Msk Flashcards
1
Q
Bones shoulder
A
Scapula humerus clavicle
2
Q
Acromion
A
Protrusion scapula
3
Q
Muscles shoulder greater tubercle of humerus
A
Supraspiantus, infraspinatus, teres minor
4
Q
Subscapularis
A
Attach to lesser tubercle
5
Q
Deltoid
A
Abdutor
6
Q
Supraspinatus
A
Abduction 15 degrees first
7
Q
Subscapularis
A
Internal rotate
8
Q
Infraspinatus
A
External rotate
9
Q
Teres minor
A
External toration
10
Q
Suprascapular
A
Supraspinatus
Infraspinatus
11
Q
Axillary
A
Teres minor deltoid
12
Q
Upper and lower subscapularis nerves
A
Subscapularis muscle
13
Q
Shoulder impingement syndrome
A
Pain with overhead activity
Athletes in overhead sports-swimming, volleyball, job painting stocking shelves,
14
Q
Impingement syndrome path
A
When arm abducted over 90 degrees the greater tuberosity of humerus compresses the rotator cuff against the acromion causing pain and decreased motion in the shoulder
15
Q
Diagnose
A
Clinical
- cross over test…cross arm pain in shoulder
- never test passively raise arm forward
- Hawkins Kennedy test floes shoulder 90 degrees and internally rotate
No radiograph, US can evaluate impingement bursitis ,MRI f no work could be tear
16
Q
Treat
A
Rice, PT, corticosteroid injections into subacromial space
17
Q
Thoracic outlet syndrome
A
OT-above 1st rib behind clavicle
Arteries nerves pass though
18
Q
Cause
A
Muscular abnormalities
19
Q
Brachial plexus and subclavian pass between what
A
Anterior and middle scalene in thoracic outlet…scalene muscles can have attachments that narrow space OR fusion of anterior and middle scalene or numerous
20
Q
Cervical rib
A
1% women cervical rb can complex brachial plexus or subclavian
Higher risk of getting TOS after hyperextensive injury
21
Q
Injury TOS
A
1st rub fractures, clavicle, whip lash, repetitive overhead movement, pitching, swimming
22
Q
Symptoms thoracici outlet syndrome
A
What is compressed
23
Q
Types of TOS
A
Neurogenic
arterial
Venous
24
Q
Neurogenic
A
Most common
Arm. Hand pain, numbness weakness
Aggravated by elevation or sustained use
Muscle atrophy
25
Venous TOS
Swelling pain
Bluish color
Venous thrombosis ay develop
26
Arterial TOS
Least common
Associated with cervical rb
Spontaneous symptoms hand ischemia
Thromboembolization in subclavian artery
27
Diagnosis
Reproduce symptoms on exam with arm movements
Imaging
US initial duplex first test done
CT, MRI more anatomical
28
Treat TOS neurogenic
PT, surgical decompression
29
Treat venous
Anticoagulation
| Surgical decompression
30
Treat arterial
Surgical embolectomy
| Surgical decompression
31
Developmental dysplasia of hip
In utero displacement from acetabulum
At birth not formed completely ..interactions ith femoral head forms it
If dont get femoral headin disrupt hip joint
32
Risk factors
First born
Breech presentation
Female
33
Presentation
Hip clicks or clunk from Barlow or ortolani maneuver
34
Barlow test
Flex hip 90 degrees internal rotate and press down or back
If feel or hear clunk or click +
Then external rotate and punch femoral head anterior to relocate doesn’t take a lot of force and clunk
35
Ortolani
Then external rotate and punch femoral head anterior to relocate doesn’t take a lot of force and clunk
Clunk positive
36
Appearance
Asymmetric skin folds and unequal leg length knees unequal height when flexedGALEAZi sign
37
If diagnosis not made
Delayed walking abnormal gait
38
Gait
Trendelenberg—opposite hip sag when weight on hip
39
Diagnose
PE
Hip US
X rays not helpful not enough bone mineralization
Screening-if from breech, female, female neonates with family history
40
Treat before 6 moths
Pavlik harness positions femoral head in proper place so it can develop correctly before 6 month
41
Treat after 6 months
Closed or open reduction and spica casting for 6 months to 2 years
42
