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HDS > Mod 1: Clinical Correlates > Flashcards

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
Q

What is a type of cell that uses clathrin endocytosis?

A

steroid hormone secreting cell

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26
Q

Leg bone fractures

A 
tibia and fibula often shattered together
breaks midshaft (weakest here)
open fractures (esp at ant surface of tibia)
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27
Q

Fractures at distal locations of leg bones due to

A

skiing accidents – leg is bent over top of rigid ski boot

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28
Q

Diagonal fracture of tibia and fibula result in…

A

shortening

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29
Q

What prevents bow-stringing of muscles of ant compartment of leg?

A

sup and inf extensor retinaculum

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30
Q

Ant compartment syndrome

A

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

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31
Q

5 P’s of ACS

A 
Pain 
Pallor
Paraesthesia
Pulselessness
Paralysis
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32
Q

Shin splints

A

overexertion injury involving tibialis ant

Overuse of muscle causes tears in periosteum of ant tibia – pain

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33
Q

Symptoms of abnormal mito

A

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

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34
Q

Parkinson’s disease is result of …

A

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

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35
Q

Drugs for Parkinson’s target

A

boost mitophagy

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36
Q

Uterus: gravid vs normal

A

HYPERTROPHY (inc cell size)

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37
Q

Cell change prior to menses in uterine rugal folds

A

hyperplasia (change in cell number)

–inc in number of cells in uterine glands and endometrial blood vessels

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38
Q

Dysplasia

A

REVERSIBLE replacement of DIFFERENTIATED cell type with an earlier, DE-DIFFERENTIATED form of the same cell type

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39
Q

Metaplasia

A

REVERSIBLE replacement of one differentiated cell type with another MATURE cell type

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40
Q

Change in cell type if person stops smoking

A

metaplasia (normal columnar epithelium become squamous metaplasia)

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41
Q

Anaplasia

A

IRREVERSIBLE replacement of a differentiated cell type with an earlier, de-differentiated form of the same type

42
Q

What is the cancer continuum?

A

Dysplasia –> metaplasai –> anaplasia

43
Q

What is the cell change that is irreversible?

A

Anaplasa

44
Q

Why is it important to make early diagnosis?

A

earlier, more likely for cells to be viable

45
Q

Describe how mvmts of ankle structure affect injury

A

Ankle joint strongest in dorsiflexion and weakest in plantarflexion
Most ankle injuries occur in plantar flexion

46
Q

Components of lateral lig of ankle

A

Ant talofibular
Post talofibular
Calcaneofibular

47
Q

Components of medial ligament of ankle

A

Ant tibiotalar
Post tibiotalar
Tibionavicular
Tibiocalcaneal

48
Q

How lig of ankle are involved in ankle injury

A

Lat lig weaker, so more likely to sprain this side

Med lig stronger –> stabilizes everted ankle and prevents dislocation

49
Q

What is the most freq injured joint in body?

A

ankle

50
Q

What lig is most likely to be torn in inversion injury?

A

ant talofibular lig

51
Q

Potts fracture

A

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
Q

Carpal tunnel syndrome

A

tunnel: carpals and flexor retinaculum
tendons: 4 FDS, 4 FDP, FPL
Median nerve
tendons swell –> impact median nerve
Cut flexor retinaculum to treat

53
Q

Where do you test sensory innervation of:
radial
median
ulnar nerves?

A

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
Q

Test motor function of
radial
median
ulnar nerves

A

Radial: thumbs up (IP joint extension)
Median: Ok sign (palmar abduction)
Ulnar: cross index and middle fingers (test interossei)

55
Q

Test motor function of
FPL
FDP
FDS

A

FPL: flexion of thumb at IP joint
FDP: flexion at DIP joint
FDS: flexion at PIP

56
Q

Claw hand

A

Ulnar nerve at wrist (inactive hand)

Lumbricals 3 and 4 affected

57
Q

Hand of benediction

A

Median n at ELBOW (when attempting to make fist)

Lumbricals 1 and 2 and lateral half of FDP affected

58
Q

Ape hand

A

Median nerve AFTER elbow (passive)
cannot abduct or oppose thumb
Abductor pollicis brevis and oppens pollicis affected

59
Q

Radial nerve injury causes

A

wrist drop (no intrinsic hand extensors

60
Q

What artery of hand gives rise to the digital arteries?

