Ms-Ct Nerve Damage And Such To Learn

Front 1

How is the C7 root damaged?

Back 1

compressed by cervical disk lesions

Front 2

How is the lower trunk of the brachial plexus damaged and what is the resulting deficit?

Back 2

Compressed by cervical rib or pancoast tumor of the lung.

Leads to Klumpke's palsy

Front 3

how is the radial nerve damaged?

Back 3

compressed in the axilla by incorrect use of a crutch

Front 4

How is the median nerve damaged around the elbow and what results?

Back 4

compressed by supracondylar fracture of the humerus

Causes pronator teres syndrome

Front 5

How is the ulnar nerve damaged and the elbow?

Back 5

Lesioned by repeated minor trauma; fracture of medial epicondyle of the humerus

Front 6

How is the anterior interosseus nerve damaged?

Back 6

It can be compressed in the deep forearm.

Front 7

How is the median nerve damaged around the wrist?

Back 7

Compressed in carpal tunnel syndrome and by dislocated lunate carpal bone

Front 8

How is the ulnar nerve damaged around the wrist?

Back 8

Lesioned by trauma to heel of the hand or fracture of the hook of hamate

Front 9

How is the recurrent branch of the median nerve damaged?

Back 9

lesioned by superficial laceration.

Front 10

How is the radial nerve (deep branch) damaged in the forearm?

Back 10

Stretched by subluxation of radius

Front 11

How is the radial nerve potentially damaged in the upper arm?

Back 11

Lesioned by midshaft fracture of the humerus.

Front 12

How is the axillary nerve damaged?

Back 12

Lesioned by fracture of surgical neck, dislocation of the humerus or intramuscular injections.

Front 13

How is the upper trunk of the brachial plexus damaged?

Back 13

trauma to the neck/upper shoulder area

Front 14

What protects the brachial plexus in a clavicle fracture?

Back 14

the subclavius muscle

Front 15

What are some causes of mononeuropathy?

Back 15

compression, trauma, diabetes, vasculitis, radiation, inflammation (VZV?)

Front 16

What nerve roots are axillary neve?

Back 16

C5
C6

Front 17

What nerve roots make up the radial nerve?

Back 17

C5-C8

Front 18

What nerve roots make up the median nerve?

Back 18

C6-C8, T1

Front 19

What nerve roots make up the ulnar nerve?

Back 19

C8, T1

Front 20

What nerve roots make up the musculocutaneous nerve?

Back 20

C5-C7

Front 21

Motor and sensory deficits in axillary nerve injury?

Back 21

Motor: arm abduction at shoulder

Sensory: over deltoid muscle

Front 22

What is the sign of axillary nerve injury

Back 22

Flattened deltoid

Front 23

What does Saturday night palsy involve?

Back 23

extended compression of axilla by back of chair occurs when you fall asleep drunk on a Saturday night.

Front 24

Motor and sensory deficits in radial nerve injury?

Back 24

Motor: wrist extension, finger extension at MCP joints, supination, thumb extension and abduction.

Sensory: posterior arm and dorsal hand and dorsal thumb

Front 25

What is the sign of radial nerve injury?

Back 25

Wrist drop

Front 26

What are the motor and sensory deficits in proximal median nerve injury?

Back 26

Motor: Lateral finger flexion, wrist flexion.

Sensory: dorsal and palmar aspects of lateral 3.5 fingers, thenar eminence

Front 27

What are the motor and sensory deficits in distal median nerve injury?

Back 27

motor: opposition of thumb

sensory: dorsal and palmar aspects of lateral 3.5 fingers.

Front 28

What is a sign of proximal median nerve injury?

Back 28

ape hand-loss of opponens pollicis muscle function-- unopposable thumb (inability to abduct thumb), hence "ape hand"

Front 29

What is a sign of distal median nerve injury?

Back 29

ulnar deviation of wrist upon wrist flexion.

Front 30

How can the musculocutaneous nerve be damaged?

Back 30

upper trunk compression

Front 31

What motor and sensory deficits occur when the musculocutaneous nerve is damaged?

