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Mod 1: Clinical Correlates Flashcards

1
Q

Coxa vara

Coxa valga

A

Coxa vara: NSA too SMALL – MEDIAL deviation of shaft relative to the neck
–can be due to rickets (reduce bone quality during growth)
Coxa valga: NSA too LARGE – LATERAL deviation of shaft relative to neck
–can be due to slipped capital epiphyses during growth
**normal adult neck-shaft angle is 124-135 deg
**less active urban pop have higher values
**lower values as age inc
**both associated with inc risk of patello-femoral OA due to deviated pull of quads

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2
Q

Femoral fractures

A

Neck fractures most common
**direct impact injuries
**osteoporosis –old
**treat quickly to prevent femoral head necrosis as result of interuption of blood supply (med femoral circumflex a)
Shaft fractures more common in younger, more active people
**direct trauma
**may be comminuted

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3
Q

Muscles in what compartment of thigh atrophy rapidly with disease or disuse?

A

Ant compartment (extensors of knee)

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4
Q

Duchenne’s muscular dystrophy

A

progressive muscle weakness
inability of contractile apparatus to anchor properly without DYSTROPHIN
Gower’s sign is early diagnostic feature
Adipose tissue replaces muscle

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5
Q

Gower’s sign

A

Gower’s sign indicates a patient that must use its
arms to “walk up” their body from a squatting
position due to weakness of the hip and leg muscles.
–indicates Duchenne’s muscular dystrophy

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6
Q

Nemaline myopathy

A

mutations to NEBULIN, TROPOMYOSIN, TROPONIN

presence of rods/nemaline bodies in skeletal muscle fibers

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7
Q

Myasthenia gravis

A
  • -autoimmune disorder
  • -progressive muscle weakness and fatigability
  • -weakness caused by REDUCTION in number of functional ACETYLCHOLINE RECEPTORS in SARCOLEMMA of END PLATE
  • -circulating ANTIBIDIES BIND TO RECEPTORS
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8
Q

Dilated cardiomyopathy/ congestive heart failure

A

if PLN superinhibitory or chronically inhibitory, contractility is reduced
dilated cardiomyopathy: heart enlargement resulting in inability to pump blood efficiently (myocardium)

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9
Q

Treatment for spastic medial rotation and adduction of thigh in cerebral palsy

A

transect ant branch

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10
Q

Boundaries of femoral triangle

A

sup: inguinal ligament
lat: sartorius
med: adductor longus
floor: pectineus (medially) and iliopsoas (laterally)
roof: cribiform fascia centrally and tough fascia lata circumferentially

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11
Q

Contents of femoral triangle

A

Femoral nerve
Femoral artery
Femoral vein
Deep inguinal nodes and associated channels

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12
Q

What are the contents of the fibrous femoral sheath

A

Femoral a, v

Deep inguinal nodes and associated channels

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13
Q

Where does great saphenous vein pierce?

Where does it empty into?

A

Pierces cribiform fascia and femoral sheath to empty into the femoral v

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14
Q

What is the most common site for hernias in women?

A

femoral triangle – hernias of small intestine

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15
Q

Boundaries of popliteal fossa

A

superomedially: semimembranosus
superolaterally: biceps femoris
inferiorly: lat and med heads of gastrocnemius

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16
Q

Contents of popliteal fossa

A 
popliteal a and v
tibial n
common fibular n
small saphenous v
popliteus
plantaris
soleus
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17
Q

Branches of popliteal a in popliteal fossa

A

sup lat genicular
sup med
inf lat
inf med

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18
Q

Popliteal aneurysm

A

dilations of popliteal a larger than 2 cm diameter
most common aneurysm in periph vasculature
occurs bilaterally in half of pts
can cause distal limb ischemia if associated with thrombus that leads to embolism
15% of pts with acute ischemia eventually require amputation of leg
up to 40% of pts with popliteal aneurysm will also have abdominal aortic aneurysm

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19
Q

Unhappy triad

A

ACL
TCL
medial meniscus (however, lat meniscus tars more common with ACL and TCL tears)

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20
Q

Ant drawer sign

A

test ACL integrity

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21
Q

Post drawer sign

A

test PCL integrity

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22
Q

Alzheimer’s and defective plasma membrane

A

gamma secretase does not chop amyloid beta protein (which is then supposed to go inside cell to regulate gene expresssion)
mutation in gamma secretase –> accumulation of amyloid beta protein –> plaque

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23
Q

Fc receptor involved in what phagocytic process?

