FA Flashcards
1
Q
Knee exams - tests?
A
- Anterior drawer sign
- Posterior drawer sign
- Abnormal passive abduction
- Abnormal passive adduction
- McMurray test
- Lachman sign
2
Q
common knee conditions
A
- Unhappy triad
- Prepatellar bursitis
- Baker cyst
3
Q
Baker cyst?
A
popliteal fluid collection in gastrocnemius-semimembranosus bursa commonly communicating with synovial space and related to chronic joint disease
4
Q
prepateral bursitis is also called / definition / caused by
A
Housemaid’s Knee
inflammation of Knee’s largest sac of synovial fluid
caused by : 1. repeated trauma
2. pressure from extensive kneeling
5
Q
Unhappy triad - problem?
A
classically consists of damage to
- anterior cruciate ligament
- Medial collateral ligament
- medial meniscus
6
Q
rotator cuff muscles - muscles? / primary innervated by
A
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
C5-C6
7
Q
most common rotator cuff muscle injury (and explain)
A
supraspinatus muscle – trauma or degeneration and impingement –> tenindopathy or tera
8
Q
supraspinatus muscle injury is assessed by
A
empty full/can test
9
Q
overuse injuries of the elbow
A
- Medial epicondylitis (golfer’s elbow)
2. Lateral epicondylitis (tennis elbow)
10
Q
causes of medial epicondylitis (golfer’s elbow)
A
- repetitive flexion (forehand shots)
2. idiopathic
11
Q
causes of lateral epicondylitis (tennis elbow)
A
- repetitive extension (backhand shots)
2. idiopathic
12
Q
dislocation of lunate may cause
A
acute carpal tunnel syndrome
13
Q
a fall on an outstretched hand that damages the hook of the hamate can cause
A
ulnar nerve injury
14
Q
Carpal tunnel syndrome is associated with
A
- pregnancy 2. RA 3. hypothyroidism 4. repetitive use
- dislocation of lunate (acute Carpal tunnel syndrome)
- diabetes 7. dialysis related amyloidosis
15
Q
Guyon canal syndrome? / seen in
A
Compression of ulnar nerve at wrist or hand
- seen in cyclists due to pressure from handlebars
16
Q
upper extremity nerves
A
- axillary (C5-C6)
- Musculocutaneous (C5-C7)
- Radial (C5-T1)
- Median (C5-T1)
- Ulnar (C8-T1)
- Reccurent branch of median nerve (C5-T1)
17
Q
causes of axillary nerve injury
A
- fractured surgical neck of humerus
2. anterior dislocation of humerus
18
Q
presentation of axillary nerve injury
A
- flatened deltoid
- Loss of arm abduction at shoulder (>15 degrees)
- Loss of sensation over deltoid muscle and lateral arm
19
Q
causes of musculocutaneous nerve injury
A
upper trunk compression
20
Q
presentation musculocutaneous nerve injury
A
- loss of forearm flexion and supination
2. loss of sensation on lateral forearm
21
Q
causes of radial nerve injury
A
- midshaft fracture of humerus
2. compression of axilla
22
Q
causes of radial nerve injury - compression of axilla due to (e.g.)
A
- crutches
2. sleeping with arm over chair (Saturday night palsy)
23
Q
presentation of radial nerve injury
A
- wrist drop
- decreased grip strength
- loss of sensation of over posterior arm/forearm and dorsal hand
24
Q
causes of median nerve injury
A
- supracondylar fracture of humerus (proximal lesion)
- carpal tunnel syndrome (distal lesion)
- wrist laceration (distal lesion)
25
median injury - presentation
1. ape hand 2. Pope's blessing 3. loss of wrist flexion
4. loss of thumb opposition 5. loss of lumbricals of 2nd and 3rd digits 6. loss of flexion of lateral fingers
7. loss of sensation over thenar eminence
8. loss of sensation at dorsal and palmar aspects of lateral 3.5 fingers (proximal lesion)
9. Tinel sign (in carpal tunnel syndrome)
sensation on in proximal lesions
26
ape-hand deformity
Lack of ability to abduct, flex and oppose the thumb due to paralysis of the thenar muscles
27
pope's blessing sign (Hand of benediction)
The ability to flex the digits 2–3 at the metacarpophalangeal joints is lost as is the ability to flex and extend the proximal and distal interphalangeal joints
28
causes of ulnar nerve injury
1. fracture of medial epicondyle of humerus funny bone (proximal lesion)
2. fractured hook of hamate (distal lesion)
29
presentation of ulnar nerve injury
1. ulnar claw on digit extension 2. radial deviation of wrist UPON FLEXION (proximal lesion) 3. Loss of wrist flexion 4. loss of flexion of medial fingers 5. loss of abduction and adduction of fingers (interossei)
6. loss of actin of medial 2 lumbrical muscles
7. loss of sensation over medial 1.5 fingers including hypothenar eminence
30
presentation of Reccurent branch of median nerve injury
1. ape hand (loss of thenar muscle group: opposition, flexion, abduction
2. no loss of sensation
31
ape hand - nerve ?
