PP Musculoskeletal, Skin, and Connective Tissue Flashcards
What is Hairy leukoplakia?
White painless plaque on the tongue that can’t be scraped off
EBV mediated
Occurs in HIV + pt
what aere 1st degree burns?
red (epidermnis)
what are 2nd degree burns?
blisters (hipodermis)
what are 3rd degree burns?
painless nueropathy (dermis)
what diseases have palms and sole rashes?
“TRiCKSSS”
- Toxic Shock Syndrome
- Rocky mountain spotted fever
- Coxsackie A: Hand-Foot-Mouth disease
- Kawasaki
- Scarlet fever
- Stahp Scaled Skin}- Syphilis
what is Erythema Multiforme?
target lesions (viral, drugs)
what is Stevens Johnson síndrome?
Erythema Multiforme Mjor (mouth, eye, avgina)
what is toxic epidermal necrolysis?
Steven Jonson w/skin sloughing
what is Pemphigus Vulgaris?
Ab against desmosomes => circular immunofluoresence, in epidermis, oral lesions, + Nikolsky sign
what is Bullous Pemphigoid?
Ab against hemidesmososmes => linear immunofluoresence, subepidermal, “floating” keratinocytes, eosinophils, (-) Nikolsky sing
what is Atopic dermatitis (Eczema)?
dry flaky dermatitis in skin flexures “itch tha rashes”
what is Nummular dermatitis?
circular eczemz
what is Spongiotic eczema?
weeping eczema: scratching causes oozing “like a sponge”
what is Lichenification?
scratching => thick leathery skin
what is Pityriasis Rosea?
“herald patch” fallow days later by “Christmas tree” distribution
Self-resolving in 6-8weeks
what is Lichen Planus?
pruritic, purple, polygonal planar papules and plaques
Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
A/w hepatitis C
what is Scabies?
linear excoriation “burrows” in webs of fingers, toes, belt line (Sarcoptes faces)
what does UV-A causes?
aging
Dominant in tanning and photoaging
what does UV-B causes?
Sunburns
Can lead to impetigo and skin cancer
what ar teh ABCDE’s that indicate worse prognosis of sking cáncer?
- asimetric
- irregular borders
- color differences
- > 6mm diameter
- evolution over time
what does the Clark level tell you?
invasión of melanoma
what does Breslow´s classification tell you?
depth of melanoma
where are Malignant Melanomas usually found?
Males: back
Females: leg
what is the precursor of a Malignant Melanoma?
hutchison´s greckle
what are the types of Malignant Melanomas?
- Superficial spreading: most common, flat Brown
- Nodural: worst prognosis, black, dome-shape
- Lentigo malignant melanoma: elderly pts, fair-skin
- Acrolentigous: AIDS pts, dark skin
where are Squamous Cell carcinomas usually found?
Face, lower lip, ear and hands.
Locally invasive
Rarely metastasize
Histology: keratin pearls
what is the precursor of Squamous Cell carcinoma?
Actinic keratosis (red scaly plaque)
what are the types of Squamous Cell carcinoma?
Bowen´s disease: SCC in situ on uncircumcised penis dorsum
Verrucous carcinoma: wart on foot
where are Basal Cell carcinomas usually found?
In sun exposed areas of the body
Locally invasive
Almost never metastasize
Pink, pearly nodules
what are the type of Basal Cell carcinoma?
Nodula: waxy nodule w/ central necrosis
Superficial: red scaly plaques, like eczema
Pigmented: looks like melanoma
Sclerosing: yellow waxy palques
what is Acne Rosaces?
blush all the time
worse w/stress / alcohol
what is a Brown Recluse Spider Bite?
painful black necrotic lesion
what is cellulitis
Acute, painful, spreading infection of dermis and subcutaneous tissue
Usually from: * S. pyogenes, * S. aureus
what is Cutaneous Anthrax?
painless black necrotoc lession
what is Decubitus Ulce?
bedsore
what is a DVT?
blood clot in veins
associated w/ hypercoagiulable state
what is Erysipelas?
shiny red
usually on face
associated w/ Step pyogenes
what is Miliaria?
“Heat rash”: burning, itching papules on trunk
what is Molluscum Contagiosum?
Umbilicated, flesh-color papules w/ central dimple pox virus (STD) parvovirus
*pathology: eosinophilia cytoplasmic inclusions bodies
what is Psoriasis?
