Musculoskeletal - First Aid

Front 1

The injury called the "unholy triad"

Back 1

damage to:
- MCL
- medial meniscus
- ACL

Front 2

Positive anterior drawer sign indicates...

Back 2

torn ACL

Front 3

abnormal passive abduction indicates...

Back 3

torn MCL

Front 4

Shoulder muscles that form rotator cuff and their functions

Back 4

Supraspinatus - ABducts arm (helps deltoid)
Infraspinatus - laterally rotates arm
Teres minor - adducts and laterally rotates arm
Subscapularis - medially rotates and adducts arm

Front 5

Common injury: upper trunk

Back 5

lesioned by trauma

Front 6

common injury: C7 root

Back 6

compressed by cervical disc lesion

Front 7

common injuries (3): axillary nerve

Back 7

lesioned by
- fracture of surgical neck of humerus
- dislocation of humerus
- intramuscular injections

Front 8

common injuries (2): lower trunk of brachial plexus

Back 8

compressed by cervical rib
or by Pancoast tumor of lung

Front 9

common injury: radial nerve in spiral groove

Back 9

lesioned by midshaft fracture of humerus

Front 10

common injury: radial nerve on medial arm

Back 10

compressed in axilla by improper use of crutches

Front 11

common injury: radial nerve (deep branch)

Back 11

stretched by subluxation of the radius

Front 12

common injury: median nerve

Back 12

compressed by supracondylar fracture of humerus:
pronator teres syndrome

Front 13

common injury: ulnar nerve

Back 13

lesioned by repeated minor trauma,
fracture of medial epicondyle of humerus

Front 14

common injury: anterior interosseous nerve

Back 14

compressed in deep forearm

Front 15

common injury: recurrent branch of median nerve

Back 15

lesioned by superficial laceration to thenar eminence

Front 16

common injury: ulnar nerve in hand

Back 16

lesioned by trauma to hypothenar eminence
fracture to hook of hamate

Front 17

Brachial plexus lesions:

Waiter's tip (Erb's palsy)

Back 17

lesion to upper trunk (C5, C6)

Front 18

Brachial plexus lesions:

total claw hand (Klumpke's palsy)

Back 18

lesion to lower trunk (C8, T1)

Front 19

Brachial plexus lesions:

wrist drop

Back 19

lesion to posterior cord (C7)

Front 20

Brachial plexus lesions:

winged scapula

Back 20

long thoracic nerve

Front 21

Brachial plexus lesions:

deltoid paralysis

Back 21

axillary nerve lesion (C7)

Front 22

Brachial plexus lesions:

Saturday night palsy (wrist drop)

Back 22

radial nerve lesion (C7)

Front 23

Brachial plexus lesions:

difficulty flexing elbow,
variable sensory loss

Back 23

musculocutaneous nerve (C5, C6)

Front 24

Brachial plexus lesions:

decreased thumb function ("ape hand"), "Pope's blessing"

Back 24

median nerve (C5, C6, C8, T1)

Front 25

Brachial plexus lesions:

intrinsic muscles of hand,
claw hand

Back 25

ulnar nerve (C8, T1)

Front 26

Etiology & appearance: Erb-Duchenne Palsy

Back 26

Traction or tear of upper trunk (C5, C6)
follows blow to shoulder or perinatal trauma

findings:
- paralysis of abductors
- paralysis of lateral rotators (constant medial rotation)
- loss of biceps (forearm pronated)

Front 27

Klumpke's palsy

Back 27

embryologic or perinatal defect affecting inferior trunk (C8, T1)
cervical rib compresses subclavian artery & inferior turnk, resulting in
THORACIC OUTLET SYNDROME

Front 28

Thoracic Outlet Syndrome - findings

Back 28

atrophy of thenar and hypothenar eminences
atrophy of interosseus muscles
sensory deficits on medial side of forearm and hand
disappearance of radial pulse upon moving head toward opposite side

Front 29

Distortions of the hand involve which muscle group?

