Musculoskeletal Flashcards
Erb palsy
Waiter’s tip
Traction or tear of upper trunk C5-C6
Lateral traction on neck during delivery and other trauma
Injury to deltoid, supraspinatus, infraspinatus
Klumpke palsy
Claw hand
Traction or tear of lower trunk C8-T1
Upward force on arm during delivery
Injury to intrinsic hand muscles, lumbricals, interossei
Thoracic outlet syndrome
Compression of lower trunk and subclavian vessels
Cervical rib injury, pancoast tumor
Injury to intrinsic hand muscles
Winged scapula
Lesion of long thoracic nerve
Axillary node dissection after mastectomy, stab wounds
Injury to serratus anterior
Axillary C5-C6 injury
Fractured surgical neck of humorous, anterior dislocation of humorous
Loss of abduction of shoulder
Musculocutaneous C5-C7 injury
Upper trunk compression
Loss of forearm flexion and supination
Radial C5-T1 injury
Midshaft fracture of humerus
Wrist drop (loss of elbow, wrist, and finger extension)
Median C5-T1 injury
Supracondylar fracture of humerus, carpal tunnel syndome
Pope’s blessing
Loss of wrist and later finger flexion, thumb opposition
Ulnar C8-T1 injury
Fracture of medial epicondyle of humerus (funny bone)
Loss of flexion of wrist and medial fingers
Recurrent branch of median C5-T1 injury
Superficial laceration of palm
Loss of thenar muscle group activity (Ape hand, cannot move thumb away from rest of fingers)
Obturator L2-L4 injury
Pelvic surgery
Decrease thigh adduction
Femoral L2-L4 injury
Pelvic fracture
Decreased thigh flexion and leg extension
Common peroneal L4-S2 injury
Trauma or compression of lateral aspect of leg
Foot drop (inverted and plantar flexed, loss of eversion and dorsiflexion)
PED (peroneal everts and drosiflexes)
Tibial L4-S1 injury
Knee trauma, tarsal tunnel syndrome
Inability to curl toes, foot evert w/ loss of inversion and plantar flexion
TIP (tibial inverts and plantar flexes)
Superior gluteal L4-S1 injury
Posterior hip dislocation
Trendelenburg sign (pelvis tilts because weight bearing leg cannot maintain alignment of pelvis through hip abduction w/ lesion contralateral to side that drops)
Inferior gluteal L5-S2 injury
Posterior hip dislocation
Difficulty climbing stairs or rising from seated position, loss of hip extension
Paget disease
Ostetits deformans
Common localized disorder of bone remodeling caused by increase in both osteoblastic and osteoclastic activity
Mosaic pattern of woven and lamella bone
Hat size can be increased, hearing loss is common due to auditory foramen narrowing
Osteosarcoma
Malignant, predisposed by paget disease
Usually involves metapysis of long bones
Sunburst pattern radiological
Ewing sarcoma
Malignant
Usually involves diaphysis of long bones
Anaplastic small blue cell tumor
Onion skin apperance on radiographs
Chondrosarcoma
Rare, malignant, cartilaginous
Usually involves pelvis, spine, or diaphysis of long bone
Can emerge from osteochondroma (benign)
Giant cell tumor
Benign
Epiphyseal end of long bones
Soap bubble sign on X-ray
Sjogren syndrome
Autoimmune disorder characterized by destruction of exocrine glands especially lacrimal and salivary glands
Xerophthalmia (no tears), xerostomia (no saliva)
Presence of anti-Ro and antiLa antibodies (SS-A, SS-B)
Bilateral parotid enlargement
Reactive arthritis (Reiter syndrome)
Seronegative (without rheumatoid factor) spondylarthropathy (HLA-B27 gene) strong association
Can see (conjunctivitis), can pee (urethritis), can bend knees (arthritis)
Post GI (shigella, salmonella, campylobacter) or chlamydia
Polymyositis
Progressive symmetric proximal muscle weakness
Most often involves shoulder
Inflammation w/ CD8+ T cells
Increased CK, positive ANA, positive anti-Jo
Dermatomyositis
Progressive symmetric proximal muscle weakness w/ skin involvement (malar rash, heliotrope rash)
Increased risk of occult malignancy
Inflammation w/ CD4+ T cells
Increased CK, positive ANA, positive anti-Jo
Polymyalgia rheumatica
Pain and stiffness in shoulders and hips often w/ weigh loss and fever
No muscle weakness, associated w/ temporal arthritis
Increased ESR, normal CK
Scleroderma (systemic sclerosis)
Excessive fibrosis and collagen deposition throughout body
CREST syndrome (local, antiCentroere) Calcinosis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
Diffuse (Scl-70 antibody, anti-DNA topoisomerase I)
Pemphigus vulgaris
Potentially fatal autoimmune skin disorder w/ IgG antibody against desmosome protein (reticular/net pattern w/ immunofluorescence)
Flaccid intraepidermal bullae caused by acantholysis (separation of epidermal cells)
Positive Nikolsky sign (separation of epidermis upon manual stroking of skin)
Bullos pemphigoid
Less severe than pemphigus vulgarism
IgG antibody against hemidesmosomes (linear immunoflurescence pattern)
Tense blisters containing eosinophils
Negative Nikolsky sign
Erythema multiform
Associated w/ infections (HSV, m. pneumoniae), drugs (sulfa, beta-lactams), cancers, and autoimmune
Presents w/ multiple types of lesions (papules, macules, vesicles, target lesions)
Erythema nodosum
Painful inflammatory lesion of subcutaneous fat, usually on anterior shins
Can be idiopathic or associated w/ sarcoidosis, TB, fungal, or strep infections, and leprosy
Basal cell carcinoma
Most common skin cancer, found in sun exposed area
Locally invasive, but almost never metastasizes
Pink, pearly nodules, commonly w/ telangiectasis, roller borders, central clearing, or ulceration
Squamous cell carcinoma
Second most common skin cancer
Associated w/ excessive exposure to light, immunosuppression, or arsenic exposure
Locally invasive, but may spread to lymph nodes, but rarely metastasizes
Ulcerative red lesions w/ frequent scale
Melanoma
Common tumor w/ significant risk of metastasis
S-100 tumor marker (mesodermal origin)
ABCDE: asymmetry, border irregularity, color variation, diameter > 6 cm, evolution over time
Alendronate
Biphosphonate
Bind hydroxyapatite in bone, inhibiting osteoclast activity
Treat osteoporosis, Paget disease of bone
Colchicine
Binds and stabilizes tubulin to inhibit microtubule polymerization, imparing leukocyte chemotaxis and degranulation
Acute and prophylactic treatment for gout
Etanercept
TNFalpha inhibitor (decoy receptor)
Fusion protein produced by recombinant DNA
Treat RA, psoriasis, ankylosing spondylitis
