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1
Q

Knee exams - tests?

A
  1. Anterior drawer sign
  2. Posterior drawer sign
  3. Abnormal passive abduction
  4. Abnormal passive adduction
  5. McMurray test
  6. Lachman sign
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2
Q

common knee conditions

A
  1. Unhappy triad
  2. Prepatellar bursitis
  3. Baker cyst
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3
Q

Baker cyst?

A

popliteal fluid collection in gastrocnemius-semimembranosus bursa commonly communicating with synovial space and related to chronic joint disease

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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

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5
Q

Unhappy triad - problem?

A

classically consists of damage to

  1. anterior cruciate ligament
  2. Medial collateral ligament
  3. medial meniscus
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6
Q

rotator cuff muscles - muscles? / primary innervated by

A
  1. supraspinatus
  2. infraspinatus
  3. teres minor
  4. subscapularis
    C5-C6
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7
Q

most common rotator cuff muscle injury (and explain)

A

supraspinatus muscle – trauma or degeneration and impingement –> tenindopathy or tera

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8
Q

supraspinatus muscle injury is assessed by

A

empty full/can test

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9
Q

overuse injuries of the elbow

A
  1. Medial epicondylitis (golfer’s elbow)

2. Lateral epicondylitis (tennis elbow)

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10
Q

causes of medial epicondylitis (golfer’s elbow)

A
  1. repetitive flexion (forehand shots)

2. idiopathic

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11
Q

causes of lateral epicondylitis (tennis elbow)

A
  1. repetitive extension (backhand shots)

2. idiopathic

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12
Q

dislocation of lunate may cause

A

acute carpal tunnel syndrome

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13
Q

a fall on an outstretched hand that damages the hook of the hamate can cause

A

ulnar nerve injury

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14
Q

Carpal tunnel syndrome is associated with

A
  1. pregnancy 2. RA 3. hypothyroidism 4. repetitive use
  2. dislocation of lunate (acute Carpal tunnel syndrome)
  3. diabetes 7. dialysis related amyloidosis
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15
Q

Guyon canal syndrome? / seen in

A

Compression of ulnar nerve at wrist or hand

- seen in cyclists due to pressure from handlebars

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16
Q

upper extremity nerves

A
  1. axillary (C5-C6)
  2. Musculocutaneous (C5-C7)
  3. Radial (C5-T1)
  4. Median (C5-T1)
  5. Ulnar (C8-T1)
  6. Reccurent branch of median nerve (C5-T1)
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17
Q

causes of axillary nerve injury

A
  1. fractured surgical neck of humerus

2. anterior dislocation of humerus

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18
Q

presentation of axillary nerve injury

A
  1. flatened deltoid
  2. Loss of arm abduction at shoulder (>15 degrees)
  3. Loss of sensation over deltoid muscle and lateral arm
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19
Q

causes of musculocutaneous nerve injury

A

upper trunk compression

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20
Q

presentation musculocutaneous nerve injury

A
  1. loss of forearm flexion and supination

2. loss of sensation on lateral forearm

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21
Q

causes of radial nerve injury

A
  1. midshaft fracture of humerus

2. compression of axilla

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22
Q

causes of radial nerve injury - compression of axilla due to (e.g.)

A
  1. crutches

2. sleeping with arm over chair (Saturday night palsy)

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23
Q

presentation of radial nerve injury

A
  1. wrist drop
  2. decreased grip strength
  3. loss of sensation of over posterior arm/forearm and dorsal hand
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24
Q

causes of median nerve injury

A
  1. supracondylar fracture of humerus (proximal lesion)
  2. carpal tunnel syndrome (distal lesion)
  3. wrist laceration (distal lesion)
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25
Q

median injury - presentation

A
  1. ape hand 2. Pope’s blessing 3. loss of wrist flexion
  2. loss of thumb opposition 5. loss of lumbricals of 2nd and 3rd digits 6. loss of flexion of lateral fingers
  3. loss of sensation over thenar eminence
  4. loss of sensation at dorsal and palmar aspects of lateral 3.5 fingers (proximal lesion)
  5. Tinel sign (in carpal tunnel syndrome)
    sensation on in proximal lesions
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26
Q

ape-hand deformity

A

Lack of ability to abduct, flex and oppose the thumb due to paralysis of the thenar muscles

