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Musculoskeletal Extras > Pathologies > Flashcards

Pathologies Flashcards

1
Q

Radial Nerve Injury

A

MOA: Can be caused by radial groove of the humerus fracture or Saturday Night Palsy (pressure on radial nerve)
Clinical Presentation: Wrist-Drop Sign. Paralysis of the triceps, brachioradialis, supinator and extensor muscles of the writs and digits. Loss of sensation in the dorsum hand and digits

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2
Q

Musculocutaneous Nerve Injury

A

Clinical Presentation: Paralysis of coracobrachialis, biceps, and brachialis. Weakened forearm flexion and supination. Loss of sensation on the lateral surface of the forearm
*Commonly caused by weapons

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3
Q

Pronator Syndrome

A

Clinical Presentation: Pope’s Hand Sign/Sign of Benediction (ring and pinky can bend, but pointer and middle stay straight) Pain and tenderness in the proximal anterior forearm
MOA: Median nerve injury from compression of 2 heads of Pronator Teres muscle

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4
Q

Cubital Tunnel Syndrome

A

Clinical Presentation: Claw Hand Sign (pinky and ring finger stick up when making a fist). Numbness and tingling of the medial part of the palm and medial 1.5 fingers. Reduced/impaired adduction of fingers. When flexing wrist, hand is drawn to the lateral
MOA: Ulnar nerve compressed by flexor carpi ulnaris at proximal attachment site where 2 heads form a tunnel

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5
Q

Occlusion/Laceration of brachial artery

A

Leads to ischemia involving forearm flexor muscles

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6
Q

Fracture/dislocation of the proximal humeral epiphysis

A

Happens to children or adolescents when the arm or shoulder is directly hit by a blow

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7
Q

Rupture of the tendon of the biceps

A

Clinical Presentation: Popeye deformity (muscle balls near the center of the distal part of the anterior aspect of the arm)
MOA: wear and tear of inflamed tendon (older athletes), excessive forceful flexion of the arm (weight lifting)

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8
Q

Dislocation of the tendon of the long head of the biceps

A

Clinical Presentation: May notice popping or catching sensations
MOA: Tendinitis and traumatic separation of the proximal epiphysis of the humerus
*associated with rotator cuff injuries 70% of the time

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9
Q

Biceps Tendinitis

A

Clinical Presentation: tenderness and crackling sound (crepitus) in the region
MOA: repetitive micro trauma from certain motions such as throwing or using a racquet
*tends to have similar pain levels whether actively or passively moved

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10
Q

Ulnar Nerve Injury

A

Claw Hand Sign (pinky and ring finger stick up when making a fist). Numbness and tingling of the medial part of the palm and medial 1.5 fingers. Reduced/impaired adduction of fingers. When flexing wrist, hand is drawn to the lateral
MOA: Direct hit against hard object or fracture of the medial epicondyle of the humerus
*locations: posterior to medial epicondyle & uncommonly the canal of Guyon

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11
Q

Surgical neck of humerus fracture

A

MOA: Caused by a fall on an outstretched hand. Causes axillary nerve damage
Clinical Presentation: Pt can still move the injured arm passively with little pain. Dx’d by XR or CT
*common in elderly (trouble abducting after 15 degrees)

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12
Q

Distal end of the humerus fracture

A

can damage the median nerve

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13
Q

Erb’s Palsy

A

Clinical Presentation: Waiter’s Tip Position (injured limb hands in medial rotation), loss of sensation on the lateral aspect of the upper limb (deltoid, biceps, brachialis, and brachioradialis)
MOA: Damage to C5 and C6 of brachial plexus from excessive separation of the head and neck
*superior part injury
*common in motorcycle accidents and shoulder dystocia

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14
Q

Backpacker’s Palsy

A

Clinical Presentation: Sensory deficits in musculocutaneous nerve and radial nerve. Sometimes muscle spasms
MOA: microinjury of the superior trunk of the brachial plexus
*superior part injury
*caused by carrying a heavy backpack

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15
Q

Klumpke’s Palsy

A

Clinical Presentation: Claw Hand Sign (Pinky and ring finger stick up when making a fist)
MOA: Damage to C8 and T1 of brachial plexus from sudden pulling of the arm superiorly
*inferior part injury
*causes could be grasping a tree branch to stop a fall or pulling of the arm during delivery

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16
Q

Painful Arc Syndrome

A

aka: Supraspinatus tendonitis, subacromial bursitis and calcification
MOA: inflammation and calcification of the supraspinatus tendon, inflammation of subacromial bursa
Clinical Presentation: pain during the abduction in the 50 - 130 degree range

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17
Q

Rotator Cuff injuries

A

Clinical Presentation: pain in the anterosuperior part of the shoulder. Shoulder joint dislocation
MOA: Throwing a ball hard, shoulder joint dislocation, or avoiding crushing into and object using your arm
Test: ask patient to lower a fully abducted arm slowly and when reaches 90 degrees it will drop

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18
Q

Thoracodorsal Nerve Injury

A

Clinical Presentation: Pt is unable to use axillary crutch or do pullups b/c or lack of innervation and thus tension in the latissimus dorsi muscle
*can be injured in surgical operation

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19
Q

Paralysis of Serratus Anterior

A

MOA: Injury to long thoracic nerve

Clinical Presentation: Winged scapula. Arm cannot abduct above the horizontal position

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20
Q

Fracture of the clavicle

A

MOA: Indirect forces transmitted through bones of the arm and forearm or falls directly onto the shoulder
Clinical Presentation: medial fragment will elevate (b/c sternocleidomastoid) and lateral will depress (b/c weight of shoulder/arm). Shoulder drops
*70% in the middle 1/3 of the clavicle. relatively common

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21
Q

Avulsion fracture of the greater tubercle of the humerus

A

MOA: fall on the shoulder of hand
Clinical Presentation: proximal end pulled superio-posterio-laterally by supraspinatus and infraspinatus. Distal end pulled and rotated medially by subscapularis
*common in middle aged and elderly

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22
Q

Transverse fracture of the body of the humerus

A

Proximal end is pulled laterally by deltoid. Distal end is pulled upward by biceps. Arm is shortened and fracture ends overlap

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23
Q

Supracondylar fracture of the humerus

A

Distal fragment may be displaced either anteriorly or posteriorly and pulled upward causing the arm to shorten

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24
Q

Colles’ Fracture

A

MOA: complete transverse fracture of the radius and sometimes ulna within the distal 2 cm. commonly from forced dorsiflexion
Clinical Presentation: dinner form appearance (distal fragment displaced dorsally and proximally. Normal relationship between the radial and ulnar styloid processes is changed and the radial styloid process is moved proximally

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25
Q

Olecranon Fracture

A

MOA: fall on the elbow

Clinical Presentation: Olecranon is pulled upward by triceps

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26
Q

Fracture of the scaphoid

A

MOA: Fall onto the palm while hand os abducted
Clinical Presentation: pain when pressing on anatomical snuff box. Poor blood supply to the proximal part of the scaphoid causes slow bone union/avascular necrosis of proximal fragment
*most frequently fractured and most common injury of the wrist

