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50 Cards in this Set
- Front
- Back
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Unhappy triad
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Injury at lateral side
1. MCL 2. Medial meniscus 3. ACL (+) Drawer sign : ACL tear |
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Rotator cuff muscles
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CCW:
1. Supraspinatus (MC injured) - deltoid --> abduct arm 2. Infraspinatus - laterally rotate arm 3. Teres minor - inferior to infraspinatus; adduct + laterally rotate arm 4. Subscapularis - medially rotate and adduct arm Rotator cuff syndrome: can't lift arm above head |
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Axillary Nerve
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C5-6; wraps around humerus
Fractured surgical neck of humerus, dislocation of humeral head Can't abduct arm at shoulder Sensory loss over deltoid muscle |
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Radial Nerve
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C5-C8; lies in radial groove on humerus, the "great extensor" nerve - innervation to Brachioradialis, Extensors of wrist/fingers, Supinator, Triceps (BEST)
Fracture at midshaft of humerus Saturday night palsy Can't extend wrist, extend fingers @ MCP joints, supinate, extend or abduct thumb Sensory loss: Posterior arm, dorsal hand, dorsal thumb Sign: Wrist drop |
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Median Nerve
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C6-8, T1
B/w brachial a. + biceps brachii + brachialis B/w humeral + ulnar heads of pronator teres B/w flexor digitorum superficialis + flexor digitorum profundus Proximal lesion: Fracture of supracondylar humerus - Loss of thumb opposition - Loss of dorsal/palmar aspects of lateral 3 1/2 fingers, thenar eminence sensation - Sign: Ape hand |
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Median Nerve cont.
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Distal Lesion: Carpal Tunnel Syndrome
- Dislocated lunate - Loss of lateral finger flexion and wrist flexion - Loss of dorsal and palmar aspects of lateral 3 1/2 fingers - Sign: Pope's blessing, ulnar wrist deviation w/ wrist flexion |
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Ulnar Nerve
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C8, T1
Proximal lesion: fracture of medial epicondyle of humerus or lesioned by repetitive minor trauma - Loss of medial finger flexion and wrist flexion - Loss of medial 1 1/2 fingers, hypothenar eminence - Sign: radial deviation of wrist upon wrist flexion Distal lesion: fracture of hook of Hamate (falling on outstretched hand) - loss of abduction/adduction of fingers (interossei), adduction of thumb, 4th and 5th finger extension - Sign: Ulnar claw hand (can't straighten fingers) |
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Musculocutaneous Nerve
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C5-C7
B/w biceps brachii and coracobrachialis Upper trunk compression Loss of arm flexion at elbow (paralysis of biceps & brachialis) Loss of lateral forearm sensation |
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Erb-Duchenne palsy
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Tear of upper trunk of brachial plexus (C5-6 roots) - blow to shoulder or trauma during delivery
Paralysis of abductors - limb by side Paralysis of lateral rotators - medially rotated Pronated forearm - loss of biceps |
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Klumpke's palsy
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Embryolog/childbirth defect
C8-T1 affected Can also cause thoracic outlet syndrome - atrophy of thenar/hypothenar eminences, interosseus muscles - sensory loss on medial side of forearm/hand - move head to opp side --> disapp of radial pulse |
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Lunate dislocation
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Can also fracture scaphoid
Potential late sequelae : avascular necrosis & impingement on medial nerve |
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Long Thoracic Nerve Injury
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Paralysis of serratus anterior muscle
Signs: 1. Winged scapula 2. Failure to abduct arm higher than horizontal Due to penetrating trauma or radical masectomies |
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Anatomical Snuff Box
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Anteriorly: tendons of abd pollicis longus and extensor pollicis brevis
Posterior: tendon of extensor pollicis longus Floor: scaphoid bone and radial artery |
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Obturator nerve
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Only nerve that exits pelvis via obturator foramen
Injury: Anterior hip dislocation Loss of thigh adduction Loss of medial thigh sensation |
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Femoral Nerve
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Exits abdomen posterior to inguinal ligament
Injury: pelvic fracture Loss of thigh flexion and leg extension Loss of anterior thigh and medial leg sensation |
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Common peroneal nerve
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MC injured nerve in leg
SIGNS: FOOT DROP, HIGH STEP GAIT Injury: trauma to lateral aspect of leg or fibula neck fracture - loss of foot EVERSION & dorsiflexion, toe extension - loss of anterolateral leg and dorsal aspect of foot |
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Tibial nerve
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branch of sciatic nerve, descends thru popliteal fossa around neck of fibula
SIGN: can't stand on tiptoes Injury: knee trauma - loss of foot inversion & plantar flexion, toe flexion - loff of sole of foot sensory |
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Superior Gluteal Nerve
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SIGN: (+) Trendelenburg
Injury: Posterior hip dislocation or polio - loss of thigh abduction |
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Inferior Gluteal Nerve
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Injury: posterior hip dislocation
- can't jump, climb stairs, or rise from seated position |
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Femoral triangle
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Inguinal ligament (S)
Sartorius (lateral) Adductor longus (medial) NAVeL Femoral nerve, artery, vein, empty space, lymph nodes |
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Muscle contraction
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Dihydropyridine and ryanodine coupled receptors on SR
H & I band shortening A band ALWAYS same length |
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Type 1 muscle fibers
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SLOW twitch
Red fibers b/c inc mito and myoglobin (inc ox. phosphorylation) Sustained contraction |
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Type 2 muscle fibers
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Fast twitch
White fibers b/c dec mito and myoglobin (inc anaerobic glycolysis) Weight training --> hypertrophied fast twitch fibers |
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Skel/Cardiac muscle contraction
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Ca2+ binds to troponin C --> conf change --> tropomyosin moves out of the way --> facilitates actin/myosin cycling
Release ADP from myosin --> power stroke (displaced on actin) ATP binds to myosin --> release actin filament No ATP = rigor mortis |
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Smooth muscle contraction
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Ca2+ binds to calmodulin --> activates MLCK --> myosinP + actin --> cross bridge formation --> MLCPhosphatase --> Myosin + actin --> relaxation
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Osteopetrosis
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Marble Bone Dz
Genetic def of CAII and abn osteoclast fxn Normal Ca, PO4, alkaline phosphatase Dec marrow space --> anemia, thrombocytopenia, infection Erlenmeyer flask bones |
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Osteitis deformans
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Paget's Dz
Inc ALP Chalk stick fractures, mosaic bone Inc blood flow from inc AV shunts --> high output CHF Hearing loss is common (auditory foramen narrowing) 3 phases of dz: 1. Lytic 2. Mixed 3. Sclerotic burn out |
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Polyostotic fibrous dysplasia
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Bone replaced by fibroblasts, collagen, irreg bony trabeculae.