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27
Q

pope’s blessing sign (Hand of benediction)

A

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

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28
Q

causes of ulnar nerve injury

A
  1. fracture of medial epicondyle of humerus funny bone (proximal lesion)
  2. fractured hook of hamate (distal lesion)
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29
Q

presentation of ulnar nerve injury

A
  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)
  2. loss of actin of medial 2 lumbrical muscles
  3. loss of sensation over medial 1.5 fingers including hypothenar eminence
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30
Q

presentation of Reccurent branch of median nerve injury

A
  1. ape hand (loss of thenar muscle group: opposition, flexion, abduction
  2. no loss of sensation
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31
Q

ape hand - nerve ?

A
  1. median

2. reccurent branch of median nerve

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32
Q

loss of foreman supination - nerve?

A

musculocutaneous

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33
Q

radial nerve injury - nerve of sensation?

A

loss of sensation over posterior arm/forearm and dorsal hand

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34
Q

median nerve injury - sensation

A

loss of sensation over thenar eminencea and at dorsal and palmar aspects of lateral 3.5 fingers

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35
Q

Erb palsy (waiter’s tip) - injury

A

traction or tear of upper trunk

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36
Q

causes of Erb palsy (waiter’s tip)

A

infants - lateral traction of neck during delivery

adults - trauma

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37
Q

causes of Erb palsy - muscle deficit

A
  1. deltoid
  2. suraspinatus
  3. infraspinatus
  4. Bicepts branchi
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38
Q

causes of Erb palsy - functional deficit presentation (and muscle responsible)

A
  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)
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39
Q

Klumpke palsy (Claw hand) - injury

A

traction or tear of lower trunk

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40
Q

causes of Klumpke palsy (Claw hand)

A

infants - upward force on arm during delivery

adults - trauma (grabbing a tree branch to break a fall)

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41
Q

Klumpke palsy (Claw hand) - muscle deficits

A

intrinsic hand muscles

  1. lumbricals
  2. interossei
  3. thenar
  4. hypothenar
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42
Q

Klumpke palsy (Claw hand) - presentation

A

total claw hand

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43
Q

normal action of hand lumbricals

A

flex MCP and extend DIP and PIP joints

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44
Q

muslce deficit of Klumpke palsy are the same as the …. s

A

thoracic outlet syndrome

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45
Q

causes of thoracic outlet syndrome

A
  1. Cervical rib

2. Pancoast tumor

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46
Q

thoracic outlet syndrome - presentation

A
  • atrophy of intrinsic hand muscles

- ischemia, pain and edema (due to vascular

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47
Q

Winged scapula - injury

A

lesion of long thoracic nerve

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48
Q

causes of Winged scapula

A
  1. axillary node dissection after mastectomy

2. stab wound

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49
Q

Winged scapula - functional deficit (presentation)

A

problem on serratus anterior –> inability to anchor scapula to thoracic cage –> cannot abduct arm above the horizontal position

50
Q

Distortions of the hand - clawing seen best in

A

DISTAL lesions of median or ulnar nerves

51
Q

clawing appearance of the hand - pathophysiology

A

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
Q

ulnar claw vs pope’s blessing sign: location of lession

A

ulnar claw –> DISTAL ulnar nerve (near to hand)

Pope’s blessing –> proximal median nerve

53
Q

ulnar claw vs pope’s blessing sign - more prominence during

A

ulnar claw –> extending fingers/rest

Pope’s blessing –> making a fist

54
Q

OK gesture is a result of

A

proximal ulnar nerve

55
Q

lower extremity nerves:

A
  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
Q

causes of obturator nerve injury

A

pelvic surgery

57
Q

presentation of obturator nerve injury

A
  1. decreased tight sensation (medial)

2. decreased adduction

58
Q

causes of femoral nerve injury

A

pelvic fracture

59
Q

presentation of femoral nerve injury

A
  1. decreased tight flexion

2. decreased leg extension

60
Q

sciatic nerve splits into

A
  1. common peroneal nerve

2. tibial nerve

61
Q

causes of common peroneal nerve injury

A
  1. trauma or compression of lateral aspect of leg

2. fibular neck fracture

62
Q

presenation of common peroneal nerve injury

A
  1. foot drop

2. loss of sensation on dorsum foot

63
Q

foot drop - gait?