Nonspecific receptor?

A

Fc: phagocytosis of foreign bio molec
Nonspecific: dirt/debris (nonbio)

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24
Q

Dynamin involved in what process?

What kind of protein is it?

A

Receptor-mediated endocytosis (w/ clathrin)

GTPase

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25
What is a type of cell that uses clathrin endocytosis?
steroid hormone secreting cell
26
Leg bone fractures
``` tibia and fibula often shattered together breaks midshaft (weakest here) open fractures (esp at ant surface of tibia) ```
27
Fractures at distal locations of leg bones due to
skiing accidents -- leg is bent over top of rigid ski boot
28
Diagonal fracture of tibia and fibula result in...
shortening
29
What prevents bow-stringing of muscles of ant compartment of leg?
sup and inf extensor retinaculum
30
Ant compartment syndrome
Elevated pressure following fracture (hemorrhage and edema) exacerbated by casting exceeds arterial pressure --> ischemia and tissue death Treat: fasciotomy Muscles and neurovasculature of ant compartment surrounded by imcompressible tissues with little room for expansion Pain due to perforating branch of deep fib n
31
5 P's of ACS
``` Pain Pallor Paraesthesia Pulselessness Paralysis ```
32
Shin splints
overexertion injury involving tibialis ant | Overuse of muscle causes tears in periosteum of ant tibia -- pain
33
Symptoms of abnormal mito
poor growth loss of muscle corrdination, muscle weakness visual/hearing problems developmental delays, learning disabilities mental retardation heart, liver, kidney disease GI disorders, severe constipation
34
Parkinson's disease is result of ...
improper balance of fusion/fission of mito deterioration of nerve cells in part of brain that controls mvmt dopamine produced in this area, but damage reduces levels insufficient dopamine disturbs balance b/w dopamine acetylcholine --> loss of muscle function
35
Drugs for Parkinson's target
boost mitophagy
36
Uterus: gravid vs normal
HYPERTROPHY (inc cell size)
37
Cell change prior to menses in uterine rugal folds
hyperplasia (change in cell number) | --inc in number of cells in uterine glands and endometrial blood vessels
38
Dysplasia
REVERSIBLE replacement of DIFFERENTIATED cell type with an earlier, DE-DIFFERENTIATED form of the same cell type
39
Metaplasia
REVERSIBLE replacement of one differentiated cell type with another MATURE cell type
40
Change in cell type if person stops smoking
metaplasia (normal columnar epithelium become squamous metaplasia)
41
Anaplasia
IRREVERSIBLE replacement of a differentiated cell type with an earlier, de-differentiated form of the same type
42
What is the cancer continuum?
Dysplasia --> metaplasai --> anaplasia
43
What is the cell change that is irreversible?
Anaplasa
44
Why is it important to make early diagnosis?
earlier, more likely for cells to be viable
45
Describe how mvmts of ankle structure affect injury
Ankle joint strongest in dorsiflexion and weakest in plantarflexion Most ankle injuries occur in plantar flexion
46
Components of lateral lig of ankle
Ant talofibular Post talofibular Calcaneofibular
47
Components of medial ligament of ankle
Ant tibiotalar Post tibiotalar Tibionavicular Tibiocalcaneal
48
How lig of ankle are involved in ankle injury
Lat lig weaker, so more likely to sprain this side | Med lig stronger --> stabilizes everted ankle and prevents dislocation
49
What is the most freq injured joint in body?
ankle
50
What lig is most likely to be torn in inversion injury?
ant talofibular lig
51
Potts fracture
caused by forcible eversion tears deltoid ligament (med ligament) breaks distal shaft, med malleolus, lat malleolus, and post margin of distal tibia (trimalleolar fracture)
52
Carpal tunnel syndrome
tunnel: carpals and flexor retinaculum tendons: 4 FDS, 4 FDP, FPL Median nerve tendons swell --> impact median nerve Cut flexor retinaculum to treat
53
Where do you test sensory innervation of: radial median ulnar nerves?
Radial: space b/w thumb and index finger on dorsal hand Median: palmar surface, tip of index finger or thumb Ulnar: palmar surface, tip of little finger