Papule and plaques with silver scale on knees and elbows
Increase stratum spinosum and decrease stratum granulosum
- Auspitz sing: remove scale => pinpoint bleeding
A/w nail pitting and psoriatic arthritis
What is a Pyogenic Granuloma?
vascular nodule at site of previous injury
what is Seborrheic Dermatitis?
Greasy areas, dandruff in eyebrowns, nose, behind ears
what is Seborrheic Keratosis?
Flat, greasy, pigmented squamous epithelial priliferation with keratin-filled cyst ( horn cyst)
Looks “stuck on”
Common bening neoplasm in older person (GI)
Leser-Trelat sing-> sudden appearance of multiple seborrheic keratoses, indicate an underlying malignancy
what is Trombophebitis?
veins inflamation w/ thrombus
what is Vitíligo?
White patches
Cause by a decrease of Melanocytes
what is Xeroderma Pigmentosa?
bad DNA repair
what is Erythemna Chronicum Migrans?
Lyme disease (solitary lesión that spreads)
what is Erythema Infectiosum?
fifth disease “slapped cheeks” do to Parvovirus B19
what is Erythema Marginatum?
reumatic fever (red margins)
what is Erythema Multiforme?
Iris-like target lesión do to: HSV Phenytoin Barbs Sulfas
what is Erythema Multiforme Mjor?
Steven Johnson síndrome ( >1 mucosal surface)
what is Erythema Nodosum? What diseases are a/w?
Subcutaneous fat inflammation ( painfull red nodules on anterior shins)
A/w sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep infection, IBD, Behcet disease
what is Erythema Toxicum?
Newborn beninh rash ( looks like flea bites w/ eosinophils)
where is CK-MM found?
muscle
where is CK-BB found?
brain
how does a neurogenic mucle disease presents?
distal weakness + fasciculations
how does a myophatic muscle diseae presents?
proximal weakness + pain
what is Duchenne´s MD?
dystrophin framershift
Gower sing
Clsf pseudohypertrophy
what is Becker´s MD?
Dystriphin missense
sx > 5 y/o
what is Myotonic Dystrophy?
Bird´s beak face
cant let go when shake hands
what is Myasthenic syndrome = Lambert-Eaton?
gets stronger as day goes by
stronger w / EMG
not small cell CA
what is Myasthenia gravis?
gets weak as the day goes by
stronger w/ Edrophonium}weaker w / EMG
rule out Thymoma
what is multiple sclerosis?
Anti-myelin Ab
Young woman w /visión problems
xs comes and go
what is Metachromatic Leukodystrophy?
Arylsulfatase deficiency
kids with MS presentation
what is Ataxia Telangectacia?
spider veins
IgA deficiency
what is Friedreich ataxia?
rinitis pigmentosa
scoliosis
what is Adrenal Leukodystrophy?
carnitine shuttle problema
adrenal failure
what is Guillain-Barre?
Ascending paralysis
2 weaks after URI
what is ALS?
middle age male w/ fasciculations, descending paralysis,
no sensory problems
what is Werdnig-Hoffman?
fasciculations in a newborn
no anterior horn
what is Polio?
asymetric dasciculation in child
2 wks after gastroenteritis
what is Choreoathetosis?
dance-like movements
wringing of hands
quivering voice
what is Atonic cerebral plasy?
no muscle tone
floppy
what is Slipped Capital Femoral Epiphysis?
obese boys w/ dull achy pain
what is Legg-Calves-Perthes?
limp ( femur head avascular necrosis)
what is Osgood-Schlatter?
A traction apophysitis of the tibial tubercle
- growing pains
- knee pain ( tibial tubercle avascular necrosis) common in adolescent
what is Septic Arthritis?
joint pain (staph aereus)
what is Ankylosing Spondylitis?
ligament ossification => vertebral body fusión, decrease lumbar curve, stiffer in morning, kyphosis, uveítis, HLAB-27
what is Cauda Equina Syndrome?
“Saddle anesthesia”: can¨t feel butt, thighs, perineum
where does bone cáncer metástasis occur from?
breast
prostate
lung
kidney
what is Costochondritis?
Painful s2welling of chest joint-bone attachments
worse w/ deep breath
what is Disk Herniation?
Straight leg raise => shooting pain
what is Lumbar Stenosis?