Back 29

Lumbricals - flex MCP and extend DIP/PIP

Front 30

Ulnar claw

Back 30

distal ulnar nerve lesion -->
loss of medial lumbrical function
4th & 5th digits are clawed "Pope's blessing"

Front 31

Median claw

Back 31

Distal median nerve lesion
loss of lateral lumbrical function
2nd & 3rd digits clawed

Front 32

"Ape hand"

Back 32

proximal median nerve lesion
loss of opponens pollicis muscle function
unopposable thumb (inability to abduct thumb)

Front 33

Klumpke's total claw

Back 33

Lesion of lower trunk (C8, T1)
loss of function of all lumbricals;

forearm finger flexors (C5-C7) & finger extensors (radial n) unopposed -->

clawing of all digits

Front 34

"Great extensor nerve"

Back 34

radial nerve

Front 35

Radial nerve innervates which four muscles:

Back 35

BEST!

Brachioradialis
Extensors of wrist and fingers
Supinator
Triceps

Front 36

Muscles of Thenar eminence

Back 36

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

Front 37

Muscles of Hypothenar eminence

Back 37

Opponens digitis minimi
Abductor digiti minimi
Flexor digiti minimi

Front 38

Function: dorsal interosseious muscles

Back 38

abduct the fingers

Front 39

Function: palmar interosseous muscles

Back 39

adduct fingers

Front 40

Function: lumbrical muscles

Back 40

flex at MP joint

Front 41

Repetitive elbow trauma

Back 41

degenerative injury due to repeated use
leads to tiny tears in tendons in muscles
may be inflammatory,
e.g.: lateral epicondylitis (tennis elbow)
medial epicondylitis (golf elbow)

Front 42

Lateral epicondylitis

Back 42

tennis elbow

Front 43

medial epicondylitis

Back 43

golf elbow

Front 44

Nerve: obdurator
Cause of injury:
Motor deficit:
Sensory deficit

Back 44

Nerve: Obdurator
Cause of injury: anterior hip dislocation
Motor deficit: thigh adduction
Sensory deficit: medial thigh

Front 45

Nerve: femoral
Cause of injury:
Motor deficit:
Sensory deficit:

Back 45

Nerve: femoral
Cause of injury: pelvic fracture
Motor deficit: thigh flexion, leg extension
Sensory deficit: anterior thigh & medial leg

Front 46

Nerve: common peroneal
Cause of injury:
Motor deficit:
Sensory deficit:

Back 46

Nerve: common peroneal
Cause of injury: trauma to lateral aspect of leg or fibular neck fracture
Motor deficit: foot eversion, dorsiflexion; toe extension
Sensory deficit: anterolateral leg, dorsal foot

Front 47

Nerve: tibial
Cause of injury:
Motor deficit:
Sensory deficit:

Back 47

Nerve: tibial
Cause of injury: knee trauma
Motor deficit: foot inversion, plantarfelxion, toe flexion
Sensory deficit: sole of foot

Front 48

Nerve: inferior gluteal
Cause of injury:
Motor deficit:
Sensory deficit:

Back 48

Nerve: inferior gluteal
Cause of injury: posterior hip dislocation
Motor deficit: can't jump, climb stairs, rise from seated position
Sensory deficit: none

Front 49

Muscle contraction

Back 49

review First Aid pages 356 - 7

Front 50

Endochondral ossification

Back 50

longitudinal bone growth
cartilaginous model from chondrocytes
osteocasts & osteoblasts replace with woven bone, remodel to lamellar bone

Front 51

Membranous ossification

Back 51

flat bone growth (skull, facial bones, axial skeleton)
woven bone formed directly without cartilage
later remodelled to lamellar bone

Front 52

Osteoporosis
- sequellae
- prophylaxis
- treatment

Back 52

Osteoporosis
Sequellae:
- vertebral crush fractures (acute back pain, loss of height, kyphosis)
- distal radius (Colles') fractures
- vertebral wedge fractures