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27
Q

Fracture of the metacarpals

A

boxer’s fracture from punching

*4th and 5th metacarpals most vulnerable

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28
Q

Dislocation of the epiphysis of the femoral head

A

MOA: acute trauma or repeated microtrauma
Clinical Presentation: may result in coxa vara. Initial symptom is hip discomfort that may be referred to the knee
*children age 10-17

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29
Q

Tibial fracture

A

MOA: direct for to the tibia
Clinical Presentation: “boot-top fracture” “bumper fracture” at the middle to distal 1/3 junction
*easily become compound fractures. Can bone graft using fibula

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30
Q

Fibular fracture

A

MOA: forced inversion or eversion of the foot
*commonly occurs in 2-6 cm proximal to the distal end of the lateral malleolus and often associated with dislocation of ankle joint

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31
Q

Medial epicondylitis

A

“golfer’s elbow”. painful shaking hands, swinging of a golf club etc.
Tx: RICE

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32
Q

Osteopetrosis

A

No secondary marrow cavity. Lead weighted long bones

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33
Q

Charcot Joints

A

Clinical Presentation: peripheral neuropathy, loss of feeling leads to loss of proprioception leading to microfractures, Ca2+ deposits, and abnormal growth b/c the bones can’t respond to normal forces and changes in position
*complication of NIDDM and IDDM most commonly in lower extremities b/c they are weight bearing

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34
Q

Lipoma

A

Clinical Presentation: soft, mobile, painless mass on the proximal extremities and trunk
MOA: Tumor of adipose tissue. BENIGN.
Histo: well encapsulated/ circumscribed mass of mature fat cells with no pleomorphism
* most common soft tissue tumor of adulthood. Cured by excision

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35
Q

Liposarcoma

A

MOA: tumor of adipose tissue, MALIGNANT. Arises in the deep soft tissues of the proximal extremities and retroperitoneum.
*occurs in mid-late adulthood. One of the most common sarcomas of adulthood. Aggressive types can metastasize via blood and lymph.

Variants:

  1. well-differentiated (indolent): amplification of MDM2 oncogene, binds and inactivates p53
  2. Myxoid/round cell (intermediate in behavior) = chromosomal abnormality/translocation
  3. Pleomorphic (aggressive, can metastasize)
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36
Q

Nodular Fasciitis

A

Tumor-like lesion of fibrous tissue
MOA: Self-limited, reactive pseudosarcomatous proliferations in deep dermis, subcutis, or muscle. Nodular and poorly defined
Clinical Presentation: several week history of a solitary,, rapidly rowing, and sometimes painful mass, often on the volar aspect of the forearm, chest, and back`

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37
Q

Superficial Fibromatoses

A

tumor of fibrous tissue. BENIGN
MOA: fibroblastic infiltrative proliferations
Dupuytren contracture: palmar fibromatosis
Peyronie’s disease: penile fibromatosis
*not called a fibroma b/c not well-defined

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38
Q

Deep Fibromatoses

A

tumor of fibrous tissue. BENIGN
MOA: mutation in beta-catenin genes present in most
Clinical Presentation: in abdominal wall or muscles of trunk and extremities
*most often in the teens to 30s

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39
Q

Fibrosarcoma

A

tumor of fibrous tissue. MALIGNANT
*rare, most commonly affects retroperitoneum, thigh, knee, and distal extremities
Slow growing and often present for serveral years at Dx
Can metastasize hematogenously, usually to lungs

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40
Q

Benign Fibrous Histiocytoma (Dermatofibroma)

A

Fibrohistiocytic tumor. BENIGN
MOA: Uncertain pathogenesis. painless, slow-growing, firm small, mobile nodule in dermis and subcutaneous tissue, well circumscribed

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41
Q

Malignant Fibrous Histiocytoma (MFH)/Undifferentiated Pleomorphic Sarcoma (UPS)

A

Fibrohistiocytic tumor. MALIGNANT.
In proximal extremities and retroperitoneum
Gross: large gray-white unencapsulated masses

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42
Q

Rhabdomyoma

A

Tumor of skeletal muscle. BENIGN

extremely rare

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43
Q

Rhabdomyosarcoma

A

Tumor of skeletal muscle. MALIGNANT.
Histo: “strap cell”. Stains positive for actin, desmin, and myoglobin. Can manifest as soft grapelike masses in mucosal surfaces.
*most common soft tissue of childhood and adolescence < age 20
*most occur in head/neck or GU tract
3 types:
1. Embryonal: most common. develops in the wall of hollow mucosal lined organs
2. Alveolar: deep musculature of the extremities, poor prognosis. Unique cytogenic abnormalities - PAX3 or PAX7 w/ FOXO1a. Causes dysregulated skeletal muscle differentiation. Characteristic histological pattern resembles lungs.
3. Pleomorphic

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44
Q

Leiomyoma

A

Tumor of smooth muscle. BENIGN
MOA: often arises in uterus (aka fibroids)
*can cause infertility

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45
Q

Leiomyosarcoma

A

Tumor of smooth muscle. MALIGNANT.
MOA: most develop in the skin, deep soft tissues of the extremities, and retroperitoneum
*must use smooth muscle stain to differentiate from fibrosarcoma and MFH
*more common in females

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46
Q

Hemangioma

A

Vascular tumor. BENIGN.
MOA: increased number of normal or abnormal vessels filled with blood
3 types:
1. Capillary hemangioma: skin, subq, mucous membranes. “strawberry type” common
2. Cavernous hemangioma: dilated/spongy, larger, more frequently involve deep structures (ex. liver). Doesn’t usually indicate a problem, but could bleed out if traumatized and large enough
3. Pyogenic granuloma (aka lobular capillary hemangioma): exophytic nodule on skin, gingiva, or oral mucosa. No aggregates of histiocytes, but often traumatized/erupted, becomes ulcerated and covered w/ pus

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47
Q

Kaposi Sarcoma

A 
Vascular tumor, low to intermediate grade.
MOA: Transmitted sexually. Regardless of clinical subtype, 95% of KS are infected with HHV-8, also known as KSHV. 
*stain for HHV-8
4 types:
1. Classic/European
2. African/Endemic
3. Transplant associated
4. AIDS associated
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48
Q

Angiosarcoma

A

Vascular tumor. MALIGNANT.
MOA: most commonly involving skin, soft tissue, breast, and liver
Hepatic - associated arsenic, thorotrast, polyvinyl chloride
Breast - associated with radiation

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49
Q

Synovial Sarcoma

A

Tumor of uncertain histiogenesis. biphasic tumor with both epithelial and mesenchymal components
MOA: most occur in deep soft tissue around large joints of extremities. characteristic chromosomal translocation (x;18)
*occurs in young adults 20-40
*may metastasize to lung

