Musculoskeletal Flashcards
Sebaceous gland
Holocrine secretion of sebum. Hair follicle
Eccrine gland
Sweat, Everywhere
Apocrine gland
Milky viscious fluid found in axillae, genitalia and areolae. No function until puberty, malodorous due to bacteria,
Pudendal nerve block
ischial spine(relieve pain of delivery)
Lumbar puncture
iliac crest
Rotator cuff muscles
Supraspinatus(abduction)- most common
Infraspinatus(laterally rotates)-pitching injury
Teres Minor- adducts and laterally rotates
Subscapularis- medially rotates and adducts
c5-c6
Dislocation of lunate
Median nerve injury
Axillary nerve injury
surgical neck of humerus
Radial nerve injury
fracture of midshaft of humerus
compressed in axilla via crutch use
Ulnar nerve injury
medical epicondyle fracture, fracture of hook of hamate
Median nerve injury
dislocation of lunate and carpal tunnel syndrome
Long thoracic nerve injury
injury to serratus anterior. C5-c7 lesion. injured via mastectomy. Winged scapula.
Axillary nerve(C5,C6)
Deltoid arm abduction.
Radial(c5-t1)
BEST extensors Brachioradialis Extensors of wrist and fingers Supinator Triceps
Wrist drop
Median nerve(c5-T1)
loss of opposition of thumb, lateral finger flexion, wrist flexion. Ape/pope hand
Ulnar(c8-t1)
Wrist flexion and medial finger flexion lost. Ulnar claw. Radial deviation of wrist upon flexion
Musculocutaneous
Biceps, brachialis, coracobrachialis. Loss of flexion at elbow.
Erb Duchenne, Waiters tip
Tear of C5-c6, seen in delivery of baby w/ trauma.
Paralysis of abductors, medially rotated, forearm pronated
Klumpke’s palsy
C8-T1. Thoracic outlet syndrome, cervical rib compression.
Atrophy of thenar/hypothenar eminences
Atrophy of interosseous muscles
sensory lows on medial side of forearm and hand
disappearance of radial pulse upon moving head to ipsilateral side.
Clawing
Loss of lumbricals which flex at MCP joints and extend both DIP and PIP joints
Median claw
carpal tunnel or dislocated lunate
popes blessing/ape hand
proximal median nerve lesion
Obturator
L2-L4. Anterior hip dislocation injury lesion. Loss of thigh adduction and medial thigh sensory defect
Femoral
L2-L4 Pelvic fracture. Lesion causes thigh flexion and leg extension deficit. Loss of sensory of anterior thigh and middle leg
Common Peroneal
L4-S2. Fibula fracture or compression of lateral leg. Lesions causes foot eversion dorsiflexion. Sensory defect of anterolateral leg and dorsal of foot
PED- Peroneal Everts and dorsiflexes (with injury thus FOOT DROP)
Tibial
L4-S3. Knee trauma. Causes foot inversion and plantarflexion. Loss of sensory on sole of foot.
TIP- tibial inverts and plantarflexes
Superal gluteal
L4-L1. Due to posterior hip dislocation or polio. Thigh abduction lost. Positive trendelenburg sign, contralateral hip drop
Inferior gluteal
L5-s2. posterior hip dislocation. cant jump, climb stairs, or rise from seated position.
Osteogenesis imperfecta
Pathologic fractures, hearing loss, blue sclera
Achondroplasia
Normal-sized head and vertebral column, shortened arms and legs, normal growth hormone and IGF1 levels.
Osteopetrosis
Pathologic fractures, anemia (replaceent of marrow cavity), cranial nerve compression w/ visual and hearing loss
Osteomyelitis
Most often in metaphysis. Most often due to Staph aureus 90%.
In sickle cell patients due to salmonella paratyphi.
Fever, bone pain
Osteoporosis
Loss of mineralized bone and organic bone matrix.
Compression fractures of vertebral bodies
Colles’ fracture of distal radius
Dowager’s hump
Osteochondroma
Males 10-30 yr. solitary/multiple. Metaphysis. Outgrowth of bone capped by benign cartliage. Most common benign
Chondrosarcoma
Males 30-60 in pelvic or femur. Metastasis to lungs. Located in the medullary cavity
Osteoma
Males, facial bones. Gardner syndrome assoc.
Giant cell tumor
females 20-40yr. epihysis of distal femur or proximal tibia. Reactive multinucleated osteoclasts. Double bubble/soap bubble appearance
Ewing Sarcoma
males 10-20. diaphysis of long bones, pelvis, ribs. Small round cell tumor, anaplastic small blue cell. Onion skin appearance. T11:22 translocation. Early metastasis
Osteogenic sarcoma
males 10-25. Metaphysis of distal femur. Pagets disease and Rb are risk factors. Codmans triangle from periosteum. Aggressive. Metastasizes to lung.
Pagets disease
Bone pain, headaches, hearing/vision loss, increased hat size. Serum calcium, phosphorus and PTH are normal. Increased AVM leading to high output cardiac failure. Increased risk of osteogenic sarcoma
polyostotic Fibrous dysplasia
defect in osteoblastic differentiation and maturation. Medullary bone replaced with fibroblasts, collagen and irregular bony trabeculae. Ribs most common. McCune Albright syndrome: cafe au lait spot and precocious puberty.
Diseases with morning stiffness
Rheumatoid arthritis, Polymyalgia rheumatica, systemic lupus erythematous.
Colles’ fracture
Common fracture when falling on outstretched hand. Fracture of distal radius with or without fracture of ulnar styloid.