Back 31

Motor: flexion of arm at the elbow

Sensory: lateral forearm

Front 32

What are the motor and sensory deficits of proximal ulnar nerve lesions?

Back 32

motor: medial finger flexion, wrist flexion.

sensory: medial 1.5 fingers, hypothenar eminence

Front 33

What are the motor and sensory deficits of distal ulnar nerve lesions?

Back 33

Motor: Abduction and adduction of fingers (interossei), adduction of thumb, extension of 4th and 5th fingers (lumbricals)

Sensory: none.

Front 34

What is a sign of proximal lesion of the ulnar nerve?

Back 34

radial deviation of wrist upon wrist flexion

Front 35

What is a sign of distal lesion of the ulnar nerve?

Back 35

ulnar claw hand (when asked to straighten fingers)-- Pope's blession / hand of benediction.

Front 36

How does Erb-Duchenne palsy (waiter's tip) occur?

Back 36

Traction or tear of the upper trunk of the brachial plexus (C5 and C6 roots); follows blow to shoulder or trauma during delivery.

Front 37

What are the findings in Erb-Duchenne palsy?

Back 37

limb hangs by side (paralysis of abductors), medially rotated (paralysis of lateral rotators), forearm is pronated (loss of biceps).

Front 38

How does Klumpke's palsy occur and what does it cause?

Back 38

it is an embryo or childbirth defect affecting the inferior trunk of brachail plexus (C8-T1).

The cervical rib can compress the subclavian artery and inferior trunk and result in thoracic outlet syndrome.

Front 39

What are the symptoms of thoracid outlet syndrome?

Back 39

1) Atrophy of the thenar and hypothenar eminences

2) Atrophy of the interosseous muscles

3) Sensory deficits on the medial side of the forearm and hand

4) Disappearance of the radial pulse upon moving the head toward the ipsilateral side.

Front 40

What is the function of the lumbrical muscles?

Back 40

The lumbricals flex the MCP joints and extend both the DIP and PIP joints.

Front 41

What causes and is Klumpke's total claw?

Back 41

Lesion of lower trunk (C8-T1) of the brachial plexus.

Loss of function of all lumbricals, forearm finger flexorsand finger extensors are unopposed which causes clawing of all digits

Front 42

What does the radial nerve innervate?

Back 42

BEST
Brachioradialis
Extensors of the wrist and fingers
Supinator
Triceps

To SUPinate is to move as if carrying a bowl of SOUP.

Front 43

What does the thenar eminence include?

Back 43

Opponens pollicis, Abductor pollicis brevis, flexor pollicis brevis

Front 44

What does the hypothenar eminence include?

Back 44

Opponens digiti minimi, Abudctor digiti minimi, Flexor digiti minimi

Front 45

What are the functions of the muscles in the thenar eminence and hypothenar eminence?

Back 45

Both groups perform the same functions: OAF
Oppose
Abduct
Flex

Front 46

What is the function of the dorsal interosseus muscles?

Back 46

abduct the fingers

DAB=Dorsals ABduct

Front 47

What is the function of the palmar interosseous muscles?

Back 47

adduct the fingers

PAD=Palmars ADduct

Front 48

What is the function of the lumbrical muscles?

Back 48

Flex at the MP joint

Front 49

What complications can result when there is repetitive elbow trauma?

Back 49

Degenerative injury due to repeated use which leads to tiny tears in tendons and muscles. May be inflammatory (e.g. lateral epicondylitis--tennis elbow), medial epicondylitis (golf elbow)

Front 50

Cause of obturator nerve injury--motor and sensory deficits that result?

Back 50

Cause: anterior hip dislocation

Motor deficit: thigh adduction.

Sensory Deficity: medial thigh

Front 51

Femoral nerve cause of injury. Motor and sensory deficits

Back 51

Cause: pelvic fracture

Motor deficit: thigh flexion and leg extension

sensory deficit: anterior thigh and medial leg

Front 52

Common peroneal cause of injury. Motor and sensory deficits

Back 52

cause: trauma to lateral aspect of leg or fibula neck fracture.

motor: foot eversion and dorsiflexion; toe extension.