1. median
| 2. reccurent branch of median nerve
32
loss of foreman supination - nerve?
musculocutaneous
33
radial nerve injury - nerve of sensation?
loss of sensation over posterior arm/forearm and dorsal hand
34
median nerve injury - sensation
loss of sensation over thenar eminencea and at dorsal and palmar aspects of lateral 3.5 fingers
35
Erb palsy (waiter's tip) - injury
traction or tear of upper trunk
36
causes of Erb palsy (waiter's tip)
infants - lateral traction of neck during delivery
| adults - trauma
37
causes of Erb palsy - muscle deficit
1. deltoid
2. suraspinatus
3. infraspinatus
4. Bicepts branchi
38
causes of Erb palsy - functional deficit presentation (and muscle responsible)
1. abduction (arms hangs by side) (deltoid, supraspinatus)
2. Lateral rotation (arm medially rotated) (infraspinatus)
3. flexion and sunipation (arm extended and pronated) (bicepts branchi)
39
Klumpke palsy (Claw hand) - injury
traction or tear of lower trunk
40
causes of Klumpke palsy (Claw hand)
infants - upward force on arm during delivery
| adults - trauma (grabbing a tree branch to break a fall)
41
Klumpke palsy (Claw hand) - muscle deficits
intrinsic hand muscles
1. lumbricals
2. interossei
3. thenar
4. hypothenar
42
Klumpke palsy (Claw hand) - presentation
total claw hand
43
normal action of hand lumbricals
flex MCP and extend DIP and PIP joints
44
muslce deficit of Klumpke palsy are the same as the .... s
thoracic outlet syndrome
45
causes of thoracic outlet syndrome
1. Cervical rib
| 2. Pancoast tumor
46
thoracic outlet syndrome - presentation
- atrophy of intrinsic hand muscles
| - ischemia, pain and edema (due to vascular
47
Winged scapula - injury
lesion of long thoracic nerve
48
causes of Winged scapula
1. axillary node dissection after mastectomy
| 2. stab wound
49
Winged scapula - functional deficit (presentation)
problem on serratus anterior --> inability to anchor scapula to thoracic cage --> cannot abduct arm above the horizontal position
50
Distortions of the hand - clawing seen best in
DISTAL lesions of median or ulnar nerves
51
clawing appearance of the hand - pathophysiology
DISTAL lesions of median or ulnar nerves --> remaining exrinsic flexors of the digits exaggerate the loss of the lumbricals the loss of the lumbricals --> extension of MCP, flexion of DIP and PIP
52
ulnar claw vs pope's blessing sign: location of lession
ulnar claw --> DISTAL ulnar nerve (near to hand)
| Pope's blessing --> proximal median nerve
53
ulnar claw vs pope's blessing sign - more prominence during
ulnar claw --> extending fingers/rest
| Pope's blessing --> making a fist
54
OK gesture is a result of
proximal ulnar nerve
55
lower extremity nerves:
1. obturator nerve (L2-L4)
2. femoral nerve (L2-L4)
3. Common peroneal nerve (L4-S2)
4. Tidial nerve (L4-S3)
5. superior gluteal nerve (L4-S1)
6. inferior gluteal nerve (L5-S2)
7. sciatic nerve (L4-S3)
8. pudendal (S2-S4)
56
causes of obturator nerve injury
pelvic surgery
57
presentation of obturator nerve injury
1. decreased tight sensation (medial)
| 2. decreased adduction
58
causes of femoral nerve injury
pelvic fracture
59
presentation of femoral nerve injury
1. decreased tight flexion
| 2. decreased leg extension
60
sciatic nerve splits into
1. common peroneal nerve
| 2. tibial nerve
61
causes of common peroneal nerve injury
1. trauma or compression of lateral aspect of leg
| 2. fibular neck fracture
62
presenation of common peroneal nerve injury
1. foot drop
| 2. loss of sensation on dorsum foot
63
foot drop - gait?
