musculoskeletal

Question 1

posterior drawer sign

Answer 1

posterior gliding due to PCL injury

Question 2

unhappy triad

Answer 2

lateral force applied to planted leg

ACL, MCL, and medial meniscus (attached to MCL) or lateral meniscus (more common)

Question 3

prepatellar bursitis

Answer 3

“housemaids knee”

knee walking type of movement for an extended period of time

Question 4

locking and unlocking the knee joint

Answer 4

unlocking–lateral rotation of the femur, popliteus muscle

locking–medial rotation

Question 5

baker’s cyst

Answer 5

fluid filled cyst in the posterior aspect of the knee often caused by arthritis or cartilage tear (popliteal cyst)

Question 6

infrapatellar bursitis

Answer 6

kneeling on hard surface for extended period of time

Question 7

rotator cuff

Answer 7

S-supraspinatus (suprascapular nerve)–abducts arm initially (before action of deltoid) most common, assessed by empty/full can test
I-infraspinatus (suprascapular nerve)–lateral rotation, pitching injury (laterally rotate arm to pitch ball at infrared beam)
t-teres minor–axillary nerve, adducts and laterally rotates
S-subscapularis (upper and lower subscapular nerve)–medially roates and adducts arm
C5-C6
medial rotation–subscapularis
lateral rotation-infraspinatus and teres minor
abduction-supraspinatus
adduction–teres minor

Question 8

medial vs lateral epicondylitis

Answer 8

medial–golfer’s elbow–repetitive flexion

lateral–tennis elbow (backhand)–repetitive extension

Question 9

scaphoid bone

Answer 9

palpated in anatomic snuff box

most commonly fractured carpal bone and is prone to avascular necrosis (retrograde blood supply)

Question 10

hamate

Answer 10

hook of hamate can be damaged by fall on outstretched arm causing ulnar nerve damage

Question 11

wrist bones

Answer 11

some lovers try positions that they cant handle
palm up, left hand, left to right
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate

Question 12

carpal tunnel

Answer 12

entrapment of median nerve in carpal tunnel
palmar cutaneous branch of median nerve arises proximal to the canal and passes superficial to flexor retinaculum, so sensation in tact.
muscles of the thenar compartment, and 1st and 2nd lumbercals
1/2 LOAF
1/3 lumbercles, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
sensory innervation to the skin on the lateral palm and palmar surface of the lateral 3 1/2 digits, and dorsal distal half of these digits
median nerve…. so opposite of ulnar (pinky) side.. thenar compartment

Question 13

ulnar tunnel/guyon’s canal

Answer 13

medial side of anterior wrist
flexor retinaculum is floor, palmar carpa ligament is roof, pisiform and hamate are lateral border
ulnar artery and nerve pass through palm

Question 14

axillary nerve injury

Answer 14

surgical neck of humerus
anterior dislocation of humerus
flattened deltoid–>flattened abduction of shoulder after 15 degrees (first 15 is supraspinatus via suprascapular nerve)
loss of sensation over deltoid muscle and lateral arm

Question 15

musculocutaneous

Answer 15

upper trunk compression
loss of forearm flexion and supination
loss of sensation over lateral forarm

Question 16

radial

Answer 16

midshaft fracture of humerus, compression of axilla (crutches) or saturday night palsy
wrist drop (loss of elbow, wrist, and finger extension)
decreases grip strength
loss of sensation over posterior arm/forearm and dorsal hand

no hand muscles, but skin over the lateral aspect of the ahnd and the dorsum of the proximal parts of lateral 3 1/2 digits

posterior compartment of forearm–brachioradialis, extensor carpi radialis longus/brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, supinator, abductor pollicis longus, extensor pollicus longus, extensor pollicis brevis, extensor indicis,
ALL EXTENSORS

Question 17

median nerve

Answer 17

supracondylar frature of humerus/proximal lesion
carpal tunnel syndrome
ape hand, pope’s blessing
lost of wrist flexion, flexion of lateral fingers, thumb opposition (APE), lumbericals of 2nd and 3rd digits
sensation over thenar eminence

Question 18

ulnar

Answer 18

fracture of medial epicondyle of humerus, funny bone
ulnar claw on extension
radial deviation of wrist upon flexion (proximal)

Question 19

reccurrent branch of median nerve

Answer 19

superficial laceration of palm
ape hand,
no loss of sensation

Question 20

brachial plexus lesions

Answer 20

upper trunk (C5-C6)— erb palsy/waiter’s tip
lower trunk–claw hand
posterior cord (axillary/radial=extensors)–wrist drop
long thoracic–wing scapula
axillary–deltoid payalysis
radial–saturday night palsy with wrist drop
musculocutaneous–difficulty flexing elbow
median–pope’s blessing
ulnar–intrinsic hand muscles, claw hand

Question 21

pairing of neurovasculature

Answer 21

surgical neck of humerus–axillary and posterior circumflex
midshaft of humerus–radial and deep brachial
distal humerus/cubital fossa–medial and brachial
popliteal fossa-tibial nerve, popliteal artery
posterior to medial malleolus–tibial nerve, posterior tibial artery

Question 22

type 1 muscle fibers

Answer 22

1 slow red ox
slow twitch
red fibers from increased mitochondria and myoglobin
increased oxidative phosphorylation–>sustained contraction

Question 23

Myasthenia gravis

Answer 23

most common NMJ disorder
autoantibodies to postsynaptic ACh receptor
AChE inhibitor administration reverses symptoms

Question 24

layers of skin

Answer 24

Can lynn get some beer
corneum (keratin)
lucidum (thick skin)
granulosum
spinosum (desmesomes)
basale (stem cell site, melanocytes)

Question 25

adherins junction

Answer 25

zonula adherins, below tight junction, CADherins, (Ca2+ dependent adhesion proteins)
loss of e-cadherin promotes metastasis

Question 26

gap junction

Answer 26

channel proteins called connexons promote electrical and chemical communication through cells

Question 27

allopurinol

Answer 27

inhibits xanthine oxidase after being converted to alloxanthine, decrease conversion of xanthine to uric acid.

Question 28

anterior drawer sign

Answer 28

anterior gliding of tibia due to ACL injury