54
Test motor function of radial median ulnar nerves
Radial: thumbs up (IP joint extension) Median: Ok sign (palmar abduction) Ulnar: cross index and middle fingers (test interossei)
55
Test motor function of FPL FDP FDS
FPL: flexion of thumb at IP joint FDP: flexion at DIP joint FDS: flexion at PIP
56
Claw hand
Ulnar nerve at wrist (inactive hand) | Lumbricals 3 and 4 affected
57
Hand of benediction
Median n at ELBOW (when attempting to make fist) | Lumbricals 1 and 2 and lateral half of FDP affected
58
Ape hand
Median nerve AFTER elbow (passive) cannot abduct or oppose thumb Abductor pollicis brevis and oppens pollicis affected
59
Radial nerve injury causes
wrist drop (no intrinsic hand extensors
60
What artery of hand gives rise to the digital arteries?
Sup palmar arch (from ulnar a)
61
Thalassemia
production of Hb chains dysfunctional alpha and beta thalassemia (chains can be normal, but amounts are insufficient) Result: anemia Treatment: blood transfusion, B vit, folic acid
62
Sickle cell
HbS caused by variant of beta-globin gene (Gla --> Val) autosomal recessive Result (anemia, sickle crisis, stroke, splenic dysfunction, resistence to malaria) Treatment: bone marrow transplant
63
Erythrocytes of iron deficient pts under microscope looks like...
pale staining | low Hb levels
64
HbA1C, HGBA1C, GHb
diagnostic indicator for diabetes, cardiovascular disease
65
Describe glycation of Hb
Rate of HbA1C formation proportional to ambient glucose in which RBC circulates to the duration of exposure until turnover
66
When is HbA1C not a reliable indicator of mean blood glucose?
``` Abnormal Hb (HbS, HbC) Malignancies Iron deficiency ```
67
Hereditary spherocytosis
Cause: mutations in ankyrin, band 3 and spectrin -- weak interactions b/w cytoskeletal and intrinsic proteins destabilizes lipid bilayer causing cell to become spherical Symptoms: anemia, jaundic, splenomegaly (enlarged spleen) Result: spherocytes enter spleen and are killed by macrophages; spherocytes get stuck in splenic cords --> splenomegaly --> excessive RBC production, anemia Treatment: blood transfusion, partial splenectomy, remove cells stuck in cords
68
If the primary cilia become nonfunctional, what occurs?
primary cilia involved in hedgehog pathway ciliopathies result -- cystic kidneys, obesity, mental retardation, blidness, and developmental malformations (ex. Bardet-Biedl syndrome)
69
Dermatomes for hand
C6: thumb C7: index and middle C8: ring and pinky
70
Klumpke paralysis is characterized by...
claw hand | damage to lower brachial plexus -- ulnar n
71
Varicose veins
when valves either become lax or completely rotating so blood flows back distally and veins become engorged --pregnancy: common iliac vv compressed by enlarge uterus -- increased venous pressure
72
Coronary bypass
great saphenous v used -- strip valves or put upside down easy access b/c very superficial (however, higher success when int thoracic a is used for bypass)
73
Venous cutdown
Great saphenous used -- 1 cm ant and sup to medial malleolus
74
Deep vein thrombosis
formation of blood clot (thrombosis) in deep vein of lower limb (due to venous stagnation -- elongated periods of rest) - -ant or post tibial vv - -pulmonary thromboembolism -- blocks pulmonary artery
75
Pelvic fractures
``` complex, many breaks direct trauma (motor vehicle) or extreme loads transmitted by lower extremity (fall) Many complications b/c many structure sin pelvis --Urogenital/neurological injury ```
76
Avulsion fracture
Hip bone avulsion fractures -- tendon pulls away from attachment site, removing bone in the process Common at iliac spines and ischial tuberosity Teen athletes -- high loads on epiphyses b/f growth plate ossifies
77
Types of avulsion fractures of the pelvis
``` Iliac wing (Duverney fracture) Sup pubic ramus Inf pubic ramus Transverse sacral Coccyx ASIS AIIS Ischial tuberosity ```
78
Hip joint dislocation