Prophylaxis:
- exercise
- dietary calcium before age 30

Treatment:
- estrogen &/or calcitonin
- biphosphonates or pulsatile PTH for severe cases

Front 53

Osteopetrosis
- etiology
- lab values
- sequellae
- radiography

Back 53

Osteopetrosis
Etiology:
- failure normal osteoclastic bone resorption --> thickened, dense bones
- genetic deficiency carbonic anhydrase II

Lab values:
- Ca2+, PO4(3-), Alk. Phos. = NORMAL

Sequellae:
- decreased marrow space leads to anemia, thrombocytopenia, infection
- flared bones can case CN impingement, palsies 2* narrowed foramina

Xrays show "Erlenmeyer flask" bones that flare out

Front 54

Osteomalacia

Back 54

Soft bones 2* defective mineralization/calcification of osteoid

Vitamin D deficiency in adults -->
decreased calcium levels -->
increased PTH secretion & decreased serum phosphate

reversible when vitamin D is replaced

Front 55

RIckets

Back 55

Vitamin D deficiency in childhood

Front 56

Osteitis fibrosa cystica
- histology
- serum levels (Ca, P, ALP)

Back 56

caused by hyperparathyroidism
characterized by "brown tumors"
- cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood

Serum levels:
- high calcium,
- low phosphorus,
- high ALP

Front 57

Paget's disease (osteitis deformans)

Back 57

abnormal bone architecture caused by increased in both osteoblastic and osteoclastic activity

possibly viral in origin (paramyxovirus?)

Serum, Ca, P, PTH levels normal

Increased ALP

Mosaic bone pattern
Long bone chalk-stick fractures
Increased blood flow from increased AV shunts may cause high-output CHF

Can lead to osteogenic sarcoma

Front 58

Osteoporosis:
Serum Ca2+:
Phophate:
ALP:
PTH:
Other:

Back 58

Osteoporosis
Serum Ca2+: normal
Phophate: normal
ALP: normal
PTH: normal
Other: decreased bone mass

Front 59

Osteopetrosis:
Serum Ca2+:
Phophate:
ALP:
PTH:
Other:

Back 59

Osteopetrosis:
Serum Ca2+: normal
Phophate: normal
ALP: normal
PTH: normal
Other: thickened, dense bones

Front 60

Osteomalacia/rickets
Serum Ca2+:
Phophate:
ALP:
PTH:
Other:

Back 60

Osteomalacia/rickets:
Serum Ca2+: decreased
Phophate: decreased
ALP: normal
PTH: increased
Other: soft bones

Front 61

Osteitis fibrosa cystica:
Serum Ca2+:
Phophate:
ALP:
PTH:
Other:

Back 61

Osteitis fibrosa cystica:
Serum Ca2+: increased
Phophate: decreased
ALP: increased
PTH: increased
Other: "brown tumors"

Front 62

Paget's disease
Serum Ca2+:
Phophate:
ALP:
PTH:
Other:

Back 62

Paget's disease
Serum Ca2+: normal
Phophate: normal
ALP: increased
PTH: normal
Other: abnormal bone architecture

Front 63

Polyostotic fibrous dysplasia

Back 63

bone replaced by fibroblasts, collagen, irregular bony trabeculae
affects many bones

variation: Mc-Cune Albright syndrome

Front 64

McCune Albright syndrome

Back 64

form of polyostotic fibrous dysplasia
multiple unilateral bone lesion
endocrine abnormalities (precocious puberty)
unilateral pigemented skin lesions (café-au-lait spots)

Front 65

Osteoma

Back 65

Benign bone tumor
associated with Gardner's syndrome (FAP)
new piece of bone grows on another bone, often in skull

Front 66

Osteoid osteoma

Back 66

Benign bone tumor
interlacing trabeculae of woven bone
surrounded by osteobasts
< 2 cm
proximal tibial & femur
most common in men < 25 y/o

