musculoskeletal Flashcards
muscles of the rotatator cuff are? function and innervation?
1 supraspinatus/ abduction (impingement, empty a full can),
2 infraspinatus ext. rotation pitching injury,
3 supscapularis in. rotation, adduct
123 are inverated by supscapular nerve
and teres minor ext. rotation, adduct (axillary nerve),
0-15 degree of abduction does?
suprapinatus
15-100 degree of abduction does?
deltoid
greater than 90 degrees of abduction?
Trapezius (accessory)
greater than 100 degrees of abduction?
serratus anterior (long thoracic)
name the wrist bones?
scaphoid, lunate, triquetrum, pisiform, hamamate, capitate, trapozoid, trapezium
so long to pincky here comes the thum
which ist the most commen fracture in the carpal bones?
+complication?
scaphoid, due to fall on the outstretched hand
complication is avascular necrosis and noneunion due retrograde blood supply of the radial artery
which bone injury may cause acute carpal tunnel syndrome?
lunate
hand muscles and innervation?
thenar mucles (median)- opponens pollices, adbuctor pollices bevis, flexor pollices brevis, superficial head (deap head of the ulnar nerve)
Hypothenar (ulnar)- opponens digiti mini, aductor digit minimi, flexor digiti minimi brevis
OAF: oppose, abduct and flex
dorsal intertossei (ulnar nerve)_ abduct fingers
palmar interossei (ulnar) -abduct fingers
lumbrcalis 1 and 2(median), 3,4 (ulnar) flex MCP, extent PIP and DIP
fractured surgical neck of the humerus and anterior dislocation of the humerus can result in what type of injury and present as?
axillary (C5-6),
flattend deltoid, loss of abduction greater than 15 degrees, loss of sensation of the deltoid and the lateral arm
what type of injury will cause upper trunk compression?
musculocutanoeus (c5-7) dicreased biceps or triceps reflex
weakness of foram flexion and suppination
loss of sensation of the over the lateral forarm
compression of axilla due crutches sleep with arm chair
miftshaft fracture of the humerus
repetitive pronation/supination of the forarm eg screwdriver use “finger drop”
injury presents as?
radial (c5-t1)
wrist drop: loss of elbow, wrist and finger extension
decreased grip strength ( wrist extension necessary for maximal flexion
lost of sensation of posterior arm, forarm and dorsal hand
Radial nerve gives out muscular branches to supply the long head, medial head, and lateral head of triceps brachii muscles before and during its course in the radial sulcus. After it emerges out from the radial sulcus, it supplies the brachialis, brachioradialis and extensor carpi radialis longus.
supracondylar fracture of the humerus leads proximal lesion of the nerve
carpal tunnel syndrome and wrist laceration leads to distal lesion of what nerve and representation?
Median (C5-T1)
ape hand and pope blessing
loss of wrist flexion, flexion of lateral hand, thumb opposition, lumbricals index and middle fingers
loss of sensation over the thenar eminance and dorsal palmar aspect of 3 1/2 with proximal lesion
Fracture of the epicondyle of the humerus funny bone proximal lesion
fracture hook hamate dital lesion from the fall on the outstretched hand
ulnar claw on the digit
radial devition of wrist upon flexion ( prox. lesion)
what is sceroderma?
is a systemic sclerosis. Triad of autoim. noninflam. vasculitis and collagen deposition with fibrosis. there a 2 types:
diff. scleroderma
limited scleroderma: also with crest
what is crest syn.?
calcinos cutis, anti-centromere antibodies, raynaud phenomen, esophagial dysmotility, sclerodactyly, and telangiectasia
Lupus is asocisted with
libman sacks endocarditis
lupus nepritis/-ros: DNA-anti-DNA immune complex deposition
defieciency of c1q, c4, c2
rash or rain
rash arthrits serositis (pleuritis, pericaditis) hematologic disorders oral/nasopharyngial ulcers renal disease photosensivity antinuclear antibodies immone disorder (antidsDNA, anti-Sm, antiphspholid) neurological disorders (seisures, psychosis)
lupus redness in the cheeks
fibromyalgia is?
muscuskeletal pain associated with tender points, stiifness, paresthesia, poor sleep, fatique, cog disturb.
polymyositis dermatomyositis is?