hip is flexed, abducted, externally rotated (sitting position--weakest position for hip joint) Iliofemoral lig prevents ant dislocations -- very rare Post dislocations most common -- tear joint capsule and surrounding lig, accompanied by fracture of acetabular rim
79
Hip dislocation vs fracture
Fracture: externally rotated Dislocation: internally rotated
80
Piriformis syndrome
overextension/hypertrophy of piriformis muscle can result in compression of sciatic n, causing pain in buttock and post thigh and muscle weakness Treatment: stretching, antiinflammatory meds, surgery to cut tendon of piriformis
81
Gluteal injections
Sup lateral quadrant is safest (inf quadrant: damage sciatic n, inf gluteal NAV, pudendal n, internal pudendal vessels) (sup med quadrant: sup gluteal n and vessels)
82
Clavicular fracture
med segment of clavicle projecting superiorly (sternocleidomastoid) upper limb depressed (wt of limb), adducted (pec major and lat dorsi), and med rotated (pec major, lat, teres major, subscapularis) (sagging shoulder) greenstick fracture in kids
83
Rotator cuff muscles that attach at greater tubercle vs lesser tubercle
greater: supraspinatus infraspinatus teres minor lesser: subscapularis
84
``` Nerves that directly contact parts of humerus: Surgical neck Radial groove Distal end of humerus Medial epicondyle ```
Surgical neck: axillary n Radial groove: radial n Distal end of humerus: median n Medial epicondyle: ulnar n
85
What tendon pierces the glenohumeral capsule?
long head of biceps tendon
86
Coracoacromial arch
protective structure limits superior displacement
87
Shoulder separation vs dislocation
Separation: dislocation of AC joint; more severe if includes tear of coracoclavicular lig --prominence on shoulder where clavicle extends above acromion Dislocation: dislocation of glenohumeral joint (humeral head displaced ant/inferiorly) -- ant to infraglenoid tubercle --intact AC joint looks more prominent
88
Inf dislocation of glenohumeral joint (shoulder dislocation) often accompanied by what kind of fracture?
avulsion fracture of greater tubercle
89
Injury to thoracodorsal nerve
paralysis of lat dorsi unable to raise trunk with the upper limbs (climbing) cannot use axillary crutch b/c shoulder is pushed superiorly by it --these activities require active depression of scapula
90
Dorsal scapular n innervates
levator scapulae | rhomboid major and minor
91
Lower subscapular n innervates
teres MAJOR
92
Injury to axillary n
deltoid atrophy -- depression Loss of sensation Inability to abduct arm "Policeman's patch" syndrome
93
Rotator cuff muscle action and innervation
Supraspinatus: abduct, suprascapular n Infraspinatus: lat rotate, suprascapular n Teres minor: lat rotate, axillary n Subscapularis: adducts and med rotates, upper and lower subscapular nn
94
Rotator cuff injury
usually supraspinatus trouble abducting arm may occur with fraying of intracapsular part of tendon of long head of biceps -- stiff shoulder
95
Branches of thyrocervical trunk
transverse cervical a | suprascapular a
96
What blood supply would provide circulation around an occlusion/trauma to the axillary artery above the subscapular a?
Scapular arterial anastamoses suprascapular (from subclavian) dorsal scapular (from transverse cervical from subclavian) circumflex scapular (from subscapular of axillary) intercostal aa (from thoracic aorta)
97
Ehlers-Danlos syndromes
result from defects in synthesis/structure of collagen
98
Necrosis: Mycobacterium tuberculosis
Caseous: soft, cheese-like center containing dead tissue
99
Necrosis: coagulative
ex. spleen, liver, heart wall vascular blockage/infarct WBC infiltration after cell death is minimal (tissue architecture preserved for days/weeks)
100
Liquefactive necrosis
related to bacterial/fungal infections or hypoxia in brain | many WBC recruited
101
Fat necrosis
fat cell destruction through enzyme degradation or blunt force trauma -- lipids released from cells are calcified (chalky, white)
102
Fibrinoid necrosis
immune complexes deposited on arterial walls -- microscopic tears and fibrin deposition ex. SLE, lupus (autoimmune disorder)

HDS (14 decks)

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