MSK Flashcards
what are symptoms of axillary nerve injury?
(C5-6) flat deltoid, failure with abduction of arm >15 degrees, usually with neck fracture of humerus or anterior dislocation
Radial nerve injury?
C5-T1, wrist drop, loss of extension of wrist, elbow, finger , dec grip strength, , loss sensation posterior forearm and dorsal hand
Median nerve injury?
supracondylar fracture, carpel tunnel, loss of wrist flex and fingers, thumb opposition. Loss of sensation over thenar eminence and palmar aspect of 3.5 fingers
Ulnar injury?
fracture median epicondyle- hamate- loss wrist flexion, flexion medial fingers, adduction of the fingers
what is erbs palsy?
(C5/6)lateral traction neck during delivery, arm is adducted, medially rotated, pronated and extended
what is klumpke palsy?
lower trunk C8-T1, you get claw hand, upward force of the arm at delivery or adults, grabbing tree branch during fall, lumbricals, interossei, thenar and hypothenar
what does the McMurray test for?
Meniscal tears- popping or pain with external rotation is a medial menicus tear, while popping or pai with internal rotation is a lateral menicus tear
what is a baker’s cyst?
fluid collection (secondary to inflam-osteoarthritis or rheumatoid) in gastrocnemius and semimembranous bursa- popliteal fluid collection
What is the most common lower ankle sprain? What is the most common high ankle sprain?
low- anterior talofibular ligament
high- anterior inferior tibiofibular ligament
what nerve injury is associated with pelvic fracture?
femoral nerve (L2-4), anterior thigh and medial thigh sensation, , dec thigh flexion and leg extension
what does the sciatic nerve split into?
common peroneal and tibular nerves (injury from herniated disc)
what causes trendelenburg gait?
superior gluteal nerve injury (L4-S1), the hip that drops- the injury is on the other side
what does the pudenal nerve supply?
(S2-4) perineum-urethral and anal sphincters
what is De Quervain tenosynovitis
non inflam thickening of abductor pollicis brevis and extensor pollicis brevis, pain on Finkelsteins , radial styloid with active or passive stretch of thumb
What is Legg-Calve Perthes?
usually 5-7 year olds necrosis of femoral head, x-ray often normal, hip pain with limp
What is slipped capital femoral epiphysis?
epiphyses slips relative to femoral head, usually obese 12 year old due to axial forces, hip/knee pain and surgery needed
which direction to lumbosacral discs usually herniate?
posterolateral into the central canal so affect nerve underneath (ie L3/4 affects L4)
what are the common lumbosacral radiculopathies?
- L3/L4- difficulty with knee extension, dec patellar reflex
- L4/5- difficulty with heel walking and dorsiflexion
- L5/S1- difficulty with toe walking and plantar flexio, dec achilles reflex
What are type 1 and type 2 muscle fibers?
Type 1: red, high mitochondria and myoglobin, red, for endurance, oxidative phosphorylation
Type 2: white: low mitochondria, low myoglobin, weight training, sprinting, white fibers, anaerobic glycolysis
How does estrogen work in bone metabolism?
-inhibits osteoclasts and increases osteoblasts. Fusion of epiphyseal plate in puberty
What is achondroplasia?
failure of endochondral and membranous ossification- failure of long bones and big head relative to rest of body (membranous), constitutive activation of FGFR inhibits chondrocytes. Most sporadic, can be AD, homozyg lethal
What is osteomalacia/Ricketts?
failure of bone mineralization, vitamin D deficiency
-widening epiphyses, metaphyseal cupping, rachitic rosary (bead-like costo-chondral junctions)
What is Pagets disease?
increased osteoclast then osteoblast formation, , poor quality bone
- Ca, PTH and phosphorus all normal
- hearing loss is common secondary to auditory foramen narrowing
Why do you get osteonecrosis (avascular necrosis) of the femoral head?
medial circumflex femoral artery
-legg calve perthes, slipped capital femoral epiphyses, alcohol, corticosteroids,sickle cell, gaucher disease
What are the antibodies for rheumatoid arthritis?
IgM against IgG Fc portion, anti-CCP
whats the difference between Rheumatoid joint involvement and OA?
OA- DIP, PIP, 1CMC, osteophytes, heberdej nodes on DIP, bouchard on PIP
Rheumatoid- 1st CMC, PIP, erosions, subluxations, swan neck and boutinerres
What are the most common bugs for septic arthritis?
staph, strep and neisseria
What are the seronegative spondyloarthropathies?