Front 67

Osteoblastoma

Back 67

same morphologically as osteoid osteoma,
but larger and found in vertebral column

Front 68

Giant cell tumor

Back 68

occurs moly at epiphyseal end of long bones
peak incidence 20-40 y.o
locally aggressive
often in distal femur, proximal tibia
characteristic "double bubble" or "soap bubble" appearance on x-ray
spindle-shaped cells with multinucleated giant cells

Front 69

Osteochondroma

Back 69

most common benign bone tumor
mature bone with cartilaginous cap
usually in men < 25 y/o
commonly originates from long metaphysis

Front 70

Endochondroma

Back 70

benign cartilaginous neoplasm
intramedullary bone
usually distal extremities (vs. chondromsarcoma)

Front 71

Osteosarcoma

Back 71

Malignant bone tumor
2nd most common 1* malignant tumor of bone
peak incidence: men 10-20 y/o
commonly found in metaphysis of long bones, around knee

Codman's triangle (sunburst pattern from elevation of periosteum) on xray
predisposing factors:
- Paget's
- bone infarcts
- radiation
- familial retinoblastoma

Poor prognosis

Front 72

Ewing's sarcoma

Back 72

Anaplastic small blue cell malignant tumor
most common in boys < 15 y/o
extremely aggressive with early metastases
responsive to chemo
characteristic onion-skin appearance in bone
commonly in diaphysis of long bones, pelvis, scapula, ribs
11;22 translocation

Front 73

Chondrosarcoma

Back 73

malignant cartilaginous tumor
most common in men 30-60 y.o
usually in pelvis, spine, scapula, humerus, tibia, femus
expansile glistening mass in medullary cavity

Front 74

Primary bone tumor: epiphysis

Back 74

Benign: giant cell tumor (osteoclastoma)
Malignant: N/A

Front 75

Primary bone tumor: metaphysis

Back 75

Benign: osteochondroma
Malignant: osteosarcoma

Front 76

Primary bone tumor: diaphysis

Back 76

Benign: osteoid osteoma
Malignant: Ewing's sarcoma

Front 77

Primary bone tumor: intramedullary

Back 77

Benign: enchondroma
Malignant: chondrosarcoma

Front 78

Osteoarthritis

Back 78

review p. 361

Front 79

RA

Back 79

review p. 362

Front 80

Sjorgren's syndrome:
Classic triad -
Other symptoms -
Epidemiology -

Back 80

Sjorgren's syndrome
Classic triad -
(1) xerophthalmia (dry eyes, conjunctivitis, "sand in my eyes")
(2) xerostomia (dry mouth, dyphagia)
(3) arthritis

Other symptoms:
- parotid enlargement
- increased risk B cell lymphoma
- dental caries
- autoantibodies to ribonucleoprotein antigens (SS-A (Ro), SS-B (La))

usu. in females 40-60 y.o
associated with RA

Front 81

Sicca syndrome

Back 81

like Sjorgren's, but without arthritis:

dry eyes, dry mouth, anal and vaginal dryness, chronic bronchitis, reflex esophagitis

Front 82

gout & pseudogout

Back 82

review p. 363

Front 83

Infectious arthrtis: septic

Back 83

S. aureus, Streptococcus, N. gonorrhoeae

affected joint is swollen, red, painful

Front 84

Gonococcal arthritis

Back 84

presents as monoarticular, migratory arthritis with asymmetrical pattern

Front 85

Infectious arthritis: chronic

Back 85

TB
Lyme disease

Front 86

Seronegative spondyloarthropathies

Back 86

review p. 364

Front 87

SLE

Back 87

review p. 364

Front 88

Polymyositis/dermatomyositis: symptoms of polymyositis

Back 88

progressive symmetric proximal muscle weakness
caused by CD8+ T cell induced injury to myofibers
most often involves shoulders
mucle biopsy with evidence of inflammation is diagnostic

