Mistakes Flashcards
Nerve compressed in lunate dislocation
Median nerve
Spilled tea cup sign
Volar lunate dislocation
Ligaments injured in volar lunate dislocation
Scapholunate
Capitolunate
Lunotriquetral
Motor symptoms of median nerve compression at carpal tunnel are?
Via recurrent branch of median nerve to thenar muscles
Weakness of ABDUCTOR POLLICIS BREVIS—- thimb abduction lost
FLEXOR POLLICES BREVIS
OPPONENES POLLICES
Sensory loss of carpal tunnel syndrome
Palmar digital branches of median nerve— paresthesia in palmar aspect of first 3 and half digits
Weakness of 1st and 2nd lumbrical— no interphalangeal joint extension
Thumb adduction is by?
Adductor policis
Ns - deep motor branch of ulnar nerve
Injury- guyons canal syndrome when hook of hamate is fractured
Features of guyons canal syndrome?
Ulnar nerve compression in guyons canal
Dorsal and volar interossei lost — finger abduction
Adductor policis— thumb adduction
Nerve supply of extensor pollices longus and brevis
Radial nerve
Before entering wrist
Name the muscles of thumb with nerve supply
Abductor pollicis brevis— median nerve
Flexor pollicis brevis—superficial head median nerve deep head ulnar nerve
Opponens pollices— median nerve
Adductor pollicis—-ulnar nerve
Extensor pollicis longus and brevis— radial nerve
Primary muscle of wrist extension
Extensor carpi radialis brevis
Extensor digitorum
Lateral epicondylitis tennis elbow
Muscle responsible for adduction of fingers
Palmar interossei
Originates from metacarpals
Forearm flexors
Biceps brachii
Brachialis
Brachioradialis
Boundaries of anatomical snuff box
Lateral—- EPB AbPL
Medial— EPL
TENDINOPATHY OF THESE TENDONS ESP LATERAL ONES CAUSES DEQUERVAINS TENDINOPATHY
Osgood schlatter disease
Avulsion growth spurt at secondary ossification centre —tibial tubercle due to repeated knee extension
Muscles inserting in pes anserinus
Semitendinosus
Gracilis
Sartorius
Origin and insertion of serratus anterior
First 8 ribs origin
Medial border of scapula insertion
What is the function of serratus anterior
During overhead abduction of shoulder the glenoid cavity must rotate upwards
This is done by trapezius and serratus anterior
Which allows completion of over head abduction
Nerve supply long thoracic nerve
C5 c6 and c7
Brachial plexus roots
Injury in clavicular fracture
Supraclavicular nerve
Subclavian vessels
Upper brachial plexus injury
Waiters tip
Erbs palsy
Injury to musculocutaneous nerve and suprascapular nerve
Hip pain on forced adduction of flexed thigh
And internal rotation of extended thigh on resistance
Piriformis syndrome
Because adduction and internal rotation of thigh stretches piriformis
Contents of greater sciatic notch
Piriformis Above it superior gluteal nerve and vessels Below it inferior gluteal vessels Internal pudendal vessels Sciatic nerve
Action of piriformis since it inserts in greaters trochanter is to abduct the flexed thigh
Or
Externally rotate the extened thigh
What is trendlenberg gait
Weakness of hip stabilisers
Gluteus medius and minimus
Contralateral hip drop when foot is raised
Superomedial gluteal quadrant injections
Superomedial injection in gluteal region injures which nerve
Superior gluteal nerves L4 to S1
Weakness of hip stabilisers
Nurse maids elbow
Kids traction of arm forearm
Annular ligament gets trapped in between radial head and capitulum
Popeyes deformity
Rupture of long head of biceps brachi
Which contracts and accumulates like popeyes arm
due to displaced belly
What is lac operon
Sequence of genome in E COLI for metabolism of lactose
Contents of lac operon
Ipo zya
I is regulatory gene
P is promotor region
O is operator region
Z y a are three structural genes
What are the products of zya genes in lac operon
Z codes for B GALACTOSIDASE- which breaks down lactose to glucose and galactose
Y codes for permease- which increases the e coli permeability for lactose
A codes for B galactoside transacetylase which transfers acetyl grps to b galactoside
What is the property of mrna in E coli
M rna in ecoli is polycistronic
Meaning single mRNA contains the information of all zya genes of lac operon and all protein/ enzymes are synthesized together
Mostly prokaryotic mRNA are usually polycistronic
In order what is the structure of lac operon
LAC 1 ( regulator gene) Cap ( catalytic activator protein) P gene (promotor gene has RNA POLYMERASE)
O gene which is operator gene where repressor can bind and does not allow RNA polymerase to proceed
Then structural gene z y a
Inducer is lactose— prevents repressor from binding operator site..