MRI “bourglass”
low back pain
what is Ochronosis = Alkaptonuria?
kids with OA
black urine
homogentisic acid oxidase deficiency
what is Osteítis Fisbrosis cística?
inflammation of bone w/ holes
what is Osteogenesis Imperfecta?
blue sclera
multiple broken bone
what is Osteomalacia/ Rickets?
soft bones (waddling gait) craniotabes ( soft skull) Rachitic rosary ( costochondral thickening) Harrison´s Groove Pigeon breast ( sternum protrusión)
what is Osteomyelitis?
infected bones
what is Osteonecerosis= Legg-Calve-Perthes?
Wedge-shape necrosis of femur head
what is Osteopetrosis?
decrease osteoclas activity => marble bones (obliterate own bone marrow)
what is Osteoporosis?
loss of bone matrix ( not calcification) => compression fractures
what is Osteosclerosis?
thick bones
what is Paget´s Disease?
"My hat dosen´t fi" paramyxovirus increase osteoclast/blast fluffy bone osteosarcoma increase CO heart failure deafness increase alkaline phosphatase alone
what is Rheumatoid Factor?
An IgM against IgG Fc
what are Tophi?
Gout crystals
+ Giant cells
what is Podagra?
Big toe inflammation
what ie CREST síndrome?
Calcinosis Raynaud´s esophageal dysmotility Sclerodactyly telangiectasia
what Ab is associated with CREST
Anti-centromere Ab
What diseases have Raynaud’s syndrome?
Scleroderma
Takayasu’s
RA
SLE
Which vasculitis has a high platelet count?
Kawasaki disease
Which vasculitis has a normal platelet count?
Henoch-Scjonlein purpura
What is Osteoarthritis?
Pain worse w/ activity, relieved by rest
PIP/DIP joints
- the joint is NOT tender & systemic symptoms are absent
What is Rheumatoid Arthritis?
Morning stiffness lasting more than 30min and improving with use
MCP / PIP joint
What is STill’s disease?
Juvenile RA
What is Pseudogout?
Deposition of Ca Pyrophosphate crystals
What is Gout?
Urea te crystals in big toe
- birefringence
What is Myositis?
muscle inflammation it hurts
What is Dermatomyositis?
Myositis + rash
What is Fibromyalgia?
Widespread musculoskeletal pain (11 points)
MC in woman
A/w depression
What is Polymyalgia Rheumatica?
Weak shoulders
Temporar arteritis
What is SLE=Lupus?
Meet 4 criteria: “DOPAMIN RASH”
- Discioid rash
- Oral ulcer
- Photosensitivity
- Arthritis
- Malar rash
- Immunologic disorder: Anti-ds DNA, Sm, Cardiolipin Ab
- Neurologic disorder: seizures or psychosis
- Renal failure: DIE OF THIS
- ANA
- Serositis: pleuritis/ pericarditis ( Libman- Sacks endocarditis )
- Hemolytic anemia
What is Scleroderma?
Tight skin
Fibrosis
What is Takayasu’s arteritis?
Pulseless Asian women
Aorta inflammation
What is Polyarteritis Nodosa?
p-ANCA Ab
Attacks gut/ kidney
Hep B
What is Wegener’s Granulomatosis?
c-ANCA Ab
Attacks ENT
Lungs
Kidney
What is Goodpasture’s?
Anti-GBM Ab
Attacks lung/ kidney
RPGN
What is Reiter’s syndrome?
Males that can’t see, can’t pee or climb a tree
What is Sjögren’s syndrome?
Female that have
- dry eye
- dry mouth
- RA
What is Behcets syndrome?
Oral and genital ulcer
Uveitis
What is Churg-Strauss?
Asthma
Eosinophils
Multiple-organ involved
What is Felty’s syndrome?
RA
Leukopenia
Splenomegaly
What is Kawasaki’s disease?
“CRASH”
- conjunctivitis
- rash ( Palm/ sole)
- aneurysm ( coronary artery) -> MI in kids
- strawberry tongue
- hot ( fever > 102 for at least 3 days + cervical lymphadenopathy)
Which are the 3 type of skin cancer?
BCC SCC Melanoma Most common: BCC > SCC > Melnoma Risk of metastasize: Melanoma > SCC > BCC
What is Dermatitis Herpetiforme?