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50
Q

Nevus

A

MOA: mole, BENIGN neoplasm of melanocytes
Epidemiology: congenital, present at birth
Clinical Presentation:
Junctional: epidermis, forms nests of melanocytes in the rete ridges, flat mole, fade with age, reticular pigment
Dermal: melanocytes in dermis only, exophytic mole, globular pigment
Compound: dermis + epidermis, raised mole

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51
Q

Melanoma

A

MOA: malignant neoplasm of melanocytes characterized by two growth phases, (1) radial growth horizontally along epidermis/dermis and (2) vertical growth into deep dermis
Clinical Presentation: Asymmetry, Border Irregularity, Color Variation, Diameter >5mm, Evolving
*most common type of cancer in women (mid-20s), 1/50 people, mostly de novo

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52
Q

Solar Lentigo

A

MOA: liver spots, tumor of pigmented keratinocytes
Clinical Presentation: found on face/hands of fair skin due to sun damage
*older adults

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53
Q

Seborrheic Keratosis

A

MOA: BENIGN squamous proliferation comprised of basaloid and squamoid keratinocytes
Clinical Presentation: Leser-Trelat Sign (sudden onset of multiple seborrheic keratosis –> GI carcinoma), warty surface, stuck on plaques, on hair-bearing skin
Histo: horn cysts and lamellated keratin
*common, older adults

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54
Q

Actinic Keratosis

A

MOA: precursor lesion of squamous cell carcinoma
Clinical Presentation: red scaly papule, sandpaper feel due to sun, found on fair skin on face, back or neck
* older adults. 0.1% progress to SCC

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55
Q

Squamous Cell Carcinoma

A

MOA: MALIGNANT proliferation of squamous cells arising on sun damaged skin
Clinical Presentation: can occus anywhere on skin, firm flesh color to reddish growth with indistinct border, scaly surface or ulceration, often LOWER LIP
Histo: Keratin pearls
Risk Factors: UVB- induced DNA damage, prolonged exposure to sunlight

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56
Q

Keratoacanthoma

A

MOA: well-differentiated SCC originating from pilosebaceous glands
Clinical Presentation: cup-shaped tumor filled with keratin debris, develops rapidly and regresses spontaneously

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57
Q

Bowen’s Disease

A

MOA: SCC in-situ often progressing or coinciding with invasive SCCs
Clinical Presentation: thin, erythematous, scaling plaques

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58
Q

Basal Cell Carcinoma

A

MOA: malignant proliferation of basal cells of epidermis
Clinical Presentation: elevated nodule with central, ulcerated crater surrounded by dilated vessels (telangiectasia) pink pearlescent papule, often on UPPER LIP
*most common tumor in caucasians

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59
Q

Epidermoid Cysts

A

MOA: occluded hair follicles fill with loose keratin, aka epidermal inclusion or sebaceous cyst
Histo: granular layer in cyst wall

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60
Q

Pilar Cysts

A

Clinical Presentation: often on scalp, but can be found on any hair-bearing skin
Histo: dense pink compact keratin with no granular layer

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61
Q

Mycosis Fungoides

A

MOA: cutaneous T-cell lymphoma caused by malignant CD4+ Th cells
Clinical Presentation: favors sun-protected areas, 5cm+ patches/thin plaques, erythroderma/tumors = more severe
*1/300,000

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62
Q

Mastocytosis

A

MOA: localized mast cell collection, aka urticaria pigmentosa
Clinical Presentation: brown oval plaque. Darier sign: scratching lesion forms hives
Histo: “fried egg” appearance
*kids

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63
Q

Skin Tag

A

MOA: pedunculated papilloma
Clinical Presentation: neck, eyelids, trunk, groins, axillae
Histo: outer keratinizing squamous epithelium, inner fibrovascular core; no adnexa
Risk Factors: Weight gain, pregnancy, diabetes

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64
Q

Dermatofibroma

A

Clinical Presentation: red-brown firm nodule, dimple sign, lower extremities (itchy)
Histo: hemosiderin deposits, CD34-, spindle cell proliferation
*middle-aged adults

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65
Q

Dermatofibrosarcoma Protuberans

A

MOA: locally aggressive, bulky irregular tumor
Clinical Presentation: trunk
Histo: swiss cheese growth pattern CD34+
*middle-aged adults

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66
Q

Ichthyosis Vulgaris

A

MOA: deficiency in profilagrin causes abnormal retention of corneocytes
Clinical Presentation: fine scales, lower extremities, itchy
Histo: Diminished granular layer
*autosomal dominant, 1/250

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67
Q

Oculocutaneous Albinism

A

MOA: defect in tyrosinase which is important in forming melanin pigment
Clinical Presentation: diffuse hypopigmentation, eye problems
Histo: melanocytes and keratinocytes without melanin
*autosomal recessive 1/20,000

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68
Q

Allergic Contact Dermatitis (Eczema)

A

MOA: caused by exposure to potent external allergen such as poison ivy, nickel, balsam of peru, neomycin, irritant chemicals
Clinical Presentation: pruritic, erythematous, oozing rash with vesicles and edema; typically localized to the point of contact

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69
Q

Atopic Dermatitis (Eczema)

A

MOA: caused by Langerhan’s cells being too high in the spinous layer of the epidermis. They can easily contact antigens.
Clinical Presentation: Pruritic erythematous, oozing rash with vesicles and edema; often involves face and flexor surfaces
*Birbeck Granules EM
*Type 1 hypersensitivity

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70
Q

Lichen Planus

A

MOA: exposure to hep C virus, medication, contact allergen leads to self-antigens on basal keratinocytes; T-cells induce death via apoptosis
Clinical Presentation: pruritic, purple, polygonal papules, Wickham striae (oral involvement)
Histo: inflammation of dermal-epidermal junction with “saw-tooth” appearance, dead reds

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71
Q

Lupus Erythematosus

A

MOA: autoimmune systemic disease with anti-DNA antibodies
Clinical Presentation: butterfly pattern malar erythema
Histo: scales, mucin, positive ANA
*F>M, AA>Caucasian

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72
Q

Bullous Pemphigoid

A

MOA: IgG Ab against BM of collagen causes destruction of hemidesmosomes between basal cells and underlying BM
Clinical Presentation: subepidermal blisters of skin, oral mucosa spared; tense bullae do not rupture easily
*Ab to BP180, BP230; older adults

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73
Q

Pemphigus Vulgaris

A

MOA: IgG Ab against desmoglein causes destruction of desmosomes between keratinocytes
Clinical Presentation: upper trunk, painful skin and oral mucosa bullae, thin-walled bullae rupture easily (Nikolsky sign)
Histo: row of tombstones, suprabasilar blister, immunofluorescence-IgG surrounding keratinocytes in “fish net” patterns
*45-55y.o.
*type 2 hypersensitivity

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74
Q

Dermatitis Herpetiformis

A

MOA: Autoimmune deposition of IgA at tips of dermal papillae, form antigliadin Abs when gluten is consumed
Clinical Presentation: pruritic papules on knees, elbows, lower back, and scalp
Histo: immunofluorescence-granular deposition of IgA in dermal papillae
*strong association with celiac disease