Rotator cuff tear
pain/weakness with shoulder abduction
Tennis elbow
pain with lateral epicondyle. pain when gripping something
Golfers elbow
pain where the flexor muscles insert near the medial epicondyle. Pain flexing hand muscles and supinating the arm
Infectious arthritis
Most common cause is Staph aureus. also can be caused by N. gonorrhoeae, lyme disease. Affected joint is swollen red and painful. STD= synovitis, tenosynovitis, dermatitis.
Osteopetrosis
Defective osteoclasts due to mutation in carbonic anhydrase II. Failure to reabsorb bones leads to thickened dense bone prone to fracture. Bone fills marrow space causing pancytopenia, extramedullary hematapoiesis. Can affect vision and hearing
Increased ALP, decreased Calcium
Osteitis fibrosa cystica
brown tumors of hyperarathyroidism
increased calcium, decreased phosphate, increased ALP and increased PTH
Most common metastasis to bone
Breast
Infectious arthritis
S.Aureus, Streptococcus, Neisseria gonorrhoeae. Gonorrhea STD= synovitis, tenosynovitis, dermatitis.
Psoriatic arthritis
Joint pain and stiffness associated with psoriasis. Asymmetric and patchy involvement. Sausage fingers, pencil in cup deformity on xray
Ankylosing spondylitis
chronic inflammatory disease of spine and sacroiliac joints causing ankylosis(stiff spine,bamboo spine) uveitis and aortic regurgitation. Often associated with IBD
Reactive arthritis (Reiter’s syndrome)
Conjunctivitis, urethritis, arthritis
Cant see, cant pee, cant climb a tree
Post GI or chlamydia infection
SLE
IM DAMN SHARP
Immunoglobulines(anti dsDNA, anti-SM, anti-ANA) Malar rash(facial rash) Discoid rash Antinuclear antibody Mucositis(oropharyngeal ulcers) Neurologic disorders Serositis(pericarditis, pleuritis) Hematologic disorders Arthritis Renal disorders Photosensitivity
Sarcoidosis
Noncaseating granulomas, elevated ACE, black females. Bilateral hilar adenopathy. Restrictive lung disease, erythema nodosum, Bells palsy, Granulomas with schaumann and asteroid bodies. Hypercalcemia
Treat with steroids.
Polymyalgia Rheumatic
pain and stiffness in shoulders in hips w/ fever malaise and weight loss. NO muscular weakness. Women >50. Associated with temporal giant cell arthritis. Increased ESR.
Fibromyalgia
women 20-50. Chronic widespread musculoskeletal pain associated with stiffness, parathesia, poor sleep and fatigue.
Polymyositis
symmetrical proximal muscle weakness characterized by endomysial inflammation with CD8+ T cells. Shoulders.
Positive anti-Jo-1
Dermatomyositis
symmetrical proximal muscle weakness characterized by endomysial inflammation with CD8+ T cells. Shoulders. Also involves malar rash, gottrons papules or heliotrope rash. Perimysial inflammation and atrophy with CD4+ cells
Increased risk of malignacy
Positive anti-Jo-1
Scleroderma
Excessive fibrosis and collagen deposition. Absence of wrinkles. 75% females.
Diffuse Scleroderma- widespread skin involvement, rapid progression, Anti-scl-70 topoisomerase I
CREST Calcinosis Raynauds Esophageal dysmotility Sclerodatyly Telangiectasia *limited skin involvement, more benign, anticentromere antibody.
Albinism
Decreased melanin production due to decreased tyrosinase activity. Normal melanocytes.
Melasma
hyperpigmentation associated with pregnancy
Vitiligo
Irregular complete depigmentation. Decreased number of melanocytes.
Verrucae
Warts, HPV. Epidermal hyperplasia, hyperkeratosis, koilocytosis. Condyloma acuminatum on genetalia
Melanocytic nevus
Common mole, benign. Intradermal nevi are papular, junction nevi are flat.
Urticaria
Hies, pruritic wheals that form after mast cell degranulation
Ephelis
Freckle. Normal melanocyte number, increased melanin pigment
Atopic dermatitis, eczema
pruritic eruption commonly on skin flexure. Associated with asthma and allergic rhinitis. Starts on face in infancy and appears in cubital fossa therafter.
Type I HSR
Allergic contact dermatitis
Type IV HSR. lesion at site of contact
nickel, poison ivy, neomycin
Psorias
papule and plaques with silery scaling especially on knees and elbows. Acanthosis with parakeratotic scaling. Increased stratum spinosum, decreased granulosum. Auspitz sign of pinpoint bleeding from exposure of dermal papillae. Associated with Arthritis, possibly HLA, possibly autoimmune.
Seborrheic keratosis
flat greasy pigmented squamous epithelial proliferation with keratin filled cysts Looks stuck on. In leser trelat sign, multiple seborrheic keratosis indicates underlying malignancy.
Erythema multiform
Associated with infections(mycoplasma, HSV), drugs (sulfa, B-lactams, phenytoin) and cancer/autoimmune.
Presents with multiple types of lesions: macules, papules, vesicles, target lesions.
Steven Johnson syndrome
Fever, bulla formation and necrosis, sloughing of skin and high mortality rate. Typically 2 mucus membranes are involved and skin lesions may appear like targets as seen in erythema myltiforme.
Adverse Drug Rx
More severe form is toxic epidermal necrolysis covering >30% of body surface.
Polyostotic fibrous dysplasia
Bone is replaced by fibroblasts, collagen and irregular bony trabeculae. McCune-Albright syndrome is a form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities(precocious puberty) and cafe-au-lait spots.
McCune-Albright syndrome
form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities(precocious puberty) and cafe-au-lait spots.
