LL Clinical anatomy + Myasthenia Gravis Flashcards
Perthes Disease
Idiopathic Avascular Necrosis of the head of femur in children - most commonly seen at the age of 4-8 years of age (can progress to a collasped bone in femoral head)
How to measure true limb length:
From anterior superior iliac spine to just
below medial malleolus
Osteoarthritis of the Hip Joint
- Joint space narrowing due to erosion of the articular cartilage
- Bone sclerosis (abnormal increase in density and hardening of bone) around site where bones are in contact
- Decreased range of motion at the hip joint on examination
How is ACL commonly injured?
Commonly injured (following a jump into the air) when landing on one foot while the trunk is rotating producing a twisting motion on the knee
When is an intraosseous needle needed?
- Intraosseous access is indicated for patients in whom there is an urgent need for vascular access in order to provide fluid resuscitation or medication delivery and in whom conventional venous access is not readily available.
- Cardiac arrest, shock, trauma, extensive burns, severe dehydration, and status epilepticus are possible clinical scenarios in which intraosseous access may be needed
What’s the Trendelenburg test
How is it carried out
Check for action of hip abductors (gluteus medius and minimus)
Patient to stand on one leg, and hip shouldn’t sag Weakness of muscles etc
What movements are restricted in patients with osteoarthritis in the hip
Internal rotation
Abduction
Extension
Where is hip pain often referred to
- L3 dermatome from groin, anterior thigh to knee
- To the knee
Posterior tibial artery pulse:
Behind medial malleolus
What is pathophysiology?
Understanding how the disease has disrupted the physiology to produce symptoms
How does MG affect eyes
Ptosis (eye drooping)
Diplopia (double visions)
How does MG affect face and throat muscles
Limited facial expression
Altered speech
Problems chewing
Difficulty swallowing
(LAPD)
How does MG affect neck and limb muscles
Weakness in neck, arms and legs —> waddling walk, difficulty holding head up, lifting things, getting up from sitting to standing, climbing stairs, brushing teeth, etc.
What is one of the more life threatening symptoms of MG
Breathing
Weakness of contraction of diaphragm decreasing air movement
Some patients may need artificial ventilation
What causes Myasthenia Gravis
Antibody production which bind to ACh Receptor
Prevent action of ACh at NMJ (autoimmune disease)
How to test for MG (examination)
- Ask patient to look up at ceiling and test for ptosis
- Ask patient to hold arms out to side and test strength repeatedly
Tests to confirm diagnosis of MG:
- Anticholinesterase test: edrophonium or neostigmine –> improve muscle strength immediately
- Neurophysiological test: repetitive nerve stimulation –> MG shows a fall in compound muscle action potentials
- Anticholinergic receptor antibodies: present in 80% of patients with MG
Treatment for MG
- Thymectomy (remove thymus)
- Immunosuppression: steroids or azathioprine
- Plasmapheresis: wash out antibodies
- Intravenous Immunoglobin
How to check if ACL is intact?
Anterior drawer test
What nerve is injured in footdrop?
Common peroneal nerve
What are the Ottawa rules and when are they relevant?
When a person has an inversion injury, an X-Ray of the foot/ankle is needed if any of the following are present:
- Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
- Bony tenderness at base of 5th metatarsal
- Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
What’s the name of test for Achilles tendon rupture?
Thompson/Simmonds test
Varicose veins
- Incompetence of valve at saphenofemoral junction –> great saphenous vein exposed to high pressure —> swollen, elongated and tortuous
- Common during pregnancy
Cause of vascular peripheral disease
Most common cause: atherosclerosis (buildup of plaque inside the artery wall reduces amount of blood flow to limbs and decreases the oxygen and nutrients available to the tissue)