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75
Q

Verruca Vulgaris

A

MOA: caused by physical transmission of HPV 1, 2, and 4 at site of abrasion
Clinical Presentation: warty, keratotic papules with rough grayish surface, common on hands/feet
Histo: hyperkeratosis, thick granular layer, papillary hyperplasia, KOILOCYTES
*20% school children

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76
Q

Molluscum Contagiosum

A

MOA: caused by physical transmission of MC virus, a pox virus
Clinical Presentation: waxy, umbilicated papules up to 1cm
Histo: cytoplasmic inclusion (molluscum bodies)
*children/sexually active adults

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77
Q

Pityriasis Rosea

A

MOA: might be caused by viral infection
Clinical Presentation: occurs in spring/fall, Christmas tree pattern, starts hearld plaque with trailing scale then many lesions

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78
Q

Impetigo

A

MOA: superficial bacterial skin infection caused by Staph Aureus
Clinical Presentation: erythematous macules that progress to pustules on face/extremities, results in erosions with honey-colored crusts
Histo: staph bacterial colonies, neutrophils

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79
Q

Tinea (ringworm)

A

MOA: caused by Trichophyton rubrum infection
Clinical Presentation: annular plaques with central clearing and scaly erythematous borders, transmission by direct contact
Histo: fungal hyphae with PAS , neutrophils in pustule

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80
Q

Scabies

A

MOA: caused by sarcoptes scabei
Clinical Presentation: direct transmission, pruritic papules in fingers, webs, axillae, umbilicus, areolas, genitalia, itching is worse at night

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81
Q

Psoriasis

A

MOA: excessive keratinocyte proliferation due to genetic predisposition and external trigger, possibly autoimmune associated with HLA-C
Clinical Presentation: salmon-colored plaques with silver scale on scalp, elbows, knees, sacrum; pitting of the nails
Histo: acanthosis parakeratosis, munro’s microabcesses, Auspitz sign (longer rete ridges makes epithelial arcs look thinner)

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82
Q

Acne Vulgaris

A

MOA: abnormal retention of follicular squames and sebum with infection by Propionibacterium acnes, causing chronic inflammation
Clinical Presentation: face/back/chest with papules/pustules/comedones, worse with stress

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83
Q

Rosacea

A

MOA: abnormally pronounced vasodilation to a variety of stimuli
Clinical Presentation: facial erythema, telangiectasias, WC Fields rhinophyma, exaggerated blushing, papules, skin thickening

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84
Q

Urticaria

A

MOA: mast cells release histamine, causing vasodilation and plasma exudation, transient skin swelling due to infection, drug, physical trauma, or autoimmune disease
Clinical Presentation: wheals, individual lesion < 24 hours duration

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85
Q

Erythema Multiforme

A

MOA: secondary to HSV infection, mycoplasma, or drugs

Clinical Presentation: target lesions have central dusky zone, self-limited, acute eruption, extremities/face

86
Q

Steven Johnson Syndrome

A

MOA: severe form of erythema multiforme most often due to adverse drug reaction
Clinical Presentation: severe blistering of oral mucosa, extremities and face + fever
*more severe form = TEN

87
Q

Erythema Nodosum

A

MOA: delayed hypersensitivity reaction associated with sarcoid, respiratory infections, drugs, IBD
Clinical Presentation: tender nodules on shins, panniculitis

88
Q

Porphyria Cutanea Tarda

A

MOA: genetic or acquired deficiency in uroporphyrinogen decarboxylase (makes Hb in RBCs)
Clinical Presentation: photosensitivity with blisters, erosions on dorsal hands, hypertrichosis

89
Q

Alopecia Areata

A

MOA: common cause of non-scarring alopecia affecting pigmented hairs
Clinical Presentation: oval patch of hairless skin, exclamation mark hairs
Histo: stelae lymphocytic “swarm of bees” around follicle bulbs

90
Q

Cicatricial Alopecia

A

MOA: possible related to hair styling, scarring hair loss
Clinical Presentation: slowly expansive patch
*AA females

91
Q

Developmental Dysplasia of the Hip

A

MOA: patients who are born with dislocation or instability of the hip, which may then result in hip dysplasia
Clinical Presentation: most commonly first born female, breech, left hip

92
Q

LCP Disease

A

aka avascular necrosis
MOA: result of damage to blood supply to femoral head ossific nodules; unknown etiology
Clinical Presentation: most commonly males 4-10 years old, some cases eventually bilateral, present with chronic limp or pain

93
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

MOA: acute trauma or repetitive microtrauma, kids 10-17y.o.
Clinical Presentation: mechanical effect due to obesity, increased shear forces on physis, may result in coxa vara, hip discomfort referred to knee (obturator nerve), externally rotated gait with limp, leg length discrepancy, limited flexion

94
Q

Lateral Epicondylitis

A

*tennis elbow
MOA: caused by repetitive forceful flexion/extension of the wrist, inflammation of the periosteum of the lateral epicondyle where the superficial extensors form a common tendon to attach
Clinical Presentation: Pain at the lateral epicondyle, radiates down posterior forearm, can be felt at rest or when opening a door/lifting a glass

95
Q

Mallet/Baseball Finger

A

MOA: caused by sudden forceful extension of a long extensor tendon such as a finger jammed into a base pad.
Clinical Presentation: DIP cannot extend and is pulled in flexion by flexor tendons

96
Q

Synovial Cyst of the Wrist

A

MOA: unknown cause
Clinical Presentation: painful, most common on dorsum of the wrist about the size of a small grape, contain clear mucinous fluid, may communicate with synovial sheaths
*if on palmar hand, may cause median nerve compression

97
Q

Tenosynovitis

A

MOA: infection of the synovial sheath caused by injury to the palm
Clinical Presentation: swelling/painful digits, infection can spread to palm, carpal tunnel and forearm, if digital synovial sheath ruptures can spread into midpalmar space

98
Q

De Quervain’s Tenosynovitis

A

MOA: excessive friction of abductor pollicis longus and extensor pollicis brevis tendons causing fibrous thickening of synovial sheath and tendonitis
Clinical Presentation: pain in wrist, radiates into forearm and thumb

99
Q

Digital Tenosynovitis (Trigger Finger)

A

MOA: repetitive forceful use of fingers causes thickening of fibrous digital sheath, FDS/FDP may enlarge
Clinical Presentation: finger cannot extend, passive extension of finger results in snapping sound

100
Q

Shoulder Separation

A

MOA: direct impact to shoulder or outstretched arm
Clinical Presentation: tear of coracoclavicular ligament results in downward separation of upper limb from clavicle aka AC joint dislocation
Dx: bilateral plain films w/ and w/o weights

101
Q

Shoulder Dislocation

A

MOA: humeral head is dislocated from the glenoid cavity

102
Q

Adhesive capsulitis of glenohumeral joint (Frozen Shoulder)