Name 3 enz deficiencies for galactosemia
Galk deficiency— galactokinase
Galt deficiency- Galactose 1 p uridyl transferase
UDP galactose 4 epimerase for regeneration of UDP glucose
Most common galactosemia enz
Galt— ie udp wala
Galactose 1 phosphate uridyl transferase
Features of dangerous type Galactosemia galt
Liver and renal accumulation of galactose 1 phosphate which is toxic
Liver enz elevation hyperbilirubinemia hypoglycemia
Renal aminoaciduria and hyperchloremic metabolic acidosis
Sepsis with grm negative rods ie e coli
What enz forms galactitol from galactose
Aldose reductase
What are non glucose monosaccharides metabolised by liver
Whose metabolism is the fastest
Galactose mannose and fructose are non glucose monosaccharides metabolised by liver whose intermediaries enter glycolytic pathway at various levels
Of these fructose has the fastest metabolism because it can have two pathways one of which is independent of rate limiting glycolytic enz phosphfructokinase -1
Why glucose represses lac operon or shuts down lac operon
Because glucose decreases adenyl cyclase levels and intracellular camp levels decreases
CAP catalytic activator protein needs high level of cAMP
Leptin gene and receptor mutations would cause
Hyperphagia with obesity
Gene mutation has low levels of leptins and
Receptor mutations will have increased levels of leptin
Mechanism of action of leptin
Two actions on arcuate nucleus of hypothalamus
1 inhibits appetite stimulating neuropeptideY
2 activates appetite inhibiting pomc product alpha MSH
OVERALL EARLY INCREASED SATIETY
Enz deficient in hereditory fructose intolerance
Aldolase B
NO CATARACTS but reducing sugars in urine hypoglycemia hypophosphatemia and failure to thrive
What disease is caused by alpha galactosidase A deficiency?
Fabrys disease xlr
Cataracts with neuro symptoms with angiokeratomas
Enz deficient in essential fructosruia
Fructokinase deficiency
Only reducing sugars in urine
No cataracts ( hereditary fr intolence) No hypoglycemia ( HFI OR GALACTOSEMIA) No hypophosphatemia ( hereditary fr intoleance)
Enz deficient in von gierkes disease
Glucose 6 phosphatase
Hypoglycemia lactic acidosis
Hepatomegaly
Hypertriglyceridemia
What causes tay sachs disease
Hexosaminidase A deficiency
Cherry red spot
Loss of motor skill
No cataracts
What is complex II. In tca and electron transport chain
Complex II. Is succinate dehydrogenase complex
Participate in tca as well as etc
In TCA it converts succinate to fumarate and thereby transfers electrons to coenzyme Q via FAD producing reduced FADH2
It can also accept electrons from other sources of FADH2 like fatty acid oxidation
Mismatched nucleotides are repaired by
Proof reading of DNA polymerase delta and epsilon
What if proof reading by dna polymera delta and epsilon misses Mismatch
Mismatch repair genese MSH 2 and MLH 1 produces human mutS and mutL homologs that repairs the mismatch
Damage mutations by uv light is corrected by
Nucleotide excision repair
Because uv light causes pyrimidine esp thymine dimers which interfere with dna replication
These dimers are removed by nucleotide excision repair
Removal of RNA primers after DNA Replication before ligase can act to seal everything is done by
DNA Polymerase 1 which has 5’-3’ forward exonuclease activity
In which directions dna polymerase 3 acts
Making dna in 5’-3’ direction
And proofreading in reverse ie exonuclease activity in reverse 3’-5’ direction
In lower arm brachial artery accompanies which nerve
Median nerve
In arm radial nerve accompanies which artery?
Deep branch of brachial artery
Remember mid shaft fracture of humerus is associated with wrist drop because of radial nerve injury
And shud raise concern of lacerstion of deep brachial artery
What is deep brachial artery?
Profunda brachii is deep brachial artery
Accompanies radial nerve
Injured in mid shaft humeral fracture
Radial nerve and profunda brachi artery is situated anterior or posterior to humerus?