Pruritic papules, vesicles and bullae
Deposits of IgA at the tip of dermal papillae
A/w celiac disease
What is Acanthosis Nigrians?
Epidermal hyperplasia causing symmetrical hyperpigmented skin ( neck and axilla)
A/w hyperinsulinemia and visceral malignancy
What is Actinic keratosis?
Premalingnat lesion caused by sun exposure
Precursor of SCC ( depend of degree of epithelial dysplasia)
Sand paper-like texture
What is Impetigo?
Very superficial skin infection
Usually from: S. aureus or S. pyogenes
Contagious
Honey colored crusting
What is Bullous impetigo?
Has bullae
Usually cause by S. aureus
What is Necrotizing fasciitis?
Deeper tissue injury
From: anaerobic bacteria or S. pyogenes
Result in crepitus from methane and CO2 production
Causes bullae and a purple color to the skin
What is Staphylococcal scaled skin syndrome (SSS)?
Exotoxin destroys keratinocytes attachments in the stratum granulosum only
Fever and erythematous rash with sloughing of upper layer of epidermis
Seen in newborn and children
Which are the Rotator cuff muscles?
Supraspinatus (mc rotator cuff injury)
Infraespinatus ( pitching injury)
Teres minor
Subscapluris
Unhappy triad/ knee injury?
MCL
ACL
Lateral meniscus
Supraespinatus muscle?
Abduct arm initially
Infraespinatus muscle?
Laterally rotates the arm
Teres minor muscle?
Adducts and laterally rotates arm
Subscapularis muscle?
Medially rotates and adducts arme
Which are the wrist bone?
“Some Lovers Try Positions That They Can’t Handle”
- scaphoid ( MC fracture carpal and is prone to vascular necrosis)
- lunate ( dislocation may cause acute carpal tunnel syndrome)
- trinquetum
- pisiform
- hemate
- capitate
- trapezoid
- trapezium
What is Carpal tunnel Syndrome?
Entrapment of median nerve in carpal tunnel -> nerve compression
Which are the ligament involve in an Ankle sprain?
Lateral ( MC) 1. Anterior Talofibular 2. Calcaneofibular 3. Posterior Talofibular Medial 1. Deltoid lig
Axillary nerve?
(C5,C6)
Injury: fracture of the surgical neck of humerus, dislocation of humeral head
Motor defi: Deltoid - arm abduct at shoulder
Sign: Atrophied deltoid
Radial nerve?
(C5-T1)
Injury: fracture midshaft of humerus
Motor defi: “BEST extensor” brachioradialis, extensors of wrist and finger, supinator, triceps
Sign: wrist drop
Median nerve?
(C5-C8, T1)
Injury: fracture of the supracondilar humerus
Motor defi: opposition of thumb, lateral finger flexion, wrist flexion
Sign: “Ape hand”; “Pope’s blessing”
Ulnar nerve?
(C8, T1)
Injury: fracture of medial epicondyle of humerus
Motor defi: medial finger flexion, wrist flexion
Sign: radial deviation of wrist upon wrist flexion
Muculocutaneous nerve?
(C5-C7)
Injury: upper trunk compression
Motor defi: biceps, brachialis, coracobrachialis ( flexion of the arm at elbow)
What is ER -Duchenne palsy “Waiter’s tip”?
Due to traction or tear of the upper trunk of the brachial plexus
C5 and C6 roots
Seen in infant following trauma during delivery
Findings: limb hang by side, medially rotates, forearm is pronated
Winged scapula?
Lesion to the serratus anterior
A/w long thoracic nerve
Which are the hand muscle?
Thenar eminence (median) Hypothenar eminence (ulnar) Dorsal interosserous muscle - abduct finger Palmar interosserous muscle - adduct finger Lumbrical muscles flex at the MCP joint, extend PIP and DIP joint
Which are the muscles of the Thenar eminence?
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Which are the muscles of the Hypothenar eminence?
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi
Obturator nerve?
(L2-L4)
Injury: Anterior hip dislocation
Motor defi.: thigh adduction
Familiar nerve?
(L2-L4)
Injury: pelvic fracture
Motor defi.: thigh flexion and leg extension
Common peroneal nerve?
(L4- S2)
Injury: Trauma or compression of lateral aspect of leg or Fibula neck fracture
Motor defi.:Foot eversion and dorsiflexion; Toe extension; Foot drop; Foot slap; Steppage gait
Tibial nerve?