A

MOA: fibrosis/scarring in articular capsule due to injuries such as calcific supraspinatus tendonitis, partial rotator cuff tear or bicipital tendonitis
Clinical Presentation: difficulty abducting arm

103
Q

Dislocation of Radial Head (aka nursemaid’s elbow)

A

MOA: sudden lifting of child’s body by pulling arm, head of radius is pulled out of annular ligament, may be torn
Clinical Presentation: common in preschool children, immobile arm and protective position (pain)

104
Q

Hip Pointer

A

MOA: contusion (bruise) of the iliac crest, usually at anterior part
Clinical Presentation: may also refer to tearing of muscles at their bony attachment sites

105
Q

Charley Horse

A

MOA: painful contusion (bruise) of quadriceps muscle due to direct trauma
Clinical Presentation: May form hematoma, pain and muscle stiffness

106
Q

Psoas Abscess

A

MOA: retroperitoneal pyogenic infection from vertebral column TB or enteritis, may flow along muscle to inguinal region
Clinical Presentation: edema in inguinal region

107
Q

Femoral Hernia

A

MOA: more common in females, intestine passes through femoral canal below inguinal ligament
Clinical Presentation: Soft under skin, never enters scrotum, can be strangulated

108
Q

Varicose Veins

A

MOA: one-way valves that prevent blood from moving backward from deep veins into superficial veins fail
Clinical Presentation: backflow pressure leads to swollen cutaneous veins

109
Q

Muscle Compartment Syndrome

A

MOA: increased bulk in athletes cannot be accommodated within confined fascial compartment
Clinical Presentation: internal pressure leads to inflammation, loss of innervation, edema and atrophy of muscles; tenderness of proximal skin overlying anterior compartment as well as deep pain

110
Q

Osgood-Schlatter’s Disease

A

MOA: exertion of quadriceps muscles by athletes places strain on tibial tuberosity
Clinical Presentation: extreme pain, swelling, damage to epiphysial growth plate

111
Q

Common Fibular Nerve Injury

A

MOA: sever crushing or cutting results in loss of motor control to anterior and lateral compartment musculature
Clinical Presentation: High-stepping stride on affected side (drop foot gait)

112
Q

Housemaid’s/Surfer’s Knee

A

MOA: prepatellar bursitis

Clinical Presentation: due to excessive pressure/friction on patella/tibial tuberosity

113
Q

Flat Foot/Fallen Arches

A

MOA: collapse of medial longitudinal arch due to collapse of spring ligament
Clinical Presentation: caused by continuous stress (standing all day); pain, pathological gait

114
Q

Plantar Fasciitis

A

MOA: continuous stress of plantar fascia by running/jumping

Clinical Presentation: inflammation, pain, and swelling

115
Q

Back SPrain

A

MOA: damage to back ligaments which connect vertebrae
Clinical Presentation: less common, back pain leads to tonic muscle contraction to guard and protect back from excessive movement

116
Q

Back STrain

A

MOA: muscular problem, due to microscopic tears to muscle fibers due to overuse; weekend warrior!
Clinical Presentation: back pain leads to tonic muscle contraction to guard and protect back from excessive movement

117
Q

Dermatomyositis

A

MOA: inflammatory disorder of skin and skeletal muscle; humorally-mediated microangiopathy with ischemic necrosis of muscle fibers
Clinical Presentation: Rash on upper eyelids, malar rash or red papules on elbows, knuckles and knees, bilateral proximal weakness
Labs: positive ANA, perifascicular atrophy

118
Q

Polymyositis

A

MOA: inflammatory disorder of skeletal muscle; cell-mediated injury associated with other AI diseases
Clinical Presentation: no skin involvement, proximal weakness

119
Q

Inclusion Body Myositis (IBM)

A

MOA: progressive age-related muscle disorder
Clinical Disorder: quads, wrist/finger flexors involved early; distal asymmetric weakness
Histo: intracytoplasmic vacuoles surrounded by basophilic granules (rimmed vacuoles)
*use gomori trichrome stain

120
Q

Duchenne Muscular Dystrophy

A

MOA: deletion in dystrophin gene causes loss of functional dystrophin, tears in muscle cell membranes and cell death
Clinical Presentation: muscle cells replaced with fat and scar tissue (pseudohypertrophy) waddling gait, Gower’s sign
Labs: initial CK increase
*Becker - mutated dystrophin

121
Q

Limb-Girdle Muscular Dystrophies

A

MOA: heterogenous group of autosomally-determined progressive dystrophies
Clinical Presentation: pelvis or should girdle weakness, calf hypertrophy, cardiac/respiratory involvement

122
Q

Nemaline Myopathy

A

MOA: congenital myopathy
Clinical Presentation: proximal weakness, floppy infant with facial and respiratory weakness
Histo: rod-shaped structures in muscle fibers

123
Q

Central Core Disease

A

MOA: congenital myopathy
Clinical Presentation: slowly or non-progressive, skeletal abnormalities
*highly associated with malignant hyperthermia

124
Q

Carnitine Palmitoyltransferase II Deficiency

A

MOA: enzymatic defect that prevents long-chain fatty acids from being transported into the mitochondria for energy use
Clinical Presentation: generalized weakness, myoglobinuria precipitated by exercise
*autosomal recessive; young men

125
Q

McArdle’s Disease

A

MOA: missing myophosphorylase, glycogenosis type V, send-wind phenomenon
Clinical Presentation: pain, stiffness, cramps after exercise

126
Q

Myasthenia Gravis

A

MOA: acquired AI disease autoAb against post-synaptic acetylcholine receptor at NMJ
Clinical Presentation: muscle weakness that worsens with use, ptosis, diplopia, thymic hyperplasis, thymoma

127
Q

Fibromyalgia

A

MOA: chronic pain syndrome due to dysfunctional central pain processing
Clinical Presentation: core features of widespread pain (4 limbs, trunk), and tenderness (11 of 18 points)

128
Q

Trichinosis

A

MOA: parasitic disease caused by eating raw or undercooked pork or wild game infected with the larvae of T. spiralis, which invades skeletal muscle
Clinical Presentation: fever, mylagias, marked eosinophilia and periorbital edema, encephalitis, dyspnea, cardiac failure
Histo: oval bodies between muscle fiber, no surrounding inflammatory reaction

129
Q

ALS

A

MOA: aka Lou Gehrig’s disease; upper and lower motor neuron death leads to muscle weakness
Clinical Presentation: asymmetric weakness of hands, dropping objects, later lose muscle strength and bulk, involuntary contractions of individual motor units, respiratory infections
Histo: no type 1 fibers, some type 2 fibers show signs of degeneration
*fatal in all cases

130
Q

Carpal Tunnel Syndrome

A

MOA: entrapment neuropathy of median nerve due to lesions of the tendons/synovial sheath within the tunnel
Clinical Presentation: numbness/weakness of first 3.5 digits, mild thumb abductor weakness, thenar muscle weakness/atrophy