steppage gait
64
causes of tibial nerve injury
1. knee trauma (proximal)
2. Baker cyst (proximal)
3. tarsal tunnel syndrome
65
presenation of tibial nerve injury
1. inability to curl toes
2. loss of sensation on sole of foot
3. foot everted at rest with loss of inversion and plantarfexion (PROXIMAL LESIONS)
66
causes of superior gluteal injury
iatrogenic injury during intramuscular injection to upper medial gluteal region
67
presentation of superior gluteal injury
Trendelenburg sign/gait: pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction muscles
68
hip abduction muscles (and innervation)
medius and minimus gluteus
| innervation: superior gluteal
69
causes of inferior gluteal injury
posterior hip dislocation
70
presentation of inferior gluteal injury (and why)
difficulty in climbing stairs or rising from sited position
| loss of hip extension by gluteal maximus
71
hip extension muscle and innervation
gluteal maximus
| innervation: inferior gluteal nerve
72
gluteal muscles and innervations
```
medius gluteus (superior gluteal nerve)
minimus gluteus (superior gluteal nerve)
maximus gluteus (inferior gluteal nerve)
superior gluteal also innervates tensor fascia latae
```
73
sciatic nerve innervates
posterior thigh
74
pudendal nerve innervates
perineum
75
pudendal nerve importance in childbirth
can be blocked with local anesthetics during childbirth using the ischial spine as a landmark for injection
76
Achondroplasia --> problem
failure of longitudinal bone growth (endochondral ossification) --> short limbs
77
Achondroplasia --> pathophysiology / appearance
constitutive activation of FGFR3 --> inhibits chondrocyte proliferation --> impaired cartilage proliferation in growth plate --> impaired endochondral ossification --> short extremities with normal sizes head and chest
(large head RELATIVE to limbs)
78
Achondroplasia --> sporadic vs inherited mutation
more than 85% is sporadic
79
osteopetrosis (marble bone disease) - pathophysiology
Carbonic anhydrase --> impair ability of osteoclast to generate acidic environment (necessary for bone resorption) --> thickened, dense bones --> fractures
80
osteopetrosis - clinical manifestations (why)
1. pancytopenia (bone fills marrow space)
2. extramedullary hematopoiesis (bone fills marrow)
3. cranial nerve inmpingement and palsies (narrowed foramina --> vision and hearing impairment )
4. hydrocephalus (narrowing of the foramen magnum)
5. bone fractures
6. Renal tubular acidosis (carb anhydr II mut)
81
osteopetrosis - X-RAY appearance
bone - in - bone appearance
82
treatment of osteopetrosis (why)
Bone marrow transplant is potentially curative as osteoclasts are derived from monocytes
83
Primary osteoporosis?
trabecular (spongy) bone loses mass an interconnections despite normal bone mineralization and lab values
84
primary osteoporosis - diagnosis by
1. bone mineral density test (DEXA): T score less than 2.5
| 2. fragility fracture of hip or vertebra
85
primary osteoporosis can lead to
1. vertebral compression fractures
2. fractures of femoral neck
3. distal radius fracture (Colles fracture)
86
2ry osteoporosis can be caused by
A. DRUGS (1. long term exogenous steroid use 2. anticonvulsants 3. anticoagulants 4. thyroid replacement therapy 5. alcohol)
B. OTHER medical conditions (1. hyperparathyroidism 2. hyperthyroidism 3. MM 4. malabsorption syndromes)
87
primary osteoporosis types
```
type 1 (post-menopausal) (decreased estrogen levels)
type 2 (senile) (men and women older 70)
```
88
primary osteoporosis - treatment
- biphosponates
- PTH analogs
- SERMs
- calcitonin
- denosumab
89
Vitamin D deficiency - ALP level (why)
increased ALP (because of osteoblast hyperactivity - osteoblasts require alkaline environment)
90
causes of osteonecrosis (avascular necrosis)
```
mnemonic ASSEPTIC + slipped capital femoral epiphysis
Alcoholism
Sickle cell anemia
Storage (Gaucher disease)
Exogenous/Endogenous steroids
Pancreatitis
Trauma
Idiopathic (Legg-Calve-Perthes disease)