Sensory: anterolateral leg and dorsal aspect of the foot.

Front 53

Tibial nerve cause of injury. motor and sensory deficits.

Back 53

Cause: knee trauma

Motor: foot inversion and plantarflexion; toe flexion

Sensory: sole of foot.

Front 54

Superior gluteal cause of injury. Motor deficits.

Back 54

Cause: posterior hip dislocation or polio

motor: thigh abduction (positive Trendelenburg sign)

Front 55

Inferior gluteal nerve cause of injury. Motor deficits.

Back 55

Cause: posterior hip location

motor: can't jump, climb stairs or rise from seated position

Front 56

What does the peroneal nerve do and what happens if injured? PED

Back 56

peroneal Everts and Dorsiflexes; if injured, foot dropPED (dorsiflex=extend foot)

Front 57

What does the tibial nerve do and what happens if injured? TIP

Back 57

Tibial inverts and plantarflexes if injured can't stand on tiptoes.

Front 58

Osteoma

Back 58

Benign bone tumor.
Associated with Gardner's syndrome (FAP).

New piece of bone grwos on another piece of bone often in the skull

Front 59

Osteoid osteoma

Back 59

benign bone tumor.

Interlacing trabeculae of woven bone surrounded by osteoblasts
<2cm and found in proximal tibia and femur.
most common in men < 25 years of age.

Front 60

Osteoblastoma

Back 60

benign bone tumor

Same morphologically as osteoid osteoma but larger and found in vertebral column

Front 61

Giant cell tumor (osteoclastoma)

Back 61

Occurs most commonly at epiphyseal end of long bones.

Peak incidence 20-40 years of age.

locally aggressive benign tumor often around the distal femur, proximal tibial region (knee).

Characteristic double bubble or soap bubble appearance on x-ray.

Spindle shaped cells with multinucleated giant cells can be seen pathologically.

Front 62

Osteochondroma (exostosis)

Back 62

Most common benign bone tumor.

mature bone with cartilaginous cap. Usually in men < 25 years of age.

Commonly originates from long metaphysis.

Malignant transformation to chondrosarcoma is rare.

Front 63

Enchondroma

Back 63

benign cartilaginous neoplasm found in intramedullary bone.

usually distal extremeties (vs chondrosarcoma)

Front 64

Osteosarcoma (osteogenic sarcoma)

Back 64

2nd most common malignant tumor of bone after multiple myeloma.
Peak incidence: 10-20 yo men
metaphysis often knee region.
Presdisposing factors: paget's disease, bone infarcts, radiation, familial retinoblastoma.
Codman's triangle or sunburst pattern

Front 65

Ewing's sarcoma

Back 65

anaplastic small blue cell malignant bone tumor
Most common in boys <15 yo
Very aggressive w/early mets, but responsive to chemo.
"Onion-skin" appearance in bone
diaphysis of long bones, pelvis, scapula, and ribs
t (11;22)

Front 66

Chondrosarcoma

Back 66

malignant cartilaginous tumor.
Most common in men aged 30-60.
usually located in pelvis, spine, scapula, humerus, tibia, or femur.

May be primary origin or from osteochondroma.

Expansile glistening mass within the medullary cavity.

Front 67

osteitis fibrosa cystica

Back 67

caused by hyperparathyroidism

characterized by brown tumors (cystic spaces lined by osteoclasts filled with fibrous stroma and sometimes blood).

High serum calcium, low serum phosphorus and high ALP.

Front 68

McCune-Albright Syndrome

Back 68

form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions (cafe-au-lait spots / coast of maine spots)

Front 69

What is another name for Paget's disease?

Back 69

osteitis deformans

Front 70

What is Paget's disease of the bone?

Back 70

abnormal bone architecture caused by increase in both osteoblstic and osteoclastic activity. possibly viral (paramyxovirus)
Serum calcium, phosphorus, and PTH levels are normal.