131
Q

Common Fibular Neuropathy (Peroneal)

A

MOA: pressure on common fibular nerve

Clinical Presentation: numbness/weakness on top of foot, ankle dorsiflexion/eversion, extensors

132
Q

Meralgia Paresthetica

A

MOA: compression of lateral femoral cutaneous nerve beneath inguinal ligament
Clinical Presentation: burning of lateral thigh, decreased sensation to cold, no weakness

133
Q

Lumbar Spinal Stenosis

A

MOA: reduction in central or lateral spinal canal by bony structures (osteophytes, spurs, spondylolisthesis) or soft tissue structures (herniation, hypertrophy of ligamentum flavum, synovial cysts)
Clinical Presentation: low back pain, pseudoclaudication, unilateral leg pain, weakness, referred pain, shopping cart sign, increased pain with downhill walking

134
Q

Cauda Equina Syndrome

A

MOA: damage to the cauda equina causes acute loss of function of the lumbar plexus below the termination (conus medullaris) of the spinal cord
Clinical Presentation: saddle anesthesia, decreased reflexes, bladder retention, lax anal sphincter, foot drop

135
Q

Achondroplasia

A

MOA: impaired cartilage proliferation in growth plate due to activating mutation in FGFR3 gene; causes defect in paracrine cell signaling and decreased proliferation of chondrocytes
Clinical Presentation: dwarfism, short bowed limbs with preservation of trunk length, clinodactyly, facial abnormalities, hypophosphatemia
*autosomal dominant, most common bone dysplasia

136
Q

Osteogenesis Imperfecta

A

MOA: defect in bone resorption due of mutation in COL1A1 gene causes decreased type 1 collagen
Clinical Presentation: bone fragility, hearing loss, blue sclera, dentinogenesis imperfecta
*AD or AR (usually lethal)

137
Q

Scurvy

A

MOA: vitamin C deficiency, inability to hydroxylated collagen chains causes impaired type 1 collagen and weakened connective tissue
Clinical Presentation: blackened skin, ulcerations, difficulty breathing, tooth loss, rotten gum tissue

138
Q

Osteopetrosis

A

MOA: defect in bone resorption due to carbonic anhydrase II deficiency, very thick and brittle bone, poor osteoclast function
Clinical Presentation: anemia, pancytopenia, hepatosplenomegaly, hydrocephalus, intercurrent infections, repeated bone fractures, renal tubular acidosis
*dense bones throughout on XR

139
Q

Osteoporosis

A

MOA: reduced bone mass due to decreased bone formation or increased bone resorption. Can be caused by deficient Vit D receptor, COL1A1, estrogen receptor, ILG1-R, low physical activity, etc.
Clinical Presentation: painless; can cause vertebral, hip, wrist, or other fractures

140
Q

Paget’s Disease

A

MOA: Gain in bone mass due to 1) osteoclastic bone resorption 2) hectic bone formation 3) osteoclastic quiescence; results in thick sclerotic bone that fractures easily
Labs: elevated alk phos, enlarging hat size, bowing of long bones, microfractures, nerve compression, hearing loss
Histo: mosaic pattern of lamellar bone; extra woven bone
*can lead to osteosarcoma

141
Q

Rickets

A

MOA: defective mineralization of osteoid due to vitamin D deficiency causes impaired absorption of Ca and PO4, excess of unmineralized matrix, enlarged hypertrophic zone
Clinical Presentation: pigeon-breast deformity, frontal bossing, rachitic rosary, bone bending, enlarged growth plates
*beaded costochondral junctions
*children < 1y.o.
*Osteomalacia in adults

142
Q

Osteomyelitis

A

MOA: infection of marrow and bone by pyogenic bacteria (staph aureus, salmonella for Sickle Cell Dz, gonorrhea in young adults) caused by surgical implant or compound fracture
Clinical Presentation: most commonly at metaphysis; fever, chills, leukocytosis, pain, elevated ESR, pus in marrow cavity
Labs: XR lytic focus of bone destruction (sequestrum) surrounded by zone of sclerosis (involucrum)

143
Q

TB Osteomyelitis

A

MOA: infection travels from lung to rib, pus in marrow, dead bone fragments (sequestrum), women bone (involucrum)
Clinical Presentation: Pott’s disease: spine; infection breaks through intervetebral discs to involve multiple vertebrae

144
Q

Osteoarthritis

A

MOA: progressive erosion of articular (synovial) cartilage, noninflammatory; synovial fluid enters bone (subchondral cyst), cartilage is worn away, bony outgrowths (osteophytes), eburnated articular surface
Clinical Presentation: pain, stiffness, slight swelling, crepitus, aggravated by activity, limitation ofrange of movement, impingement on spinal foramina by osteophytes, Heberden (DIP) and Bouchard’s (PIP) nodes

145
Q

Osteonecrosis

A

MOA: necrosis due to ischemia from fracture, corticosteroids, alcohol abuse, radiation, hip fx, sickle cell
Clinical Presentation: viable cartilage overlaying dead bone

146
Q

Patellofemoral Malalignment

A

MOA: abnormal joint mechanics, cartilage, retinaculum or subchondral bone injury leads to degeneration
Clinical Presentation: instability, anterior knee pain with prolonged sitting or stairs, “giving way”
*F>M

147
Q

Rheumatoid Arthritis

A

MOA: activation of CD4+ helper T cells causes release of IL-1 and TNF, destruction of articular cartilage and ankylosis of joints, autoimmune
Clinical Presentation: synovitis leads to pannus formation, malaise, fatigue, pain, small joints (MCP/PIP) affected first, warm and painful, stiff in the morning and after inactivity, rheumatoid nodules, radial deviation of wrist, ulnar deviation of finger, swan neck/boutonnieres deformity
Labs: serum rheumatoid factor, BILATERAL, DIPs usually spared
*1% of population affected; HLA-DR4 worse outcome; women late childbearing age

148
Q

Toxic Synovitis (transient synovitis of the hip)

A

MOA: arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip; usually lasts 5-10 days
Clinical Presentation: walks with limp, afebrile
*kids 3-8
*may follow viral URI
minimal limitation of range of motion

149
Q

Infectious/Septic Arthritis

A

MOA: bacterial infection of the joint by H. influenzae (kids <2), staph aureus (older kids, adults), N. gonorrhoeae (late teens/young adult), Salmonella (SCD)
Clinical Presentation: sudden development of painful, hot swollen joint (usually knee) with limited range of motion, fever, leukocytosis
Labs: + gram stain and culture
*knee is most common joint
*Lyme arthritis caused by Borrelia Burgdorferi

150
Q

Gout

A

MOA: crystallization of urates within joints due to hyperuricemia, form of inflammatory arthritis
Clinical Presentation: transient attacks of acute arthritis, tophus (subcutaneous collections of crystals), generally affects great toe, can lead to renal failure
Histo: needle-shaped uric acid crystals in synovial fluid

151
Q

Pseudogout (CPPD)