Front 89

Polymyositis/dermatomyositis: symptoms of dermatomyositis

Back 89

similar to polymyositis
also invovles malar rash, heliotrope rash, shawl & face rash, Gottron's papules
increased risk malignancy

Front 90

Polymyositis/dermatomyositis: lab findings (both)

Back 90

increased CK
increased aldolase
(+) ANA
(+) anti-Jo-I

Front 91

Polymyositis/dermatomyositis: treatments

Back 91

steroids

Front 92

NMJ diseases (2)

Back 92

Myasthenia gravis
Lambert-Eaton syndrome

Front 93

Myasthenia gravis

Back 93

most common NMJ disorder
AutoAbs to postsynamptic AChR
ptosis, diplopia, general weakness
associated with thymoma
symptoms worsen with muscle use
reversal of symptoms with AChE inhibitors

Front 94

Lambert-Eaton syndrome

Back 94

Autoantibodies to presynaptic Ca2+ channel results in decreased ACh release
--> proximal muscle weakness
associated with paraneoplastic diseases (e.g.: small cell lung CA)
symptoms improve with msucle use
no reversal of symptoms with AChE inhibitors alone

Front 95

sarcoidosis

Back 95

review. p. 365

Front 96

polymyalgia rhematica

Back 96

rev. p. 365

Front 97

mixed CT ds

Back 97

rev. -. 365

Front 98

Scleroderma: general

Back 98

aka: progressive systemic sclerosis (PSS)
excessive fibrosis and colalgen deposition througout body
commonly sclerosis of skin
manifests as puffy and taught w/ absence of wrinkles
also sclerosis of renal, pulmonary, CV, GI systems
75% female

Front 99

Scleroderma: diffuse scleroderma

Back 99

widespread skin involvement,
rapid progression
early visceral involvement
associated with Anti-Scl-70 Ab (antiDNA topoisomerase I Ab)

Front 100

Scleroderma: CREST syndrome

Back 100

Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Limited skin involvement, oft. confined to fingers & face
more benign clinical course
assicated with antiCentrimere antibody

Front 101

Aspirin: mechanism

Back 101

irreversibly inhibits COX by covalent binding
--> decreased synthesis of TX & PG

Front 102

Aspirin: clinical use

Back 102

low dose (> 300 mg/day) decreases platelet aggregation

intermediate dose (300-2400 mg/day): antipyretic & analgesic

high dose (2400-4000 mg/day): anti-inflammatory

Front 103

NSAIDs: names

Back 103

ibuprofen
naproxen
indomethacin
ketorlac

Front 104

NSAIDs: mechanism

Back 104

reversibly inhibit COX
block PG synthesis

Front 105

NSAIDs: clinical use

Back 105

antipyretic
analgesic
anti-inflammatory

Front 106

Aspirin: toxicity

Back 106

gastric upset
chronic use can lead to
- acute renal failure
- interstitial nephritis
- upper GI bleeds

Reye's syndrome in children with viral infection

Front 107

NSAIDs: toxicity

Back 107

renal damage
aplastic anemia
GI distress
ulcers

Front 108

COX-2 inhibitors: names

Back 108

celecoxib

Front 109

COX-2 inhibitors: mechanism

Back 109

reversilby inhibit COX-2 (spares COX-1)
COX-2 found in inflammatory cells, vascular endothelium

Front 110

COX-2 inhibitors: clinical use

Back 110

RA
OA

Front 111

COX-2 inhibitors: toxicity

Back 111

increased risk thrombosis
sulfa allergy

Front 112

acetaminophen: mechanism

Back 112

reversibly inhibits COX, mostly in CNS
inactivated peripherally

Front 113

acetaminophen: clinical use

Back 113

antipyretic
analgesic
lacks anti-inflammatory properties
used instead of ASA in children