Diagnose after 8 years
Not attempted bc reduced benefit
43
Ankle sprain
Lateral most common frame xcessive inversion of plantarflexed foot
Medial from excessive eversion
Syndesmosis high ankle sprain from dorsiflexion/eversion and leads to chronic ankle instability
44
Lateral ankle sprain ligaments
Anterior talofibrular ligament(anterior aspect of lateral malleolus to talus)
Calcaneofibular ligament(lateral malleolus to calcaneous)
Posterior talofinrular ligament (posterior side of lateral malleolus to posterior surface to talus
45
Medial ankle sprain
Deltoid ligament-strongest hard to hurt it
46
Syndesmosis sprain
Anterior tbiofibular ligament and posterioinferior tibiofibular ligament and transverse ligament or interosseous membrane
47
Grade 1
Mild stretching of ligament, microscopic tears, no joint instability, bear weight, ambulated Manila pain
48
Grade II
Incomplete tear of ligament
More pain/swelling
Ecchymosis
Mild/moderate joint instability
Decreased range of motion
Walking is painful
49
Grade III
Complete tear of ligament
Severe pain/swelling
Ecchymosis
Unstable joint
Can’t walk
50
Diagnosis
```
Clincial
Tenderness, swelling
Ecchymosis
Inversion eversion test
Anterior drawer test
```
51
When get x ray
Ottawa Raul
52
Ottawa rule who gets
Bone tenderness at the posterior edge of lateral or medial malleolus
Unable to bear weight
(Can’t walk 4 steps)
Anyone with bone tenderness at fifth metatarsal or navicular
53
Treatment
Rice, range of motion exercises, bracing/splints, surgery if severe instability
54
Plantar fasciitis
First steps of day pain as walk improves sit down for breakfast but get up better then better with walking
Didn’t injure foot but walks a lot at work
Pain worse with dorsiflexion
Radiograph normal
55
What is plantar fasciitis
Thick pearly white originate at calcaneous insert at base of toe is the plantar aponeurosis inflamed and leadto plane
40-60 peak
56
Diagnose
Clincial
Heel pain worse with initiation of walking
First steps of the day, limp out of bed
Sit more pain with steps
Worsening throughout day
Point tenderness heel with dorsiflexion
57
Imaging
Not necessary
58
X ray
May see plantar fascia thickening
| Fat abnormalities
59
US plantar
Plantar fascia thickening
Hypoechogenecity
60
Treat plantar fasciitis
Weight loss, stretching, avoid flat shoes or walking barefoot, have padded arch support, even immediately after waking up , prefab silicone inserts, decrease physical activities, NSAIDS, inject glucocorticoids
61
Myasthenia gravis and lambert Eaton
Look similar
62
Myasthenia gravis
Most common NMJ disorder
Thymus pathology
-50% have thymic hyperplas, 20% have atrophy, 15% thymoma
63
Lambert Eaton syndrome
Uncommon
Associated with small cell lung cancer -may be immune response to SSC
64
Clincial presentation myasthenia
Fluctuating uncle weakness
-ptosis
-diplopia bc extraocular muscle weakness
-Bilbao msucle weakness (chewing swallowing prob or slurred speech)
Neck muscle weak
-proximal arm shoulder
-respiratory weakness and maybe need for mechanical ventilation
65
Clincial lambert Eaton’s
```
Proximal limb weakness
Har walkinga
-hard raising arm
-autonomic dysfunction
—dry mouth, ED
```
66
Myasthenia gravis cause
Antibodies post synaptic ach receptors in NMJ
Worse with muscle use**
Give edrophonium which give transient improvement with weakness (doesn’t work with lambert eaton)
67
Cause lambert eaton syndrome
Antibodies against presynaptic ca channels
Usually open , if prevent get decrease ach and muscle weakness
Weakness improves with muscle use***
68
Treat
Long acting cholinesterase inhbiitors, plasmapheresis for myasthenia
Lambert eaton-treat lung cancer
69
Asprin
Permanently inhibit cyclooxygenase
| Cox1 and 2
70
What do COX do
Convert arachidonic acid to endoperoxides
71
