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Musculoskeletal > Anatomy & Physiology > Flashcards

Anatomy & Physiology Flashcards

1
Q

“Unhappy triad” of knee injuries

A

Contact sports - lateral force (so toward medial) applied to planted leg –> MCL, ACL, medial meniscal injury

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2
Q

“Housemaid’s knee”

A

prepatellar bursitis (from repeated trauma or pressure)

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3
Q

Baker cyst

A

popliteal fluid collection, esp with chronic joint dz

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4
Q

Rotator cuff mm

A

Supraspinatus (abduct arm until delt takes over) - empty/full can test; commonly injured

Infraspinatus (lateral rotation) - pitching injury

Teres minor (adduct and laterally rotate)

Subscapularis (adduct and medially rotate)

All innervated by C5-C6

A

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5
Q

Golfer’s vs. tennis elbow

A

Golfer’s = medial epicondylitis (from repetitive flexion)

Tennis = lateral epicondylitis (repetitive extension)

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6
Q

Wrist bones

A

“So Long To Pinky, Here Comes The Thumb”

Scaphoid (most commonly fractured, prone to avasc necrosis)

Lunate (disloc –> acute carpal tunnel)

Triquetrum

Pisiform

Hamate (fall on outstretched hand –> injury, can injure ulnar n)

Capitate

Trapezoid

Trapezium

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7
Q

Carpal tunnel synd

A

Entrapment of medial nerve –> paresthesia, pain, numbness

assoc with preg, RA, hypothyroid, repetitive use

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8
Q

Guyon canal synd

A

Compression of ulnar n. at wrist or hand

esp in cyclists

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9
Q

Axillary nerve - spinal level, causes of injury + injury presentation

A

C5-C6

Superior Humerus injury

Presentation: delt problems (can’t abduct past 15deg) + loss of sensation over delt

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10
Q

Musculocutaneous n. - spinal level, causes of injury + injury presentation

A

C5-C7

Upper trunk compression

Can’t flex or supinate forearm; can’t feel lateral forearm

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11
Q

Radial n. - spinal level, causes of injury + injury presentation

A

C5-T1

Midshaft humerus fracture or axilla compression (eg crutches)

Wrist drop (loss of extension), lost sensation on dorsal hand

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12
Q

Median n. - spinal level, causes of injury + injury presentation

A

C5-T1

carpal tunnel, wrist laceration, supracondylar humerus fracture

can’t flex lateral (thumb + 2.5) fingers or wrist (Pope’s blessing/ulnar claw)

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13
Q

Ulnar n. - spinal level, causes of injury + injury presentation

A

C8-T1

Fracture funny bone or hook of hamate

Lose wrist and medial finger flexion, abd/add of fingers, 2 medial lumbricals (which extend DIP and PIP) + loss of sensation over medial 2.5 fingers

so get ulnar claw when try to extend all fingers - extended MCP, flexed DIP and PIP in two medial fingers

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14
Q

McMurray test

A

rotate knee with pt supine - if pain on ext rot, suggests medial meniscal tear

if pain on int rotation, suggests lateral meniscal tear

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15
Q

Recurrent branch of median n. - spinal level, causes of injury + injury presentation

A

C5-T1

Superficial laceration of palm

“Ape hand” - can’t move thumb b/c lose thenar mm.

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16
Q

Erb palsy

A

aka “waiter’s tip”

tear of upper trunk (C5-C6 roots)

so get delt, supraspinatus (no abd), infraspinatus (no lat rotation), and biceps (no flexion or supination) injury

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17
Q

Klumpke palsy

A

Tear of lower brachial plexus trunk (C8-T1 roots)

lose intrinsic hand muscles, so total claw hand

sim sx with Thoracic Outlet syndrome (compression of lower trunk and subclavian vv)

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18
Q

Cause and sx of Thoracic outlet synd

A

Compression of lower trunk of brachial plexus + subclavian vv from cervical rib or Pancoast tumor

Claw hand as in Klumpke palsy from atrophy of intrinsic hand mm

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19
Q

Winged scapula

A

Lesion of long thoracic nerve –> serratus anterior dysfxn and can’t anchor scapula to thoracic cage, so can’t abduct above horizontal

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20
Q

Thenar eminence - fxn + innervation

A

thumb muscles (opponens, abductor, flexor pollicis brevis) - innervated by median n.