A

Sup palmar arch (from ulnar a)

61
Q

Thalassemia

A

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
Q

Sickle cell

A

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
Q

Erythrocytes of iron deficient pts under microscope looks like…

A

pale staining

low Hb levels

64
Q

HbA1C, HGBA1C, GHb

A

diagnostic indicator for diabetes, cardiovascular disease

65
Q

Describe glycation of Hb

A

Rate of HbA1C formation proportional to ambient glucose in which RBC circulates to the duration of exposure until turnover

66
Q

When is HbA1C not a reliable indicator of mean blood glucose?

A 
Abnormal Hb (HbS, HbC)
Malignancies
Iron deficiency
67
Q

Hereditary spherocytosis

A

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
Q

If the primary cilia become nonfunctional, what occurs?

A

primary cilia involved in hedgehog pathway
ciliopathies result – cystic kidneys, obesity, mental retardation, blidness, and developmental malformations (ex. Bardet-Biedl syndrome)

69
Q

Dermatomes for hand

A

C6: thumb
C7: index and middle
C8: ring and pinky

70
Q

Klumpke paralysis is characterized by…

A

claw hand

damage to lower brachial plexus – ulnar n

71
Q

Varicose veins

A

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
Q

Coronary bypass

A

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
Q

Venous cutdown

A

Great saphenous used – 1 cm ant and sup to medial malleolus

74
Q

Deep vein thrombosis

A

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
Q

Pelvic fractures

A 
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
Q

Avulsion fracture

A

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
Q

Types of avulsion fractures of the pelvis

A 
Iliac wing (Duverney fracture)
Sup pubic ramus
Inf pubic ramus
Transverse sacral
Coccyx
ASIS
AIIS
Ischial tuberosity
78
Q

Hip joint dislocation

A

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
Q

Hip dislocation vs fracture

A

Fracture: externally rotated
Dislocation: internally rotated

80
Q

Piriformis syndrome

A

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
Q

Gluteal injections

A

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
Q

Clavicular fracture

A

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
Q

Rotator cuff muscles that attach at greater tubercle vs lesser tubercle

A

greater:
supraspinatus
infraspinatus
teres minor

lesser:
subscapularis

84
Q 
Nerves that directly contact parts of humerus:
Surgical neck
Radial groove
Distal end of humerus
Medial epicondyle
A

Surgical neck: axillary n
Radial groove: radial n
Distal end of humerus: median n
Medial epicondyle: ulnar n

85
Q

What tendon pierces the glenohumeral capsule?

A

long head of biceps tendon

86
Q

Coracoacromial arch

A

protective structure limits superior displacement

87
Q

Shoulder separation vs dislocation

A

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
Q

Inf dislocation of glenohumeral joint (shoulder dislocation) often accompanied by what kind of fracture?

A

avulsion fracture of greater tubercle

89
Q

Injury to thoracodorsal nerve

A

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
Q

Dorsal scapular n innervates

A

levator scapulae

rhomboid major and minor

91
Q

Lower subscapular n innervates

A

teres MAJOR

92
Q

Injury to axillary n

A

deltoid atrophy – depression
Loss of sensation
Inability to abduct arm
“Policeman’s patch” syndrome

93
Q

Rotator cuff muscle action and innervation

A

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
Q

Rotator cuff injury

A

usually supraspinatus
trouble abducting arm
may occur with fraying of intracapsular part of tendon of long head of biceps – stiff shoulder

95
Q

Branches of thyrocervical trunk

A

transverse cervical a

suprascapular a

96
Q

What blood supply would provide circulation around an occlusion/trauma to the axillary artery above the subscapular a?

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
Q

Ehlers-Danlos syndromes

A

result from defects in synthesis/structure of collagen

98
Q

Necrosis: Mycobacterium tuberculosis

A

Caseous: soft, cheese-like center containing dead tissue

99
Q

Necrosis: coagulative

A

ex. spleen, liver, heart wall
vascular blockage/infarct
WBC infiltration after cell death is minimal (tissue architecture preserved for days/weeks)

100
Q

Liquefactive necrosis

A

related to bacterial/fungal infections or hypoxia in brain

many WBC recruited

101
Q

Fat necrosis

A

fat cell destruction through enzyme degradation or blunt force trauma – lipids released from cells are calcified (chalky, white)

102
Q

Fibrinoid necrosis

A

immune complexes deposited on arterial walls – microscopic tears and fibrin deposition
ex. SLE, lupus (autoimmune disorder)

HDS (14 decks)

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