(L4- S3)
Injury: knee trauma
Motor defi.: Foot inversion and plantarflexion; Toe flexion
Superior gluteal nerve?
(L4- S1)
Injury: Posterior dislocation or Polio
Motor defi.: thigh abduction
Inferior gluteal nerve?
(L5- S2)
Injury: posterior hip dislocation
Motor defi.: can’t jump, climb stairs or rise from seated position
Xeroderma pigmentosum
Defective nucleotide excision repair
Basal cell carecinoma histology?
Basaltic cells with hyperchromatic nuclei.
Honey- colored crusting
Impetigo
Tx:topical abx Mupirocin (Bactroban)
Velvety, hyperpigmented plaques on the skin of neck and axillae
Acanthosis nigricans
- in flexure regions
- A/ w insulin resistance or obesity
- A/w GI and lung malignancy
Immmunofluorecens reveals linear patter (IgG C3) at epidermal ( basement mm.)- dermal junction
Bellos penhigoid
- spares oral mucosa
- biopsy: subepidermal cleavage
Tx:High potency topical glucocorticoid (Colbetasol)
Acantholysis
Separation of epidermal cell
+ in pemphigus vulgaris
Flaccid intraepidermal bullae?
Pemphigus vulgaris
- causes acantholysis
- IF: Ab around epidermal cells
Kaposi sarcoma
Endothelial malignancy
A/w HHV-8 and HIV
Has lymphocytic infiltrates
MC type of skin cancer; the lesión is a pearly-colored papeles with a translucent surface and telangectasis
BCC
Flat-topped papules
Lichen planus
Pinkish, scaling, flat lesions on the chest and back?
Tinea (pityriasis) vesicolor
*Maleasar furfur
Dewdrops on a rose petal
Lesions of primary varicella
“Crearle cap”
Seborrheic dermatitis
- adherent greasy scales with a mildly erythematous base seen on scalp
- predilection for areas with oily skin
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women
Lichen sclerosis
Exophytic nodules on the skin with varying degrees of scaling or ulceration
SCC
*2nd MC type of skin cancer
Espongiosis
Epidermal accumulation of edematous fluid in intracellular space
- eczematous dermatitis
Nikolsy sign
+ pemphigus vulgaris ( separation of epidermis upon manual stroking of skin)
- bullous pemphigoid
Cytoplasmic vacuolization (koilicytosis) forming perinuclear halos
Verruca vulgaris ( common warts) Due to HP
- non-umbilicated, skiing-colored papules or growth
- ITCHIng
Auspitz sign
Psoriasis
Radial head subluxation
Nursemaid elbow
- common in preschool
- axial traction of forearm with elbow extended ( child pulled, lifted, swung by)
- presents: arm held extended & probated. No swelling, deformities or focal tenderness.
- Tx: Hyperpronation of forearm or supination of forearm & flexión of elbow
Patellofemoral stress syndrome
Overuse injury commonly seen in runners
- Anterior knee pain that worsens upon descending steps or hills.
Inflammatory causes of low back pain
Ankylosis spondylitis, Reactive arthritis, Psoriatic arthritis, IBD
- better with activity or exercise
- no improvement with rest
- gradual unset
- HLA-B27 present
An X-ray finding of an expansive & eccentric lytic area suggestive of?
“Soap - bubble “ appearance of Giant cell tumor of bone ( Osteoclastomas)
Enthesitis
Characterized by information and pain at site of tendon and ligament attachment to bone.
- Seen in Ankylosis spondylitis ( inflammatory cause of lower back pain)
Spondylolisthesis
A developmental disorder characterized by a forward slip of vertebra ( L5 over S1)
*a palpable “step-off” is detected on examination if the problem is severe
Polyarticular Juvenile idiopathic arthritis
Autoimmune disorder of childhood make by symmetric arthritis of the upper and lower extremity.
- Labs: systemic inflammation including increase in inflammatory markers (ESR, CRP), Hyperferritinemia, Hypergammaglobulinemia & Thrombocytosis.
- Anemia is commonly seen due to the chronic inflammation &a decrease in Fe.
Trendelenburg sign
A drooping of the contralateral pelvis that occurs when the pt stands on one foot.
*due to muscle weakness of Gluteous medius & Gluteus minimus as result of Superior gluteal nerve damage
Valgus vs. Varus laxity
Valgus-> MCL tear
* laxity when leg is forced to abduction
Varus-> LCL tear
Malignancy causes of low back pain?