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21
Q

Hypothenar eminence (fxn + innervation)

A

pinky - opponens, abductor, flexor; ulnar n.

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22
Q

___ abduct the fingers

____ adduct the fingers

A

dorsal interossei abduct
palmar interossei adduct

DAB; PAD

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23
Q

Obturator n. - spinal level, causes of injury + injury presentation

A

L2-L4

pelvic surgery

decreased thigh sensation and adduction

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24
Q

Femoral n. - spinal level, causes of injury + injury presentation

A

L2-L4

pelvic fracture

decreased thigh flexion and leg ext

25
Q

Common peroneal n. - spinal level, causes of injury + injury presentation

A

L4-S2

trauma or compression of lateral leg, fibular neck fracture

Loss of eversion and dorsiflexion (foot drop - inverted and plantarflexed) + lose sensation on dorsum of foot

“PED” - peroneal everts and dorsiflexes (injury –> foot dropPED)

26
Q

tibial n. - spinal level, causes of injury + injury presentation

A

L4-S3

Knee stuff (eg baker cyst) + tarsal tunnel synd

TIP (Tibial Inverts and Plantarflexes); if injured, can’t stand on TIPtoes (i.e., can’t curl toes or plantarflex, can’t feel sole

27
Q

Superior gluteal n. - spinal level, causes of injury + injury presentation

A

L4-S1

IM injection

Trendelenburg sign (pelvis sags on side opposite lesioned nerve)

28
Q

Inferior gluteal n. - spinal level, causes of injury + injury presentation

A

L5-S2

Posterior hip dislocation

Hard to extend hip (climbing stairs, getting up from chair)

29
Q

Sciatic nerve splits into __ and ___

A

common peroneal and tibial

L4-S3

30
Q

Signs of lumbosacral radiculopathy at:

L3-L4
L4-L5
L5-S1

A

L3-L4: weak knee extension

L4-L5: weak dorsiflexion

L5-S1: weak plantarflexion (decreased Achilles reflex)

nerve affected is usually associated with inferior vertebral body that’s affected

31
Q

Type 1 vs. Type 2 muscle

A

Type 1 - slow twitch, red fibers, sustained contraction

Type 2 - fast twitch, white fibers (hypertrophy with weight training)

32
Q

Sarcomere contraction - which bands shrink?

A

H (just myosin) and I (just actin) bands get narrower; A band stays same length

33
Q

Myosin - ATP/ADP relationship

A

Myosin releases ADP and Pi to yield energy for contraction

Myosin binds new ATP and hydrolyzes it to return to high energy waiting state, storing energy for next contraction

34
Q

Smooth muscle relaxation induced by ___

A

NO

Increases GC, which turns GTP into cGMP –> increased myosin-light-chain-phosphatase –> pulls P off of myosin –> relaxation

35
Q

Smooth muscle contraction induced by ___

A

Ca++

Binds calmodulin and increases conc of myosin-light-chain kinase, which adds P to myosin –> cross bridging and contraction

36
Q

Endochondral vs. membranous ossification

A

Endochondral: cartilage –> woven bone –> lamellar bone

Membranous: woven –> lamellar bone

37
Q

Sites of membranous ossification

A

Calvarium and facial bone

spared in achondroplasia, which is why head is disproportionately large relative to rest of body

38
Q

Physio mech of achondroplasia

A

Constitutive activation of FGFR3 inhibits chondrocyte prolif

Usually sporadic mut

39
Q

T-score for primary osteoporosis

A
40
Q

Osteopetrosis pathophys

A

Osteoclasts can’t generate acidic env –> decreased bone resorption –> thick, dense bone prone to fracture