A

MOA: mutation in ANKH gene which encodes transmembrane inorganic pyrophosphate transport channel; leads to deposition of Ca phyrophosphate dihydrate (CPPD) crystals
Clinical Presentation: Crystal develop in articular cartilage (menisci and intervertebral discs), then in tendons, ligaments
Histo: geometric/rhomboid shaped crystals
*AD

152
Q

Ankylosing Spondylitis

A

MOA: form of arthritis where chronic inflammation causes bridging/fusing of one or more intervertebral discs
Labs: HLA-B27 and lack Rheumatoid factor
Clinical Presentation: sacroiliitis, synovitis, and enthesitis, vertebrae ossify and fuse, causing back pain and progressive stiffness (bamboo spine)

153
Q

Psoriatic Arthritis

A

Clinical Presentation: can resemble RA, mail pitting and pencil-in-cup DIP erosions
Labs: HLA-B27 and lack rheumatoid factor
*25% or psoriasis patients

154
Q

Reactive Arthritis

A

MOA: inflammatory arthropathy following GI or GU infection due to Chlamydia, Salmonella, Shigella, Yersinia, and Campylobacter
Clinical Presentation: Reiter’s syndrome (uveitis, urethritis, arthritis)

155
Q

Enteropathic Arthritis

A

MOA: inflammatory arthropathy accompanying IBD (Crohn’s and UC)

156
Q

Systemic Lupus Erythematosus

A

MOA: autoimmune disease dsDNA Ab’s and Smith Ab’s
Clinical Presentation: 4 of the following: SOAP BRAIN MD (serositis, oral ulcers, arthritis, photosensitivity/pulmonary fibrosis, blood cells, renal, Raynaud’s, ANA, immunologic, neuropsych, malar rash, discoid rash

157
Q

McCune-Albright Syndrome

A

MOA: polyostotic fibrous dysplasia caused by mutation in gene the codes for G protein –> constitutive activation of adenylyl cyclase, leading to excess cAMP and hyperfunction of cells
Clinical Presentation: cafe au lait skin pigmentations and endocrine abnormalities such as precocious puberty, hyperthyroidism, pituitary adenomas, primary adrenal hyperplasia

158
Q

Osteochondroma

A

MOA: BENIGN cartilage-capped outgrowth that is attached to the skeleton by a bony stalk, EXT gene in growth plate chondrocytes
Clinical Presentation: arises in metaphysis, dense cauliflower-like lesions
*1% risk of transformation to chondrosarcoma
*AD

159
Q

Enchondroma

A

MOA: manifests at metaphyseal region
Clinical Presentation: usually solitary (multiple = Ollier’s disease), most common sites are hands/feet
*Maffucci syndrome: encondromatosis and soft tissue hemangiomas; small risk of malignant transformation

160
Q

Chondrosarcoma

A

MOA: malignant hyaline and myxoid cartilage
Clinical Presentation: affects central skeleton (pelvis, shoulder, ribs)
*not chemosensitive
*hematogenous spread - chest next

161
Q

Osteoid Osteoma

A

MOA: BENIGN tumor of osteoblasts surrounded by rim of reactive bone, < 2cm, excess PGE2 produced by proliferating osteoblasts
Clinical Presentation: affects cortex of long bones (femur/tibia); typically in diaphysis; bone pain resolves with aspirin
Labs: XR bony mass with radiolucent core
*M:F = 2:1

162
Q

Osteosarcoma

A

MOA: mutation in p53 and RB genes causes malignant proliferation of osteoblasts and metaphysis
Clinical Presentation: pathologic fracture or bone pain with swelling
Labs: XR destructive mass with sunburst appearance, lifting of periosteum
*Pts with retinoblastomas are 1,000x more likely to develop osteosarcoma
*worse prognosis in AA’s
*most common bone tumor in kids

163
Q

Giant Cell Tumor of Bone

A

MOA: benign but aggressive tumor typically found in epiphyseal region
Clinical Presentation: most around knee, tumor is re-brown with cystic degeneration, necrosis, hemorrhage, hemosiderin deposition, reactive bone formation
Histo: multinucleated giant cells that express RANK-L with background of morphologically identical mononuclear cells
*10% of patients have pulmonary metastases

164
Q

Ewing’s Sarcoma

A

MOA: EWS-FL1 (11,22) fusion gene, malignant proliferation of poorly differentiated cells derived from neuroectoderm in diaphysis of long bones
Clinical Presentation: pain, fever, leukocytosis, long bones
Labs: XR onion skin appearance
Histo: small round blue cell tumor that resembles lymphocytes
*kids 5-25; second most common tumor of kids

165
Q

Multiple Myeloma

A

MOA: Excess IgGk
Clinical Presentation: bone pain due to punched out lytic lesions in ribs, vertebrae, skull, pelvis
Histo: Rouleaux formation
*50s-60s; AA>whites

166
Q

Metastatic Carcinoma

A

MOA: tumor cells up-regulate osteoclasts through RANK-L, which recruits and activates osteoclasts to degrade bone, producing pockets for bone tumor cells to grow
Clinical Presentation: most commonly from breast (also produces PTHrP), thyroid, lung, kidney, and prostate

167
Q

Osteitis Fibrosa Cystica

A

MOA: increased osteoclastic bone resorption, can be caused by renal osteodystrophy which causes secondary hyperparathyroidism
Clinical Presentation: loss of bone mass, weakening of bones, formation of cyst-like brown tumors in/around bone

168
Q

Fracture of the Femur

A

MOA: neck most frequently fractured, common in older people, caused by indirect forces and trivial mishaps
Clinical Presentation: instability, thin periosteum, injury of retinacular arteries, causes bleeding and femoral head necrosis

169
Q

Stress Fracture

A

MOA: caused by change in frequency, intensity, or duration of activity
Clinical Presentation: common in pubic ramus, rib, metatarsal, tibia, and femur; present with insidious onset of pain that is aggravated by activity

170
Q

Pott’s Fracture

A

MOA: distal fibula snaps a few cm above inferior tibiofibular joint
Clinical Presentation: common in athletes, medial malleolus can be avulsed

171
Q

Compression Fracture

A

MOA: collapse of vertebral body; common in post-menopausal elderly women, cancers and osteoporosis
Clinical Presentation: trapping of spinal nerves as they pass out of intervertebral foramen, leading to pain or loss of function

172
Q

Spondylolysis

A

MOA: defect in pars interarticularis b/w superior and inferior facets
Clinical Presentation: bone breaks most common at L5, inferior facets, can lead to instability, may be unilateral or bilateral

173
Q

Spondylolisthesis

A

MOA: slipping of vertebra in relation to the adjacent inferior vertebra or sacrum
Clinical Presentation: caused by spondylolysis of L5 vertebra allowing vertebral column to slide forward on top of sacrum, compression of sacral spinal nerves, and leg pain
*most often occurs in anterior direction