RF negative (usually HLA B27- no IgG antibodies)
- Psoriatic
- IBD
- Ankylosing spondylitis
- Reactive
What is the classic triad for reactive arthritis and what bugs cause it?
urethritis, arthritis and conjunctivitis
-shigella, yersinia, campylobacter, chlamydia, salmonella
What are the manifestations of lupus?
SOAP BRAIN MD
-serositis, oral ulcers (painless), arthritis, photosensitivity, blood disorder (cytopenias), renal disease, ANA positive, immune (type 3 hypersensitivity-lack of early complement C1q, C4, C2, dec clearance immune complexes), neurological, malar, discoid rashes
What is the difference between polymyalgia rheumatica and polymyositis?
polymyositis/dermatomyositis has elevated CK
what are the antibiotdies for polymyositis and dermatomyositis?
anti-Jo, anti-SRP, anti-M2, elevated CK
polymyositis is associated with what on biopsy?
endomysial inflammation with CD8 T cells
what are the common derm features of dermatomyositis?
gottrons papules, heliotrope rash, malar rash that affects nasiolabial folds, shawl rash
what are the path findings for dermatomyositis?
permysial inflam with CD4 T cells
What antibodies are diffuse scleroderma related to?
anti-Scl70 and anti-topoisomerase I antibody
What is CREST?
calcinosis cutis -anti-centromere antibody raynauds esophageal dysmotility sclerdactyly telangiectasia
what is acantholysis?
separation of the epidermal layers
what is acanthosis?
epidermal hyperplasia
what is auspitz sign?
psorasis- pinpoint bleeding when scale removed
what is erysipelas?
upper dermis infection, usually S pyogenes, well demarcated area
what layer does cellulitis often affect?
the deeper dermis, S aureus or S pyogenes
what is necrotizing fasciitis?
deeper layers of skin, walled off, anaerobic or S pyogenes, produces methane and Co2 so you get crepitus
what is staph scalded skin?
the exotoxin destroys the keratin, separates the epidermal layer and destroys attachment to granulosum, fever and generalized rash, heals completely but can cause renal insufficiency
-+Nikolsky sign
what is pemphigus vulgaris?
autoimmune- IgG against desmoglein that connects keratinocytes to the stratum spinosum- get intraepidermal bullae, acanthlolysis (separation of keratinocytes) tombstone pattern
- type 2 hypersensitivity reaction
- nikolsky sign
what is the difference between pemphigus vulgaris and bullous pemphigoid?
BP is IgG to hemidesmosomes
- tense blisters with eosinophils
- type 2 hypersensitivity
- no nikolsky sign
- linear pattern on immunofluroscence as opposed to reticular like BP
what is dermatitis herpetiformis?
pruritic papules, vesicles, bullae
- igA in tip of dermis
- celiac disease
- dapsone
what is steven johnson syndrome?
fever, bullae, sloughing of skin at epidermal-dermal junction, usually in reaction to drug
- > 30% involved and its toxic epidermal necrolysis (TEN)
- life threatening
what layer of the skin does erythema nodosum disrupt?
subcutaneous fat (panniculitis) -sacoidosis, coccidiodomycosis, histoplasmosis, streptococcal infection, leprosy, IBD
What is lichen planus?
6 Ps- purple, pruritic, polygonal, planar, papules, plaques
- can be associated hep C
- reticular involvement of mucosa- Wickham striae, sawtooth infiltrates of lymphocytes
what is a herald patch associated with?
pityrasis rosea
what type of UV is with sunbruns and which is aging and tanning?
UVB is burn and UVA is tAnning and Aging
what are the burn depths?
- epidermis
- partial thickness through epidermis and dermis
- full thickness through epidermis, dermis and hypodermis (scarring), waxy, leathery, nonblanching
what correlates with risk of mets in melanoma?
depth of the lesion (breslow)
what is the mutation associated with melanoma?
BRAF kinase
how does tylenol work?
reversibly inhibits cyclooxygenase in CNS, inactive peripherally
how does celecoxib work?
selective cox2 inhibitor, helps maintain gastric mucosa, spares plt as well
what are some important functions of prostaglandins that cox inhibitors interfer with?
protect the gastric mucosa and cause vasodilation of afferent arteriole in the kidney