What inhibits cyclooxygenase from converting aa to endoperoxidase
NASIDS< celecoxib, apap, asa
72
How make arachidonic acid
Phospholipase a2 makes it from cell membrane phospholipids
73
How stop phospholipase 2 from making aa
Glucocorticoids
74
How does arachidonic acid become hydroperoxides
5-lipoxygenase
75
How stop 5 lipoxygenase from making hydroperoxides
Zileuton
76
What do endoeroxides become
PGI2, prostagladina, thromboxane a2
77
Pgi2
Decrease platelet aggregation
Decrease vascular tone
Decrease uterine tone
78
Prostagladin
Increase uterine tone (PGE2,2a)
Decrease vascular tone PGE1
79
Thromboxane a2
Increase platelet aggregation and increase vascular tone
80
What does hydroperoxides become
Leukotrienes
81
What do leukotrienes do
Neutrophil chemotaxis (LBT4)
Increase bronchial tone (LTC4, LTD4, LTE4)
82
How stop leukotriene
Zafirlukast, montelukast
83
NSAID effect
Decrease platelet aggregation, decrease fever, analgesia, decrease inflammation
84
Most ocommon use
Antiplatelet drug to prevent mi stroke
85
Acute mi
Take an asprin
86
Side effects asprin
Increase risk of bleeding
Increase risk of peptic ulcers
Hyperventilation (stimulate respiratory centers of brain)
High anion gap metabolic acidosis
Tinnitus
Interstitial nephritis
AKI
Reye syndrome -hepatoencephalopathy ..and hypoglycemia from impaired gluconeogenesis
87
What pediatric disease give asprin
Kawasaki disease
88
Kawasaki disease
Vasculitis in kids high fever, inflammation lips tongue and coronary artery aneurysm
89
NSAIDS
Ibuprofen, naproxen, indometacin, diclofenac, asprin, ketorolac
90
NSAID
Inhibit cyclooxygenase 1 and 2
Asprin permanent
NASIDS reversible
91
Effect of nsaids
Decrease fever, decrease pain, decrease inflammation, decrease platelet aggregation
92
Endomethacin
Can close PDA in new born
Inhibit prostagladins increase vascular tone in newborn increase vascular tone in PDA and close
93
Side effects nsaids
AKI from increase vascular tone and reduced RBF
Acute interstitial nephritis
Gastric ulcers
Aplastic anemia
94
Cox 2 inhibitors selective
Celecoxib
Meloxicam
Nabumetone
95
Cox 2 enzyme
In inflammatory and endothelial cells
96
Cox 1
Everywhere
97
Cox 2 inhibitor benefit and bad
Decrease peptic ulcer disease
Increase risk fo thrombosis though so careful with heart disease
Sulfa drug allergies
98
Rem and derm
Ok
99
Epiphysis plate
End of long bone to allow bone to lengthen-signs of endochondral ossification
100
Limbs achondroplasia
Proximal shorter than distal
Bowing tibia
101
Life expectancy achondroplasia
Fine life span and fertility
Pass on AD
102
One parent achondroplasia what chance pass, both have what is likely hood have
1/2
3/4. 1/5 hetero, 1/4 die bc homozygous
103
Bone healing phase
Inflammatory-hematoma forms. Then osteoclasts resorb 1-2 mm of bone along the fracture edges (takes a few days why fracture lines show up better a week after fracture then right after) then fill in with granulation tissue. Then multipotent periosteal cells become osteoprogenitor cells
Reparative-new blood vessels form outside the bone. Cartilage forms across the fracture site from fibroblasts chondroblasts. Callus formation (endochondral ossification of cartilage)
Remodeling-callus becomes completely ossified. New bone is structurally remodeled by osteoclasts and osteoblasts
104
Osteochondroma
Hamartoma of hte bone
105
Where is osteoclastoma
Distal femur or proximal tibia
106
Most tumors in the bone
Metastatic
107
What cancers metasticize to the bone
Permanently relocated tumors that like bones
| -prostate, renal cell cancer, testes, thyroid, lung, breast
108
Lytic lesion
Renal cell carcinoma
Thyroid
109
Blastic lesion
Prostate cancer
110
Lytic of blastic
Breast cancer , lung cancer
111
Clincial manifestation bone mass
Bone pain