McCune Albright syndrome |
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Giant Cell tumor
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Osteoclastoma
epiphyseal end of long bones charac double bubble/soap bubble XR appearance spindle-shaped cells w/ multinuc giant cells |
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Avascular Necrosis
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Assoc w sickle cell dz, steroid tx (glucocorticoids), SLE, alcoholism
Acute onset of pain exacerbated by weight bearing NO swelling, erythema, or temp change Dx w MRI - usu femoral head |
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Sjogren's syndrome
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Triad:
1. Xerophthalmia 2. Xerostomia 3. Arthritis Parotid enlargement, inc B-cell lymphoma risk, dental cavities SS-A (Ro) + SS-B (La) autoAbs to ribonucleoprotein Ags |
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Gout v Pseudogout
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Gout:
- parallel to light = yellow crystals - perp to light = blue Pseudogout: - parallel to light = blue - perp to light = yellow |
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Fibromyalgia
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F, 20-50y
Chronic widespread MSK pain exacerbated by exercise Sx's: multiple symmetrically distrib tender spots on pt muscles, joints, tendons on scapula, lateral epicondyle, fat pad of knee Req for dx: tenderness in 11/18 predet. joints |
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Ganglion cyst
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Arises in CT of joint/capsule sheath
Extensor surfaces of hands/feet Focal myxoid degen of CT --> cystic space |
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Sarcoidosis
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GRAIN"
Gammaglobulinemias Rheum arthritis ACE increase Interstitial fibrosis Noncaseating granulomas --> elevated VitD --> hypercalcemia |
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Polymyositis/Dermatomyositis
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Poly: CD8+ T cell induced injury to myofibers!
In both: (+) ANA, anti-Jo-1 |
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Mixed Connective Tissue Dz
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Antibodies to U1RNP
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Scleroderma
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Inc collagen deposition in tissues
CD4 accumulation in skin + tissues --> stim fibroblasts to produce collagen 2 types: 1. Diffuse - antiScl70 Ab (antiDNA topo I Ab) 2. CREST syndrome - Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telengiectasia; assoc w/ pulm HTN; anticentricomereAb |
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Malignant Fibrous Histiocytoma
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MC type of post-irradiation soft tissue sarcoma
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Derm lesions
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1. Macule - flat <1cm discoloration
2. Patch - macule > 1 cm 3. Papule - elevated skin lesion <1cm 4. Plaque - papule >1cm |
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Derm lesions
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Hyperkeratosis - inc. thickness of stratum corneum
Parakeratosis - hyperkeratosis with retention of nuclei in stratum corneum Acantholysis - separation of epidermal cells |
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Keratosis
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Seborrehic keratosis - looks "pasted on". BENIGN
Actinic keratosis - precursor to SqCC |
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Vitiligo
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Irreg areas of complete depigmentation caused by dec in melanocytes
Melasma - HYPERpigmentation assoc w/ PG |
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Blistering Disorders
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Pemphigius vulgaris - IgG antibody against desmosome w/ + Nikolsky sign; oral mucosa affected
Bullous pemphigiod - IgG antibody against hemidesmisome; eosinophils; (-) Nikolsky sign; eosinophils |
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Lichen Planus
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Pruritic Purple Polygonal Papules
Lymphocytic infiltrate at dermal-epidermal junction. Assoc w/ HepC |
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Verruca Vulgaris
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HPV warts
NOT malignant |
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Superficial fibromatosis
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Dupuytren contracture
Lesions contain mature fibroblasts surrounded by dense collagen Unlikely to be malignant |
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Arach Acid products
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Lipoxygenase yields Leukotriennes
LTB4 = neutrophil chemotactic agent "neutrophils arrive B4 others" LCT4, D4, E4 = bronchoconstriction, vasoconstriction, smooth m contraction, inc vascular permeability PGI2 inhibits platelet aggreg + prom vasodilation |
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Samters Triad
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10% asthmatics treated w/ aspirin
1. Asthma 2. Aspirin hypersensitivity 3. Nasal polyps All due to overproduction of leukotriennes when aspirin blocks COX pathways --> AA metabolites diverted into lipoxyg. pathways |
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Acute gouty arthritis
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1st line tx: NSAIDS
2nd: Colchicine 3rd: Glucocorticoids |