A

steppage gait

64
Q

causes of tibial nerve injury

A
  1. knee trauma (proximal)
  2. Baker cyst (proximal)
  3. tarsal tunnel syndrome
65
Q

presenation of tibial nerve injury

A
  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
Q

causes of superior gluteal injury

A

iatrogenic injury during intramuscular injection to upper medial gluteal region

67
Q

presentation of superior gluteal injury

A

Trendelenburg sign/gait: pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction muscles

68
Q

hip abduction muscles (and innervation)

A

medius and minimus gluteus

innervation: superior gluteal

69
Q

causes of inferior gluteal injury

A

posterior hip dislocation

70
Q

presentation of inferior gluteal injury (and why)

A

difficulty in climbing stairs or rising from sited position

loss of hip extension by gluteal maximus

71
Q

hip extension muscle and innervation

A

gluteal maximus

innervation: inferior gluteal nerve

72
Q

gluteal muscles and innervations

A 
medius gluteus (superior gluteal nerve)
minimus gluteus (superior gluteal nerve)
maximus gluteus (inferior gluteal nerve)
superior gluteal also innervates tensor fascia latae
73
Q

sciatic nerve innervates

A

posterior thigh

74
Q

pudendal nerve innervates

75
Q

pudendal nerve importance in childbirth

A

can be blocked with local anesthetics during childbirth using the ischial spine as a landmark for injection

76
Q

Achondroplasia –> problem

A

failure of longitudinal bone growth (endochondral ossification) –> short limbs

77
Q

Achondroplasia –> pathophysiology / appearance

A

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
Q

Achondroplasia –> sporadic vs inherited mutation

A

more than 85% is sporadic

79
Q

osteopetrosis (marble bone disease) - pathophysiology

A

Carbonic anhydrase –> impair ability of osteoclast to generate acidic environment (necessary for bone resorption) –> thickened, dense bones –> fractures

80
Q

osteopetrosis - clinical manifestations (why)

A
  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
Q

osteopetrosis - X-RAY appearance

A

bone - in - bone appearance

82
Q

treatment of osteopetrosis (why)

A

Bone marrow transplant is potentially curative as osteoclasts are derived from monocytes

83
Q

Primary osteoporosis?

A

trabecular (spongy) bone loses mass an interconnections despite normal bone mineralization and lab values

84
Q

primary osteoporosis - diagnosis by

A
  1. bone mineral density test (DEXA): T score less than 2.5

2. fragility fracture of hip or vertebra

85
Q

primary osteoporosis can lead to

A
  1. vertebral compression fractures
  2. fractures of femoral neck
  3. distal radius fracture (Colles fracture)
86
Q

2ry osteoporosis can be caused by

A

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
Q

primary osteoporosis types

A 
type 1 (post-menopausal) (decreased estrogen levels) 
type 2 (senile) (men and women older 70)
88
Q

primary osteoporosis - treatment

A
  • biphosponates
  • PTH analogs
  • SERMs
  • calcitonin
  • denosumab
89
Q

Vitamin D deficiency - ALP level (why)

A

increased ALP (because of osteoblast hyperactivity - osteoblasts require alkaline environment)

90
Q

causes of osteonecrosis (avascular necrosis)

A 
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
Q

Paget disease of bone (osteitis deformans) - increased risk of / etiology

A

osteogenic sarcoma

etiology: unknown, probably viral

92
Q

Paget disease of bone (osteitis deformans) - clinical presentation

A
  1. increased hat size
  2. hearing loss
  3. hight output cardiac failure
  4. long bone chalk-stick fractures
93
Q

Paget disease of bone (osteitis deformans) - stages (and process)