Posterior to mid shaft humerus
Nerve root for radial nerve
All 5 of brachial plexus
C5 to t1
What does cutaneous br of radial nerve supply
Skin overlying dorsum of hand dorsal forearm and portion of upper arm
Muscles supplied by radial nerves
Elbow and wrist extensors like common extensors and triceps
Extrinsic extensors of digits
Brachioradialis and supinator
Fracture of surgical neck of humerus can damage which nerve and artery
Axillary nerve
And
Posterior circumflex humeral artery in quadrangular space
Retroperitoneal hematoma overlying psoas can damage which nerve
Femoral nerve which descends through psoas
Emerges laterally btn psoas and iliacus
Enters limb below inguinal ligament
Femoral nerve mononeuropathy features
Quadriceps weakness— stairs climbing or knee buckling
Decreased patellar reflex
Sensory loss over anterior and medial thigh and medial leg
Impaired adduction of thigh nerve injury is
Obturator nerve injury
Also has sensory loss in medial thigh
Common peroneal nerve injury
Dorsiflexed foot — foot drop
Loss of toe extensor- cannot stand on toes
Foot inversion - cannot do eversion
Loss of sensation in lateral leg and dorsum of foot
Tarsal tunnel syndrome
Posterior tibial nerve neuralgia
Narrow tunnel behind medial malleolus at ankle overlying flexor retinaculum
Contents of tarsal tunnel
Tibialis posterior
Flexor DL
FHL
Posterior tibial artery and v
Posteiror tibial nerve (L4-S3)
What does tibial nerve supply
Sensation in sole
Inversion and plantar flexion of foot
Flexion of toes
First web space on dorsum is supplied by?
Entire dorsum is supplied by superficial peroneal nerve except for first web which is supplied by deep peroneal nerve
Femoral head arterial supply
Ascending cervical and medial circumflex femoral artery
Which are damaged in neck fracture of femur
Circumflex femoral arteries are branches of which artry
Profunda femoris
Artery of ligamentum teres
Is a br of obturator artery
It is important in children because it supplies head proximal to growth plate
Ascending cervical artery of femoral head is brn of
Lateral circumflex femoral artery
Nerve supply of latissimus dorsi and its action is?
Thoracodorsal nerve C6-c8
Inserts in biciputal groove
Internal rotation and adduction of humerus
Extension alsom
Action of infraspinatus
External rotation of arm
Ns is suprascapular nervd
Nerve supply of triceps brachi
Radial nerve
Extension of elbow
Explain nerve root of ulnar nerve
Ulnar nerve originates from medial cord of brachial plexus derived from C8-T1 ventral roots
Components of cranial nerve 3 occulomotor
Somatic - infr super and medial rectus. LPS muscle and inferior oblique ms. So if occulomotor is involved—- eye will be down out and shut (ptosis lid)
Parasympathetic component( remember 3 79 and 10 are cranial parasympathetic outflow) Supplies ciliary muscle and iris sphincter. Loss leads to fixed dilated pupil with loss of accomodation
Component of corneal reflex?
Blink reflex
Protects from foreign bodies
Afferent - nasociliary br of V1 of trigeminal nerve.
Centre- pons
Efferent- temporal and zygomatic branches of facial nerve
Orbicularis oculi which shuts the eyes is supplied by
Facial nerve
Part of efferent portion of corneal reflex
Eye opener muscles
Occulomotor nerve— Iii supplying LPS Ms opens eyes
Superior tarsal muscle supplied by sympathetic fibres from superior cervical ganglion opens eye
Holoprosencephaly causes are?
Maternal alcohol
Trisomy 13 patau
Sonic hedge hog gene mutations
Type of developmental field defect ie one embryonic disturbance leads to many malformations because it disrupts the development of many adjacent structures in same field
What is association of anomalies?
Example?
Multiple anomalies occur together without a unifying cause and also it is not by chance
Eg is vacteral anomalies— vertebral anal atresia cardiac te fistula renal and limb anomalies
Spleen is derieved from
Mesoderm of dorsal mesentry
Which finger does not have palmar interossei muscle
3rd finger
Middle finger
Remember palmar interossei causes finger adduction towards middle finger
No need for middle finger to go anywhere hence no adductor needed
What is the function of dorsal interossei
Opp of palmar
Abduction of fingers