Front 114

acetaminophen: : toxicity

Back 114

overdose --> hepatic necrosis
- acetaminophen metabolite depletes glutathione, forms toxic tissue adducts in liver

N-actetylcystein is antidote - regenerates glutathione

Front 115

Bisphosphonates: names

Back 115

etidronate
pamidronate
alendronate
risedronate

Front 116

Bisphosphonates: mechanism

Back 116

inhibit osteoCLASTIC activity
reduce both formation & resorption of hydroxyapatite

Front 117

Bisphosphonates: clinical use

Back 117

malignancy-associated hypercalcemia
Paget's disease of bone
post-menopausal osteoporosis

Front 118

Bisphosphonates: toxicity

Back 118

corrosive esophagitis
nausea
diarrhea

Front 119

Colchicine: mechanism

Back 119

depolymerizes microtubules,
impariing WBC chemotaxis & degranulation

Front 120

Colchicine: clinical use

Back 120

chronic gout

Front 121

Colchicine: toxicity

Back 121

GI effects, esp. if given orally
(N.B.: indomethacin is less toxic, used in acute gout)

Front 122

Probenecid: mechanism

Back 122

inhibits reabsorption of uric acid in PCT (proximal tubule)

Front 123

Probenecid: clinical use

Back 123

chronic gout

Front 124

Probenecid: toxcity

Back 124

inhibits secretion of penicillin

Front 125

Allopurinol: mechanism

Back 125

inhibits xanthine oxidase
decreased conversion of xanthine to uric acid
increases concentration of azathrioprine & 6-MP (usu. metabolized by xanthine oxidase)

Front 126

Bisphosphonates: mechanism

Back 126

inhibit osteoCLASTIC activity
reduce both formation & resorption of hydroxyapatite

Front 127

Bisphosphonates: clinical use

Back 127

malignancy-associated hypercalcemia
Page's disease of bone
post-menopausal osteoporosis

Front 128

Bisphosphonates: toxicity

Back 128

corrosive esophagitis
nausea
diarrhea

Front 129

Colchicine: mechanism

Back 129

depolymerizes microtubules,
impariing WBC chemotaxis & degranulation

Front 130

Colchicine: clinical use

Back 130

chronic gout

Front 131

Colchicine: toxicity

Back 131

GI effects, esp. if given orally
(N.B.: indomethacin is less toxic, used in acute gout)

Front 132

Probenecid: mechanism

Back 132

inhibits reabsorption of uric acid in PCT (proximal tubule)

Front 133

Probenecid: clinical use

Back 133

chronic gout

Front 134

Probenecid: toxcity

Back 134

inhibits secretion of penicillin

Front 135

Allopurinol: mechanism

Back 135

inhibits xanthine oxidase
decreased conversion of xanthine to uric acid
increases concentration of azathrioprine & 6-MP (usu. metabolized by xanthine oxidase)

Front 136

Allopurinol: clinical use

Back 136

chronic gout
prevention of urate nephropathy 2* tumor lysis syndrome

Front 137

2 drugs NOT to use in acute gout

Back 137

allopurinol
probenecid

Front 138

Drug class NOT to give for gout, ever

Back 138

salicylates
all but the highest doses depress uric acid clearance

Front 139

Etanercept: mechanism

Back 139

recombinant form of human TNF receptor that binds TNF

Front 140

Etanercept: clinical use

Back 140

RA
psoriasis
ankylosing spondylitis

Front 141

Infliximab: mechanism

Back 141

Anti-TNF antibody

Front 142

Infliximab: clinical use

Back 142

Chrohn's disease
RA
ankylosing spondylitis

Front 143

Infliximab: toxicity

Back 143

predisposes to infection (reactivation of latent TB)

Front 144

Nerve: superior gluteal
Cause of injury:
Motor deficit:
Sensory deficit

Back 144

Nerve: superior gluteal
Cause of injury: posterior hip dislocation or polio
Motor deficit:thigh abduction [(+) Trendelenburg sign]
Sensory deficit: none