A
  1. Lytic - osteoclasts
  2. Mixed - osteoclasts and osteoblasts
  3. Sclerotic - osteoblasts
  4. Quiescent - minimal osteoclast/osteoblast activity
94
Q

osteopetrosis - serum Ca2+ - when is decreased

A

in severe malignant disease

95
Q

Paget, osteomalacia, hypervitaminosis D, primary parathyrodidism - ALP

A

all increased except hypervitaminosis (normal)

96
Q

osteomalacia - x rays

A

osteopenia and Looser zones (pseudofractures)

97
Q

giant cell tumor - age and sex / area of bone / area of body / behaviour

A 
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
Q

MC benign tumor of the bone / age / consist of / area of the body / behaviour

A 
osteochondroma 
male under 25
mature bony exostosis with cartilaginous (chondroid) cap
metaphysis
rarely transforms to chondrosarcoma
99
Q

chondroma usually arises in the

A

medulla of small bones of the hands and feet (metaphysis)

100
Q

chondrosarcoma usually arises in

A

medulla of pelvis or central skeleton (metaphysis)

101
Q

osteosarcoma - age

A

bimodal distribution –> 10-20 (MC) and > 65

102
Q

osteosarcoma - predisposing factors

A
  1. Paget disease
  2. bone infracts
  3. radiation
  4. Familiar retinoblastoma
  5. Li-Fraumeni syndrome (germline p53 mutation)
103
Q

osteosarcoma - area of the body / malignant proliferation of

A

(metaphysis) often around knee (distal femoral and proximal tibia)
- osteoblasts

104
Q

osteosarcoma - treatment

A

surgical en bloc resection (with limb salvage) and chemotherapy

105
Q

osteosarcoma x-ray

A
  1. Codman triangle (from elevation of periosteum)

2. Sunburst pattern

106
Q

Ewing sarcoma - genetics / x-ray

A 
translocation t(11;22) --> fusion protein EWS-FLI 1
- x-ray: onion skin periosteal reaction in bone
107
Q

Ewing sarcoma - area of the body

A
  1. long bones
  2. pelvis
  3. scapula
  4. ribs
108
Q

Ewing sarcoma - histology / can be confused by

A

anaplastic smal blue cell
confused by: 1. lymphoma
2. chronic osteomyelitis

109
Q

Ewing sarcoma - behaviour / age

A

extremely aggressive wtih early metastasis (but responsive to chemotherapy)
BOYS UNDER 15

110
Q

primary bone tumors of epiphysis

A

Giant cell tumor

111
Q

primary bone tumors of metaphysis

A
  1. osteosarcoma
  2. osteochondroma
  3. simple bone cyst
112
Q

primary bone tumors of dipahysis

A
  1. fibrous dysplasia
  2. Osteoid osteoma
  3. Ewing sarcoma
  4. Multiple Myeloma
  5. osteoblastoma
113
Q

2 MC primary malignant bone tunors

A
  1. MM

2. osteosarcoma

114
Q

osteoma - area of the body

A

surface of the facial bones

115
Q

osteoid osteoma appearance

A

osteoid surrounded by a rim of reactive bone (CENTRAL NIDUS)

116
Q

osteoid osteoma - x ray

A

bony mass smaller than 2 cm with a radiolucent core

117
Q

osteoid osteoma - presentation

A

NIGHT-TIME bone pain that resolves with aspirin

118
Q

fibrous dysplasia - area of the bone

119
Q

osteoblastoma - area of the body / presentation

A

vertebrae

bone pain that does not respond to aspirin

120
Q

osteoblastoma vs osteoid osteoma - accoriding size

A

similar but osteoblastoma larger (>2cm)

121
Q

osteoblastoma vs osteoid osteoma on presentation

A

osteoblastoma - bone pain that does not respond to aspirin

osteoid osteoma –> bone pain that resolves with aspirin

122
Q

age and sex of - giant cell tumor, osteochondroma, osteosarcoma, Ewing sarcoma, chondrosarcoma, osteoid osteoma

A

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

Musculoskeletal and Connective Tissue (19 decks)

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