Metastatic cancer to bone:
- H/O Malignancy
- age > 50
- Worse at night
- cauda equina syn
Most beneficial Tx option in preventing long term morbidity in pt with septic joints?
Surgical drainage & debridement
Myasthenia graves Vs. Lambert Eatin syndrome
MG: auto-ab against post-synaptic acetylcholine receptors in NMJ.
* presents: ocular fatigue ( ptosis, diplopia) & muscular weakness
with preserved reflexes
LEMS: auto-ab against the voltage gated Ca channel in presynaptic motor nerve terminal.
* presents: proximal muscle weakness with decrease/absent tendon-
Reflexes
Pseudogout
A form of acute arthritis induce by the release of Calcium pyrophosphate dehydrate crystals from sites of chondrocalcinosis into the joint space.
- often occurs in the setting of recent surgery or medical illness.
Myotonia
Delayed muscle relaxation
Infectious causes of low back pain
Osteomyelitis,Discitis, Abscess - due to: recent infection IV drug user Diabetes * fever, exquisite point tenderness *MRI is the Dx image
Rafionuclide bone scan are used to evaluate?
Malignancy
Infections
Inflammatory diseases of bone
Neurogenic Arthropathy
Charcot joint
- complication of neuropathy & repited joint trauma
- affects weight bearing joints
- manifest with: functional limitation deformity, degenerative joint
- X-ray: loss of cartilage, osteophyte development, lose bodies
Sharp, localized pain & tenderness over the anterior-medial part of the tibial plateau just below the joint line of the knee.
Pes anserius syn
- valgus stress test will not agraviate the pain
- normal x-ray
In case of amputation injury, what is the best next step with the amputated limb?
Amputated part should be wrapped in saline-moistened gauze, sealed in a plastic bag, place on ice
A dashboard knee injury results in?
Disruption of the posterior cruciales ligament PCL
Chondrocalcinosis
Calcification of articular cartilage
* seen in Hemochromatosis
Posas sign
Abd pain with hip EXTENSION
-clinical presentation in a Psoas abscess
Legg-Calve-Perthes disease Vs. Slipped Capital Femoral Epiphysis
LCP-> idiopathic AVN(osteonecrosis) of the femoral head.
-> boys 4-10y/o peak at 7y
SCFE-> separation of the proximal femoral epiphysis.
-> boy 11-13y/o in Obese adolescent
- bouth present with limited abduction & internal rotation of the hip
What time of exam should accompany all clavicle fx & why?
A neuronascular exam.
* due to the proximity to the subclaviar art. & brachial plexus
Clinical manifestations of SLE?
- symmetric migratory arthritis (hand, knee)
- serositis: pleurisis, pericarditis, peritonitis
- thromboembolic event
- fever, fatigue, weight loss
- butterfly rash and photosensitivity
*Labs: hemolytic anemia, thrombocytopenia, leukopenia
Hypocomplemenmia (C3 &C4) decreases
Antibodies: ANA & anti-dsDNA, anti-Sm
Renal: proteinuria, increase Cr
Triad of clinical findings of Fety syndrome?
Inflammatory arthritis
- > erosive joint disease & deformi
- > rheumatoid nodules
- > vasculitis( mononeuritis, necrotizing skin lesions)
Neutropenia
Splenomegaly
Indication for imaging in low back pain?
X-ray: osteoporosis, compression fx, malignancy, ankylosis spondylitis
MRI: sensory/motor deficit, cauda equina syn, epidural abscess/ infection
Musculoskeletal causes of low back pain
- Mechanical ( muscle strain, spasm, degenerative arthritis)
- Herniated disk
- Spinal stenosis: better with spine flexión
- Compression fx
Symptoms of meniscal tear?
Acute “popping” sensation from twisting injury of the knee
Slow onset joint effusion
Impaired knee extension
Pain exacerbated with squatting
- presents: “catching” sensation, “locking”, reduce range of motion
Pt with pseudogaut should be evaluated for secondary causes like?
Hyperparathyroidism
Hypothyroidism
Hemochromatosis
Shoulder dislocation
- Anterior
- Posterior
Anterior: -MC - Axillary nerve damage
- pt holding arm in Abd & external rotation
Posterior: - in seizure ( eclampsia) pt
- pt holding arm in Add & internal rotation
Early physical sings of Compartment syn?