Epidural spinal cord compression -pain, sensory and motor deficits and bladder and bowel dysfunction
Hypercalcemia(lytic)
112
Where does new born formation take place in long bone
Epiphyseal plate
113
Osteosarcoma or osteomyeloma more common
Osteomyeloma
114
Tb mutation
Osteosarcoma
115
Hamartoma
Osteochondroma
116
Anticholinesterase
Keep acetylcholine around
117
Neostigmine
Myasthenia gravis
Reverse neuromuscular blockade
Post op urinary retention
118
Pyrostigmine
Anticholinesterase
For Anticholinergic poisoning (atropine)
119
Pyridostigmine
Reverse neuromuscular blockade
| Myasthenia gravis
120
Rivastigmine
Alzheimer’s disease
| Anticholinesterase
121
How increase heart contractility
Catecholamines-exercise stress
Increase intracellular ca
Decrease extracellular na
Digoxin-increase intracellular ca and decrease intracellular ca
122
Osteoblast to osteocytes
Osteocyte live in lacune and contact and communicate with each other by canaliculi
-osteoblast get suck and become osteocyte
123
Osteoblast look like
Multinucleated giant cell
124
Why get osteoporosis
More bone loss than bone gain
125
DEXA
How much x ray absorbed when pass-absorb more
126
Colles
Hand goes dorsally
127
Treat osteoporosis
Stop smoking, stop steroids, increase weight bearing
Calcium and vit D
Bisphosphonates -inhibit osteoc
128
Bisphosphonates
-dronate
Inhibit osteoclast allow osteoblast to catch up
129
What use bisphosphonates for
Osteoporosis
Paget
Humoral hypercalcemia of malignancy-tumor make pthrp
Long term steroid use
130
AE bisphosphonates
Erosive esophagitis
| Osteopetrosis of the jaw -wont do jaw surgery unless of for a few months
131
Conjugated estrogen for osteoporosis
WHI trial->hip fracture reduction
USPSTF recommends not using estrogen for the sole purpose for fracture reduction risk due to risk of other side effects (MI CVA)
132
SERM (raloxifene)
Decreases vertebral fracture by 40% in women with osteoporosis, no effect on risk of non vertebral fracture risk, reduces risk of breast cancer
133
Teriparatide (recombinant TPH analog that stimulates osteoblasts)
Decreases hip fracture rate by 53%. During of therapy not to exceed two years. Must use bisphosphate after stopping teriparatide to maintain bone mineral density.
134
Denosumab
Rank-L inhibitor
135
Paget disease symptoms
None
Big ass skull
Fractures
Increase osteosarcoma
136
Renal tubules not absorbing phosphate
Type 1A pseudohypoparathyroidism (Albright hereditary osteodystrophy)
PTHn resistance at renal tubules and low serum a and high phosphate
137
Reversible when VD replaced
Osteomalacia, rickets
138
Joints
-3 to -5 mmHg negative pressure
It is a potential space like pleural and pericardial cavity that brings fluid into it
139
Rupture biceps tendon /popeye lesion
Can tear at elbow or shoulder from lifting something heavy
See bruising and muscle bulge in middle part
Looks bad
If older and can function just rest
Youngster-surgery if effecting function
140
Antibiotics increase tendon rupture
Fluoroquinolones -Achilles
141
Empty can test
Abduct to 90 and flex thumb straight down try to push down as they resist if pain and weakness or both it is that injury
142
Dislocated vs separated shoulder
Dislocated-head of humerous rotates out of glenoid cavity
Separation-clavicle separate from acromion and coracoid process of scapula
143
Anterior shoulder dislocation
Axillary nerve and posterior circumflex artery
Supraspinatus tendon
Anterior glenohumoral ligaments separation glenoid labrum from articular surface of anterior glenoid neck-Bankart lesion
Posterolateral humeral head from forceful impact against anterior in of glenoid-hill sachs lesion
-see hill sacks lesion
Squared off shoulder
Resist abduction and internal rotation
Humeral head palpable anteriorly
Must texst axillary
144