174
Q

Femoroacetabular Impingement

A

Acetabular retroversion and/or overcoverage
MOA: repetitive impaction of acetabular rim and femoral head/neck
*can cause osteoarthritis

175
Q

Reiter Syndrome

A

Clinical Presentation: arthritic, uveitis, conjuctivitis
Labs: HLA-B27 and lack rheumatoid factor
*young males after GI or C. Trachomatis (chlamydia) infection

176
Q

C2-3 Spinal Cord Injury

A

Rapidly fatal unless medical intervention occurs

177
Q

C4 Spinal Cord Injury

A

Respiratory difficulty and paralysis of all four extremities (quadriplegic)
*remember C3, 4, 5 innervate the diaphragm

178
Q

C5 Spinal Cord Injury

A

some shoulder and elbow movement

179
Q

C6 Spinal Cord Injury

A

shoulder and elbow movements, limited wrist movements

180
Q

C7 Spinal Cord Injury

A

normal arm movements, limited hand movements

181
Q

C8 Spinal Cord Injury

A

normal arm movements, hand weakness

182
Q

T1-10 Spinal Cord Injury

A

paraplegic, wheel chair ambulation

183
Q

T11 Spinal Cord Injury

A

may be able to walk with braces

184
Q

C6/C7 Disc Herniation

A

Most occur in the posterior-lateral direction
C7 Myotome
Muscle: Triceps
Primary Function: Extension of forearm
Reflexes: Triceps tendon
Weakness: elbow extension flexion of the wrist

185
Q

L4/L5 Disc Herniation

A

Most occur in the posterior-lateral direction
L5 Myotome
Muscle: Extensor Hallucis Longus
Primary Function: Dorsiflexion of the Great Toe
Reflexes: minor
Weakness: difficulty walking on heels; foot drop may occur

186
Q

L5/S1 Disc Herniation

A 
Most occur in the posterior-lateral direction
S1 Myotome
Muscle: Gastrocnemius 
Primary Function: Plantar Flexion 
Reflexes: ankle jerk diminished
Weakness: difficulty walking on toes
187
Q

Neuropraxia

A

focal demyelination, axons and connective tissue intact, recover 1-8 weeks
“mild compression”

188
Q

Axonotmesis

A

axon injury, connective tissue intact, recovery length dependent, 1mm/day
“crush injury”

189
Q

Neurotmesis

A

axon transected, connective tissue disrupted, no recovery

“penetrating injury”

190
Q

Radial Neuropathy

A

AKA “Saturday Night Palsy”
MOA: pressure on radial nerve, which causes damage
Clinical Presentation: most likely neuropraxic numbness/weakness in one arm affecting wrist extension and finger flexion

191
Q

Superficial Radial Neuropathy

A

AKA “Handcuff Neuropathy”
MOA: pressure on radial nerve over extensor tendon of thumb
Clinical Presentation: most likely neuropraxic, burning numbness of triangular space between 1st and 2nd fingers on one hand

192
Q

C6 Radiculopathy

A

MOA: most common cause is herniated disc, narrowed anatomical compartment is vertebral foramen
Clinical Presentation: numbness/weakness in first 2 digits, biceps, triceps and flexor carpi radialis; six-shooter pattern of weakness

193
Q

Lumbar Radiculopathy

A

MOA: annular degeneration leads to fissuring or tearing of annulus which leads to disc rupture
Clinical Presentation: increased pain with forward flexion, sitting, driving in car, cough/sneeze/BM; decreased pain with lying supine, knees flexed, standing
*most common levels are L4-L5 and L5-S1

194
Q

S1 Radiculopathy

A

MOA: compression of S1 due to arthritis or herniated disc
Clinical Presentation: back pain radiating down leg to lateral malleolus, decreased sensation over PSIS and lateral leg, plantar flexion weakness

195
Q

“Gamekeeper’s”/Skier’s Thumb

A

torn ulnar collateral ligament of 1st MCP joint

196
Q

Mallet Finger

A

torn distal extensor tendon rupture

197
Q

Jersey Finger

A

torn distal flexor tendon rupture. Unable to flex isolated DIP

198
Q

Lateral Epicondylitis

A

“tennis elbow”. painful shaking hands, swinging of a tennis racquet etc.
Tx: RICE

199
Q

Tommy John’s Surgery

A

repairs anterior band of the ulnar collateral ligament

200
Q

Toddler’s Fracture

A

Spiral fracture of the distal 1/3 of the tibia

*could be from child abuse or falling while running or stepping on an object

201
Q

Brachial Neuritis

A

Clinical Presentation: acute, sudden onset of pain in the nerve of the BP. Weakness and numbness follows
MOA: unknown, but often follows viral infection, surgery, childbirth
*really really rare

202
Q

Limb Malformations

A

occur in 2/1000 births, period of sensitivity for teratogens is 25-36 days post conception
Talipes Equinovarus: clubfooting caused by malpositioning of baby in utero
DDH: congenital malpositioning of the fetus in utero causes acetabulum to be shallow and for the hip to be easily dislocated
Ex: Amelia, meromelia, phocomelia, syndactyly, brachydactyly, polydactyly, achondroplasia

203
Q

Spina Bifida

A

caused by lack of folic acid during crucial developmental weeks
SB Occulta: incomplete seal, completely benign and common
SB Cystica: meningocele (herniated subarachnoid), myelomeningocele (herniated subarachnoid with herniated spinal cord) needs operation
SB Myeloschisis/Rachischisis: no neural tube with or without folded neural tissue. completely incompatible with life

204
Q

Hill Sach’s Fracture

A

MOA: impact to shoulder laterally

Clinical Presentation: greater tubercle of the humerus fractures, can be seen on internal rotation radiograph

205
Q

Femoral Labrum Tear

A

MOA: traumatic tear of the acetabular labrum associated with pain and snapping of hip.
anterior tear: pain worse with flexion and internal rotation
posterior tear: pain worse with extension and lateral rotation

206
Q

Pott’s Fracture

A

MOA: distal fibula snaps a few cm above the inferior tibiofibular joint
*common in athletes, medial malleolus can be avulsed

207
Q

Dysplastic Nevus Syndrome

A

MOA: lots of clinically dysplastic nevi, could be due to CDNK2A mutation
*familial history of melanoma

208
Q

Neurogenic Atrophy

A

MOA: disease of the anterior horn cell or its axon. Two phases: individual atrophic angular fibers, later aggregating into groups

209
Q

Mitochondrial Myopathies

A

MOA: multisystem disorder with respiratory chain defects, can become encephalopathy/oculopathy
*maternal inheritance

210
Q

Drug Induced Myopathies

A

MOA: steroids can cause type 2 fibers to atrophy, statins may induce rhabdomyolysis

211
Q

Poliomyelitis

A

MOA: polio infection and invasion into the nervous system, causing inflammation in the anterior (motor) horns of the spinal cord. Meningitis and chronic inflammation of both ventral and dorsal roots causes neurogenic atrophy of the muscle

Musculoskeletal Extras (3 decks)

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