Extremity tightness
Weakness
Pain with passive motion
Pain out of proportion to injury
- untreated: paralysis , muscle contracture, sensory deficit, infection, skin ulceration & necrosis
- Tx: fasciotomy if pressure is > 20-30mmhg
Diagnosis of Myopathy with normal ESR & increase CK
- Station-induce myopathy: muscle pain/tenderness with or without weakness
- Hypothyroid myopathy: features of hypothyroid +
- > pain, cramps & weakness involving proximal muscle
- > delayed tendon reflexes & myoedema
Diagnosis of Myopathy with normal ESR and CK
Glucocorticoid- induced myopathy
- > progressive proximal muscle weakness & atrophy without pain or tenderness
- > Lower extremity muscles are more involved
Diagnosis of Myopathy with increase ESR and normal CK
Polymyalgia rheumatica
- > muscle pain & stiffness in the shoulder & pelvic girdle
- > tenderness with decreased ROM at shoulder, neck and hip
- > responds rapidly to Glucocorticoid
Diagnosis of Myopathy with increase ESR and CK
Inflammatory myopathys
- > muscle pain, tenderness and proximal muscle weakness
- > skin rash and inflammatory arthritis my be present.
Acute monoarthritis with fever?
Septic arthritis
- A/w restricted ROM
- common in pt with underlying joint disease
Reactive arthritis
Reiter syndrome
-Triad: conjunctivitis, uveitis, arthritis (can’t see, pee or climb a tree)
*2 subtypes: post- enteric(GI bugs) and post-venereal (chlamydio)
Golfer’s elbow
Medial epicondolitis
Repetitive flexión
C5,6
Bone pain, bone enlargement, arthritis
Paget disease of bone
- increase osteoblasts and osteoclasts activity
- normal Ca and phosphate, increase ALP
Patella fx
Inability to EXTEND the knee
Achondroplasia
Failure of longitudinal bone growth
- endochondral ossification ( short limbs)
FGFR3
AD
Triad of:
- Autoimmunity
- Non inflammatory vasculopathy
- Collagen deposition with fibrosis
Scleroderma (systemic sclerosis)
Primary malignant bone tumors
Osteosarcoma ( codman triangle, sunburst)
Edwing sarcoma “onion”
Polymyositis/ Dermatomyositis
Progressive symmetric proximal muscle weakness
- increase CK
- (+ )ANA, anti-Jo-1, anti-SRP and anti-Mi-2
- Polymyositis: increase CD8
- Dermatomyositis: increase CD4, malignancy, malar rash, gottron papules and heliotropic rash
Anti- U1 RNP antibody
A/w Mixed connective tissue disease
Polymyalgia rheumatica
Pain and stiffness in shoulder and hip
- increase ESR, increase CRP and normal CK
- A/w TGCA
Pseudogout
Rhomboid crystals that are weakly brirefringent under polarized light
Musculocutaneous nerve
- Inervates
- Provides
- Drive from
- Foramen flexors ( biceps) & choracobrachialis ( flexes and adduct the arm)
- Sensory innervation to the lateral forearm
- Upper truck (C5-C7)
Long thoracic nerve injury
- during axillary lymph node dissertation
- paralysis of Serratus Anterior M.
- wining of the scapula
- C5-C7
L4
- sensory loss: lower anterolateral thigh, knee and medial calf & foot
Patellar reflex
3 MC carpal bone injury
- Scaphoid Fx: MC, a vascular necrosis
- Lacunate dislocation: acute CTS
- Hook of the Hemate: fall on outstretched hand, ulnar nerve injury
Type IV collagen
Basement mm
Lens
Defective in Alport syndrome ( can’t see, pee, hear a thing)
Prescription of monosodium ureate crystals
Gout
Antinuclear antibodies
SEL, non specific
Anti- body highly specific for SEL
Anti-Smith antibodies
Piriformis syndrome
Compression of the Sciatic nerve in the Foramen
*Due to Piriformis muscle injury or hypertrophic
Tennis elbow
Lateral epicondylitis
Repetitive EXTENSION
C6-8
Osteopetrosis
Failure of normal bone resorption due to defective osteoclasts.