Test nerve damage in anterior shoulder dislocation-check before reduction and after
Sensationof deltiod region
145
Reduction closed
Put back into place
146
Open reduction
Put back into shoulder with surgery
147
Most common type of hip dislocation
Posterior
Acetabulum slips out posteriorly
MVA where knee strikes dashboard with hip abducted
Medial and lateral circumflex femoral artery-from deep femoral artery give blood to femoral neck
Femoral vein
Sciatic nerve
Head of femur
148
Posterior shoulder
Arm held addicted in internal rotation inability to actively or passively externally rotate or abduct arm, palpable posterior fullness, prominent coracoid process
From fall onoutstretched hand
Anterior flatness, unable to externally rotate or abduct the affectedarm
Humeral head medially rotated
Empty glenoid sign
149
Imaging to diagnose ACL injury
mri
| Lose clear line and hazy from hemarage and edema
150
Ligemtns ankle
1. ATF most common always tear first
2. Calcaneofibular ligament
3 posterior talo fibular ligament
151
Media ligaments
Deltoid ligament -hard to do it
152
How treat ankle sprain
RICE
Rest, ice, compression, elevation
153
Most common arthritis
Osteoarthritis
| Wear and tear of articular cartilage
154
Eburnation of bone
Bone hard and dense like ivory in osteoarthritis
See nobby hands
155
Joints effects in osteoarthritis
Hands
Knee fingers
Spine hip
156
Treat osteoarthritis
Acetaminophen
NSAIDS
COX2 inhibitor
Topical capsaicin cream
Intraarticular glucocorticoid injections .comopioids
Tramadol
Joint replacement-obese and cant walk, then
157
Acetaminophen
Max 4 grams a day
Fewer side effects than NSAIDS
158
Acetaminophen
NAPQ! Depletes glutathione
Floats around and reacts with hepatocytes ALT AST rise get liver failure and die
N acetylcysteine retreated glutathione
159
N acetylcysteine
Acetaminophen overdose
Mucolytic in CF or incubated inhaled
Prevent contrast nephropathy -chronic kidney disease where need IV contrast and worry worsen renal failure give oral n acetylcysteine
Nephropathy
160
NSAIDS for osteoarthritis
```
Asprin
Diclofenac
Ibuprofen
Naproxen
Nabumetone
Meloxicam
Indomethacin
```
161
COX2 inhibitors
Celecoxib
| Meloxicam-inhibtis more cox2 than cox1
162
Where is cox2
Inflammatory cells in vascular endothelium
Less peptic ulcer disease
Can still cause some PUD and gastritis
163
COX1
Helps gastric mucosa
164
If have PUD
Stop NSAID
165
COX2
Osteoarthritis and rheumatoid arthritis
| Gout
166
COX2 AE
Increase thrombosis
| Sulfa
167
Asprin
Antiplatelet at low
| Analgesic and anti inflammatory at higher levels
168
Asprin side effects
Gastric ulcer GI bleed
Tinnitus
Hyperventilation
Acute renal failure
169
Joint hand RA
Swan neck
| Boutonnière deformity
170
Wrist RA
Radial deviation at the wrist with ulnar deviation of the digits
Deformity resulting in median nerve entrapment (carpal tunnel syndrome)
171
Elbow RA
Flexion contracture
172
Knee RA
Synovial hypertrophy with chronic effusion and ligamentous laxity
173
Posterior knee RA
Synovial hypertrophy with chronic effusion and ligamentous laxity
174
Ankle, forefoot, subtalar
Deformities,pain with ambulatory
175
Upper cervical spine
Atlantoaxial subluxation
176
Treat RA
Acute-NSAIDS, COX2 inhibtiors, steroids
Long-DMARDS, methotrexate, hydroxychloroquine, sulfasalazine, TNF a inhibitors
177
TNF a inhibitors
```
Etanercept
Infliximab
Adalimumab
Golimumab
Certolizumab
```
178
Swollen, hard, painful finger
Osteoarthritis
179
Swollen boggy painful finger joints
RA
180
Cartilage erosion with polished bone beneath
Osteoarthritis
181
Ankylosis arthritis
Run in morning. Bc reduce stiffness
Conduction abnormalities-CVD in general
182
Treat seronegative spondylitis
TNF a inhibits
183
TNF
Cytokine that induces the immune system
184
TNFa inhibitors
Bind to TNFa
| Prevent activation of the immune system