INCREASED ALP

mosaic bone pattern;long boen chalk-stick fractures. Increased blood flow from increased arteriovenous shunts may cause high output heart failure. Can lead to osteogenic sarcoma.

Front 71

What are some clues that your patient might have paget's disease of the bone?

Back 71

Hat size can be increasing.

Hearing loss is common due to auditory foramen narrowing.

Increased ALP (alkaline phosphatase)

Front 72

Lab values in osteoporosis

Back 72

No increases or decreases but there is decreased bone mass on imaging / bone scans

Front 73

Lab values in osteopetrosis

Back 73

No increases or decreases but there are thickened, dense bones on imaging/ bone scans

Front 74

Lab Values in osteomalacia / rickets

Back 74

Decreased serum calcium.

Decreased serum phosphate.

No changes in ALP

Increased parathyroid hormone

Soft bones.

Front 75

Lab values in osteitis fibrosa cystica

Back 75

Increased serum calcium.

Decreased serum phosphate.

Increased alkaline phosphatase

Increased parathyroid hormone.

"Brown tumors"

Front 76

Lab values in Paget's disease

Back 76

No changes in serum calcium or phosphate.

Increased alkaline phosphatase (ALP).

No change in PTH.

Abnormal bone architecture on bone scans or imaging.

Front 77

osteomalacia / rickets

Back 77

defective mineralization / calcification of osteoid leading to soft bones.

Vit D deficiency in adults leads to decreased calcium levels and increased secretion of PTH and decreased serum phosphate.

This is reversible is Vit D is replaced.

**Vit D deficiency in childhood causes rickets.

Front 78

osteoporosis definition

Back 78

reduction of primarily trabecular (spongy) bone mass in spite of normal bone mineralization.

Front 79

Type I osteoporosis

Back 79

Postmenopausal.

Increased bone resorption due to decreased estrogen levels. Estrogen replacement is controversial as prophylaxis (side effects).

Front 80

Type 2 osteoporosis

Back 80

Senile osteoporosis--affects men and women > 70 yo

Front 81

What are people with osteoporosis at risk for?

Back 81

Vertebral crush fractures--acute back pain, loss of height, kyphosis.

Femoral neck fracture, distal radius (Colles') fractures.

Front 82

What is prophylaxis and treatment for osteoporosis?

Back 82

Prophylaxis: exercise and calcium ingestion before age 30.

Tx: estrogen and/or calcitonin; bisphosphonates or pulsatile PTH for severe cases.

Glucocorticoids are indicated.

Front 83

osteoblast source

Back 83

mesenchymal stem cells in periosteum

Front 84

Endochondral ossification

Back 84

Longitudinal bone growth

cartilaginous model of bone is first made by chondrocytes.

Osteoclasts and osteoblasts later replace with woven bone and remodel to lamellar bone.

Front 85

Membranous ossification

Back 85

flat bone growth (skull, facial bones, and axial skeleton).

Woven bone formed directly w/o cartilage. ALter remodeled to lamellar bone.

Front 86

Osteopetrosis aka marble bone disease

Back 86

Failure of normal bone resorption--thickened dense bones that are prone to fracture.
Bone defect is due to abnormal function of osteoclasts.
Decreased marrow space leads to anemia, thrombocytopenia, infection.
Genetic deficiency of carbonic anhydrase II.
X-rays show "erlenmeyer flask" bones that flare out.
Can result in cranial nerve impingement and palsies due to marrowed foramina.

Front 87

Achondroplasia

Back 87

Failure of longitudinal bone grwoth leads to short limbs. Membranous ossification is affected and leads to a large sized head.
Constituttive activation of fibroblast growth factor receptor (FGFR3) actually inhibits chondrocyte proliferation.
Normal life span and fertility

Front 88

Genetics of achondroplasia

Back 88

>85% of mutations occur sporadically and are associated with advanced paternal age, but the condition also demonstrates autosomal dominant inheritance.

Constitutive activation of fibroblast growth factor receptor (FGFR3) actually inhibits chondrocyte proliferation.