifasicular inflammation (dermatomyositis)

Question 26

symmetric proximal ms weakness *anti-nuclear autoantibodies anti-tRNA synthetase (anti-Jo) autoantibodies anti-SRP autoantibodies anti-Mi-2 (helicase) autoantibodies* helitrope rash “shawl and face” rash hand hyperkeratosis (mechanic) risk of occult malignancy. ms biopsy: **Perimysial inflammation and atrophy with CD4+ T cells.**

Answer 26

dermatomyositis

Question 27

osteoarthirtis is associated with what type of collagen

Answer 27

type II (hyaline cartilage) ## Footnote can wear out and result in bone cysts, narrowing of joint space, osteophytes, subchondral bone sclerosis

Question 28

osteoarthritis main issue is: osteoporisis main issue is:

Answer 28

loss of cartilage loss of bone mass

Question 29

what are minature end plate potentials | mepp

Answer 29

small depolarisations from release of single vesicle of Ach into NMJ | not sufficient to reach AP threshold occur sporadically ## Footnote mepp: caused by ligand gated nonspecific cation channels (na+, K+) as well as calcium) mepp not vary much with calcium concentration

Question 30

acute botilism affected muscle will show the following effects: epp amplitude mepp amplitute response to 1uM Ach | end plate potential minature end plate potential

Answer 30

epp = decreased mepp = unchaged 1uM Ach = unchaged ## Footnote **Ca** conc affected release of vesicles at NMJ -> affecting Ach amount released -> affecting end plate potential (epp) *(calcium dependant process)* botulism prevents release presynaptic Ach -> decreases epp & not affect mepp or exogenous Ach response

Question 31

what bone cells are crucial in bone repair process i.e. post fracture #

Answer 31

periosteal cells endosteal cells | periosteum

Question 32

what arises from the aorta just below the renal arteries

Answer 32

testicular arteries | superior mesenteric artery arises below celiac artery

Question 33

15yo joint pain inflammation uveitis lymphadenopathy rash

Answer 33

juvenille rheumatoid arthritis | before 16yo no sepsis signs

Question 34

child fever, chills, nausea myalgia, arthraliga painful, erythematous swollen joint limited range, NWB leukocytosis increased ESR, CRP synovial fluid wbc 35000,

Answer 34

monoarticular septic arthritis | common in children m/c **staph aureus** +/- gram stain growth on culture ## Footnote assoc **osteomyelitis** adjacent bone dental procedures also risk factor - transient bacteremia