Also bone in marrow, so pancytopenia and extramedullary hematopoiesis

tx: marrow transplant

41
Q

Paget disease

A

Localized bone disorder with increased OB and OC activity

Hat size increased

Stages = lytic (OC), mixed (OC + OB), sclerotic (OB –> disorganized new bone), quiescent

Increased ALP but serum Ca, phos, and PTH are all normal

42
Q

Benign bone tumors

A

Giant cell tumor (20-40yo, OCs, soap-bubble appearance usu in epiphyses of long bones)

Osteochondroma (common, young boys, little outgrowth of mature bown with cartilage cap)

43
Q

Osteosarcoma

A

10-20yo (1ary), >65yo (2ary)

Risk fx: Paget, bone infarcts, radn, Rb, Li-Fraumeni

metaphyses of long bones

Xray: Codman triangle + sunburst pattern

tx: surgical resection + chemo

44
Q

Codman triangle

A

X ray evidence of lifting of periosteum

45
Q

Xray - sunburst pattern

A

mixed lytic-sclerotic response to tumor

OSTEOSARCOMA

46
Q

Onion skin periosteal reaction to tumor on Xray

A

EWING SARCOMA

vs. sunburst = osteosarcoma

47
Q

Ewing sarcoma

A

Young boys

in diaphysis of long bones

Small blue cell, very aggressive but responsive to chemo

t(11;22)

48
Q

Joint findings in OA

A

subchondral cysts, sclerosis and joint narrowing, osteophytes (spurs), eburnation (polished bone), synovitis, Heberden nodes at DIP, Bouchard nodes at PIP

NO MCP INVOLVEMENT

49
Q

Joint findings in RA

A

Pannus (granulation tissue in MCP, PIP), subcut rheumatoid nodules (fibrinoid necrosis), ulnar deviation of fingers, subluxation, swan neck and boutonniere deformities

NO DIP INVOLVEMENT

50
Q

Key differences between RA and OA

A

OA - pain improves with rest
RA - pain improves with use (worst in AM)

OA - no systemic sx; RA - yes

RA = inflammatory (HLA-DR4 association, 80% RF positive, though anti-cyclic citrullinated peptide Ab is more specific; treat with glucocorticoids)

51
Q

Sjogren syndrome

A

Autoimmune destruction of exocrine glands, esp lacrimal and salivary

Females 40-60yo

Usu ANA+

May –> MALT lymphoma

52
Q

Gout

A

Acute inflamm monoarthritis from precip of monosodium urate crystals in joints

Usu from underexcretion of uric acid (usu idiopathic, may be exacerbated by diuretics, alcohol consumption etc)

Can be from overprodn of uric acid (Lesch-Nyhan, PRPP excess, tumor lysis syndrome, von Gierke

53
Q

Podagra

A

Gout in MTP joint of big toe

Classic presentation

54
Q

Locations of gout tophi

A

External ear, olecranon process, achilles tendon

55
Q

Acute vs. chronic gout drugs

A

Acute: NSAIDs, glucocorticoids, colchicine

Chronic: XO inhib

56
Q

How to differentiate gout from pseudogout

A

Pseudogout crystals = calcium pyrophosphate (basophilic and rhomboid) that are positively birefringent, so blue when parallel to light

Gout crystals = negatively birefringent, so yellow when parallel to light

57
Q

Infectious arthritis causes

A

S. aureus, Streptococcus, N. gonorrhea (migratory)

58
Q

Seronegative spondyloarthropathies

A

No RF, HLA-B27 (MHC class I)

PAIR

Psoriatic arthritis - dactylitis (sausage fingers) + pencil in cup deformity on xray

Ankylosing spondylitis - spine + sacroiliac joints - stiffness and fusion + uveitis and aortic regurg (bamboo spine)

Reactive arthritis/Reiter syndrome (post GI or chlamydia infxn) - can’t see, pee, or climb a tree (conjunctivitis, urethritis, arthritis)

Musculoskeletal (4 decks)

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