nonspecific +ANA, increase CK, +anti-jo-1 (histyl-tRNA synthetase), +SRP(signal recognition particle), +anti-MI-2 (helicase)
polymyositis
symmetric prox muscle weakness, cd8
dermatomyositis
like polymyositis (weakness inflam. of muscles and skin), but involves grotton papules, dirty face appearance cd4
polymyalgia rheumatica
pain and stiffness in proximal muscles, assoc. with giant cell( temporal) arthritis, ESR increased,
what is antiphospholipid syndrome
autoimm. disorder (m.c. in SLE)
anticarsiolipin, anti-beta2 glycorpotein 1 antibodies or thrombosis
sjörgren syndrome
autoimm. disorder by destruction of the exocrine glands, by lymphocytic infiltration
findins: jointpain, keratoconjuctivitis sicca, xerostomomia, antinuclear antibotis: SS-A( anti-Ro), SS-B (anti-La), parotid inlargement
in oteoarthritis the nodes are called
heberden and bouchard
rheumatoid arthrithis antibody are?
HLA-DR4, rf: (IgM antibody that targets IgG Fc region)
leflunomid is used for and its mech of action?
rev. inhib, the dihydroortate dehydrogenase, preventing pyramidine synt., suppresses t-cell proliferation
used for rheumatoid arthritis
bisphosphonates: alandronate
pyrophoshate analogs, binds to hydroxyapatite, inhibits osteoclasts activity
use is ostoeporosis
diffuse scleroderma is?
widespread, associ. with anti-scl 70 antibody( ant_DNA-topoisomerase) and anti-RNA polymerase 3.
limited scleroderma is?
limitted skin involvement confined to fingers or face. Also with crest syndrome.
lambert-eatnen myastenic syndrome
is an autoimm. disease that of the neuromuscular junction
path: autoantibodies to presynatic ca2+ channel dreases ACh release
improve with muscle use
prx mucle weakness and autonomic sys. eg dry mouth, impotence
myasthenia gravies is?
is an autoimmune disease that target the neuromuscular junctions, autoantibodies target postsynatic ACh receptor
sympotoms are, ptosis, diplopia, weakness (respiratory involvement
Ankylosing spondylits?
symmetric involvement of the spine an sacroiliac joints leads to ankylosis (joint fusion), uveitis, aortic regurgitation,
bamboo spine
may cause restric. lung diseases
seronegative spondyarthritis is?
Arthritis without rheumatoid factor (no anti-IgG antibodies). Strong associ. with HLA-B27 (MHC class I serotype). Subtpes PAIR shaire variable recurrence
What does PAIR stand for?
Psoriadic arthtritis, Ankolysing spondylitis, Inflammatory bowl disease, Reactive arthritis
Psoriadic arthtritis
assoc. with psorisis and nail lesions. asym. and pathy. Dactylitis and pencil in a cup deformity
Inflammatory bowel D
Crohn or UC offten associ. with spondyloarthritis
Reactive arthritis
Formerly Reiter syndrome. Classic triad: -Conjuctivitis, -Urethritis, -Arthritis
Cant see, cant pee, cant bend the knee
ShY ChiCS:
Shigella, Yersenia, Chlamydia, Campylobacters, Samonella
Calium pyrophosphate deposition disease
Previously called pseudogout. Deposition of calcium pyrophosphat crystals within the joint space
Cystals are rombid and weakly+ birefrigent under polarized light (blue when parallel to light)
blue Pś
Erwings sarcoma
prim bone tumor <15 Diaphysis of the long bones
t: (11;22) EWS-FLII
11+22=33 (Patrick Erwings jersy no)
Chrondrosarcoma
Tumor of malignant chrondrocytes
Location: Pelvis, femur and humerus.
Oasteosarcoma
methaphysis of the long bone, pleomorhic osteoid- producing cells (malignant oteoblasts)
Codman triangle (elevated periostium), sunburst pattern
1°<20
2° perdiposing factor like pagets
Allergic contact dermatitis is what type of hypersensitivity?