- carbonic anydrase II mutation
- thickened bone prone to fx
Landmarks Dermatomes
T4,T7,T10,L1,L4,S2-4
T4- nipple T7- xiphoid process T10- umbilical L1- inguinal ligament L4-knee S2,3,4- erectior &sensation of penil and anal zone
Osteonecrosis
Infarction of bone
* MC site is the Femoral head
“Foot drop”
Injury of Common peroneal nerve
Mosaic pattern of woven & lamellar bone
Paget disease ( osteitis deformans)
Loss of dorsal foot sensation
Impaired dorsiflexion &
Eversion resulting in “foot drop”
Common peroneal nerve injury
Type III collagen
Ehlers-Danlos syndrome ( vascular defect)
Extension of the thigh
Gluteus Maximus
- supplie by Inferior gluteal nerve
Erbs palsy
Waiters tip
Traction or tear of Upper trunk C5-6
Bone pain, worse at night and relieve by Aspirin
Osteoid osteoma
* Diaphisis ( tibia, femur)
Mid shaft fx of the Humerus can result in injury of?
Deep brachial artery
Radial nerve
- bought run together along the posterior aspect of the humerus
Thoracic outlet syndrome
Compression of lower trunk and subclavian vessels
External hip rotation
Piriformis muscle
Antibodies to ………… peptides/ proteins have a high specific for RA
Citrulinate
“ Onion skin”, periosteal reaction in bone
Edging sarcoma
A/w t(11:22)
Codman triangle or sunburst pattern on X-ray
Osteosarcoma
Seronegative Spondyloarthropathies
Arthritis without Reumatoid factor A/w HLA-B27 (MCH class I) - PAIR: psoriasis arthritic, ankylosis spondolitis, IBS, reactive arthritis
“Soap bubble” appearance on r-ray
Giant cell tumor “Osteoclastoma”
Primary bening bone tumor
Osteoclastoma Osteochondroma Osteoma Osteoid osteoma Osteoblastoma
“Empty-can” test
Isolates the action of the Supraspinatus muscle
Osteomalacia
Decrease mineralization of osteoid
MCC is vit. D defi
* presents: bone pain, muscle weakness and increase fx
*labs: increase ALP and PTH, decrease Ca, phosphorus and 25OH-D
Sistic nerve
L4-S3
Innervates posterior thigh
*splits into: common peroneal n. & tibial n.
Defective protein in Marián syndrome
Fibrillin 1
Rotator cuff muscles
Supraspinatus- Ab
Infraspinatus- lat rotation
Teres minor- Ad, lat rotation
Subscapularis- Ad, internal rotation
Pudendal nerve
Innervation to the perineal region
Tubercular (spongy) bone losses mass & interconnections
Osteoporosis
- Hilar & mediastinal Adenopathy
- Hypercalcemia
- Uveitis
- RLD ( interstitial fibrosis)
Sarcoidosis
* common autoimmune disease in young african American women
Unhappy triad
ACL
MCL
Medial meniscus
The superior gluteal nerve innervates?
Gluteus medius, minimus and tensor fascia latae m.
- they abduct the thigh
Antinuclear antibodies SS-A (anti-Ro)
SS-B (anti-La)
Sjogres syndrome
The femoral N.
1. Innervates
2 provides sensation
- Muscle of the anterior compartment of the thigh
- quadriceps
- sartorius
- pectineus
* responsible for knee extension and hip flexion - Anterior thigh & medial leg
Goodpasture syndrome
Autoantibodies against
- glimerular bm ( RPGN)
- alveolar bm ( hemorrhage)
- Anti-GBM
Obturator nerve
Addiction of the thigh
Sudden upward on the arm at the shoulder can damage?
Lower trunk C8-T1
- klumpke palsy
- finger clumsiness
- claw hand deformities
- absent grant reflex
Tibial nerve
- Innervates
- Provides sensation to
- Posterior compartment of leg and plantar aspect of foot.
- flexion of the knee & digits
- plantar flexion - Leg ( except medial side and plantar foot)
Weakened plantar flexion
Decrease inversion of foot
Decrease sensation at the sole of the foot
Tibial nerve injury
Medication to DX Myasthenia gravís
Edrophonium
Back pain that is exacerbated by standing & walking, but relieved with sitting and hyperflexion of the hip
Spinal stenosis
Immune mediated, widespread non caseating granulomas, increase ACE levels and CD4/CD8 ratio
Sarcoidosis