Caisson ("the bends")
slipped capital femoral epiphysis
```
91
Paget disease of bone (osteitis deformans) - increased risk of / etiology
osteogenic sarcoma
| etiology: unknown, probably viral
92
Paget disease of bone (osteitis deformans) - clinical presentation
1. increased hat size
2. hearing loss
3. hight output cardiac failure
4. long bone chalk-stick fractures
93
Paget disease of bone (osteitis deformans) - stages (and process)
1. Lytic - osteoclasts
2. Mixed - osteoclasts and osteoblasts
3. Sclerotic - osteoblasts
4. Quiescent - minimal osteoclast/osteoblast activity
94
osteopetrosis - serum Ca2+ - when is decreased
in severe malignant disease
95
Paget, osteomalacia, hypervitaminosis D, primary parathyrodidism - ALP
all increased except hypervitaminosis (normal)
96
osteomalacia - x rays
osteopenia and Looser zones (pseudofractures)
97
giant cell tumor - age and sex / area of bone / area of body / behaviour
```
20-40
no sex differences
epiphesial end of ling bones --> often around knee: distal femoral and proximal tibia
locally agressive bening tumor
(May recur)
```
98
MC benign tumor of the bone / age / consist of / area of the body / behaviour
```
osteochondroma
male under 25
mature bony exostosis with cartilaginous (chondroid) cap
metaphysis
rarely transforms to chondrosarcoma
```
99
chondroma usually arises in the
medulla of small bones of the hands and feet (metaphysis)
100
chondrosarcoma usually arises in
medulla of pelvis or central skeleton (metaphysis)
101
osteosarcoma - age
bimodal distribution --> 10-20 (MC) and > 65
102
osteosarcoma - predisposing factors
1. Paget disease
2. bone infracts
3. radiation
4. Familiar retinoblastoma
5. Li-Fraumeni syndrome (germline p53 mutation)
103
osteosarcoma - area of the body / malignant proliferation of
(metaphysis) often around knee (distal femoral and proximal tibia)
- osteoblasts
104
osteosarcoma - treatment
surgical en bloc resection (with limb salvage) and chemotherapy
105
osteosarcoma x-ray
1. Codman triangle (from elevation of periosteum)
| 2. Sunburst pattern
106
Ewing sarcoma - genetics / x-ray
```
translocation t(11;22) --> fusion protein EWS-FLI 1
- x-ray: onion skin periosteal reaction in bone
```
107
Ewing sarcoma - area of the body
1. long bones
2. pelvis
3. scapula
4. ribs
108
Ewing sarcoma - histology / can be confused by
anaplastic smal blue cell
confused by: 1. lymphoma
2. chronic osteomyelitis
109
Ewing sarcoma - behaviour / age
extremely aggressive wtih early metastasis (but responsive to chemotherapy)
BOYS UNDER 15
110
primary bone tumors of epiphysis
Giant cell tumor
111
primary bone tumors of metaphysis
1. osteosarcoma
2. osteochondroma
3. simple bone cyst
112
primary bone tumors of dipahysis
1. fibrous dysplasia
2. Osteoid osteoma
3. Ewing sarcoma
4. Multiple Myeloma
5. osteoblastoma
113
2 MC primary malignant bone tunors
1. MM
| 2. osteosarcoma
114
osteoma - area of the body
surface of the facial bones
115
osteoid osteoma appearance
osteoid surrounded by a rim of reactive bone (CENTRAL NIDUS)
116
osteoid osteoma - x ray
bony mass smaller than 2 cm with a radiolucent core
117
osteoid osteoma - presentation
NIGHT-TIME bone pain that resolves with aspirin
118
fibrous dysplasia - area of the bone
diaphysis
119
osteoblastoma - area of the body / presentation
vertebrae
| bone pain that does not respond to aspirin
120
osteoblastoma vs osteoid osteoma - accoriding size
similar but osteoblastoma larger (>2cm)
121
osteoblastoma vs osteoid osteoma on presentation
osteoblastoma - bone pain that does not respond to aspirin
| osteoid osteoma --> bone pain that resolves with aspirin
122
age and sex of - giant cell tumor, osteochondroma, osteosarcoma, Ewing sarcoma, chondrosarcoma, osteoid osteoma
giant cell: 20-40 (no sex differences)
osteochondroma: under twenty five (male)
Ewing sarcoma: boys under fifteen
osteosarcoma: bimodal 10-20 (MC) and > 65
chondrosarcoma: men 30-60
osteoid osteoma: under twenty five