is type IV hypersensitivity reaction
Rosacea
inflammatory skin disorder erthematous papules often seen in alcoholics, can cause nose bullous diformatis ( rhinophyma)
Angiosarcoma
blood vessel malignancy typically occurring in the breast, head and neck areas. Associ. with Radiotherapy and Post Mastectomy lymphedema
Impetigo
Very superficial skin infection, S aureus or S pyogenes, honey-crust—-> bullous impetigo
erysipales
Infect. of upper epidemis and superficial lymphatics, usu. S.pyogenes, well defined demarcation
cellulitis
Infect. of the deeper demis and sucutis usu. S pygenes and aureus
molluscum contagiosum
Umbilicated papules caused by poxvirus. Frequently in children
Pemphigous
less than 60, Desmosomes, Type II, IgG antibodies aganist desmoglein 1/ or 3 which connects kerotinocytes, Flaccid intradermal bullae
reticular pattern around epidermal cells
Phempigoid
older than 60, Hemidesmosomes, Type III, IgG antibdies against hemidesmosomes (apidermal basement membrane, antibodies are bullow the epidemis
Tense blisters
linear pattern at epidermal-dermal juction
Squamous cell carcinoma
Second most common. Associ. with sunlight exposure, immunosupression, chronic non healing wound, ulcerative red leasons spreads to the lymphnodes—–>
Histo: keratin perls.
ACTINIC KERATOSIS, ascaly plaque, is a precurser to squamous cell carcinoma
Melanoma
BRAF kinase, S100, sunlight, dysplastic nevi
Keratocanthoma
middle-aged, resembles squamous CC, present as dome shaped nodule with keratin-filled center.
Basal cell carcinoma, BCC
Most common skin cancer, sun, locally invasive, rarely met., Waxy, pink, pearly nodules, commonly with telangiectasis, rolled borders, ulceration.
“palisading nuclei”
Erythema nodosum
Painful, raised inflammatory lesions of subcutaneous fat associ, with sarcoidosis, histo, TB or strep. etc
Lichen planus
6 Ps: Pink Papules Polygonal, Planer Plaque—–> hypergranulosis, Sawtooth infiltrate of lymphocytes at dermal epidermal juctions. Associ. with hep. C
Dermatitis Herpedifomis
Pruritric papules at the elbows, knees and buttocks. Associ. with ciliacs
Erythema multiforme
multiple lesions and papules associ. with Mycoplasma, HSV, drugs
De Quervain tenosynovitis
Noninflammatory thickining of abductor pollices longus and extensor pollices brevis tendos charaterized by pain or tenderness at radial styloid. increased in golfer, mothers, racquet sport plyers.
Osteopetrosis
Failure of bone resorption due to defectve osteoclasts—> thickening of bones, dense bones that are more prone to fracture
Osteitis deformas/ paget disease
Common loc. disorder of bone remodeling caused by increased osteoclastic activity followed by osteblastic actvity. Ca++, Ph and PTH are normal. maic pattern, chalk stick fractures
Treatment: Biphosphonates
Rickets
Defective min. of osteoid or chartelage growth plated—>Vit D def.
osteopenia, looser zones on x-ray/pseudofractures, emthaphysial cupping/fraying/ genu varum, bead like costochondral junction, soft skull
decreased Vit D and Ca++, PTH increased
Osteoclasts
RANK receptor on osteoclsts are stimulated by RANKL
Avascular necrosis of the femoral head is caused by?
medial circumflex femeral artery. Cause: SS
CASTS: Coticosteriods, Alcoholism, SLE, SS
Nerve and Artery in the location of:
Axilla/lateral thorax
N:Long thoracic, A:long thoracic
Nerve and Artery in the location of:
Surgical neck of the humerus
Axillary, posterior circumflex
Nerve and Artery in the location of: Midshaft of Humerus
Radial, Deep brachial
Nerve and Artery in the location of:
Distal humerus/ cubital fossa
Median Nerve, Brachial
Nerve and Artery in the location of: Popliteal fossa
Tibial, Popliteal
Nerve and Artery in the location of: Posterior to medial malleolus
Tibial, posterior tibial
Teriparatide
recombinant PTH analog. increases osteoblastic activity
Osteoporosis
Probenecid
inhib. the reabsortion of uric acid in the PCT, also inhibi. the secretion of penecillin—–> can lead to uric acid stones
Gout drug
Allopurinol
inhibit. Xanthine oxidase, decreasing the conversion of hypoxathin and xanthin
it can increase concentration of azathioprine, 6-MP etc
Febuxostat
inhibits xanthine oxidase –Gout drug
Colchicine
Binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation
SE: GI and neuropathic
Etanercept
TNF alpha inhibitors
Fusion protein (decoy receptor for TNF-alpha and IgG1 Fc) produced by recombinant DNA
Etanercepts intercepts TNF
Rheumatoid arthritis, psorisis, ankylosing spondylitis
Imfliximab -mab
Anti- TNF-alpha monoclonal antibody.
IBD, RA, ankylosing spondylitis, psoriasis
