FINAL EXAM Flashcards
1
Q
CAUDAL
A
tail end
2
Q
Coronal / frontal plane
A
anterior / posterior halves
3
Q
Sagittal plane
A
L + R halves
4
Q
Axial Plane
A
upper and lower halves
5
Q
Auricle / Pinna
A
collects sound for localization + directs high freq. sound to eardrum
6
Q
Ext Auditory Canal
A
increases sound pressure at TM by 5-6 dB
7
Q
Mastoid Process
A
supports external ear and posterior wall of middle ear
8
Q
TM
A
vibrates in repsonse to sound
-changes acoustic energy to mechanical energy
9
Q
Ossicular Chain
A
incus, malleus, stapes
-lever system
10
Q
Eustachian tube
A
connects middle ear to nasopharynx
-equalizes air pressure
-not part of hearing process
11
Q
Stapedius Muscle
A
connects stapes to middle ear wall
-contracts in response to loud sounds (Acoustic reflex)
12
Q
Cochlea
A
converts mechanical energy into acoustic energy
13
Q
Oval Window
A
sets cochlear fluid into motion by vibration of the footplate of stapes
14
Q
Round Window
A
pressure relief port for cochlear fluid
15
Q
Organ of Corti
A
end organ of hearing
-hair cells and stereocilia
16
Q
Vestibular System
A
controls balance and shares fluid w/ cochlea
-no part in hearing
17
Q
Hair cells
A
where fibers of auditory/CN 8 are present
18
Q
Auditory Cortex
A
temporal lobe of the brain where sound is perceieved and analyzed
19
Q
Parotid gland
A
-function: secretes saliva through Stenson’s duct, facilitates mastication/swallowing [alpha amylase breaks down amylopectin and amylose]
-sympathetic innervation: superior cervical ganglion –> internal carotid artery
-parasympathetic innervation: inferior salivatory nucleus –> auriculotemporal nerve
20
Q
Tip of the tongue
A
sweet
21
Q
Anterior/lateral tongue
A
salt
22
Q
Middle/lateral tongue
A
sour
23
Q
Posterior Tongue
A
bitter
24
Q
Cranial nerve supplying Anterior 2/3 Tongue
A
CN 7/ Facial
25
Cranial nerve supplying Posterior 1/3 Tongue
CN 9/Glossopharyngeal
26
Elevatory nasal muscles
-proceris
-levator labii
-superioris alaque nasi
27
Depressor nasal muscles
-alar nasaris
-depressor septi nasi
28
Compressor nasal muscles
transverse consalis
29
Dilatory nasal muscles
posterior and anterior dilator nasaris
30
External nasal vascular supply
-**artery** = facial
-**sellar and dorsal areas** = internal maxillary, infraorbital and opthalmic
-**veins** = same as arteries
-**lymphatics** = retropharyngeal (posterior) and upper deep cervical/submandibular (anterior)
31
Internal nasal vascular supply
-**Kiesselbach plexus** = anterior 1/3 septum
-**sphenopalatine** = posterior inferior
-**ethmoid** = anterior and posterior superior
-**superior labial artery** = anterior
-**greater palatine** = posterior
-**veins** = same as arteries (direct communication with cavernosus sinus - no valves)
32
8 Cranial bones
-frontal bone
-parietal bone (2)
-temporal bone (2)
-sphenoid
-ethmoid
-occipital
33
Facial bones (14)
-lacrimal (2)
-mandible
-maxilla (2)
-nasal (2)
-palatine (2)
-vomer
-zygomatic (2)
-inferiro nasal conchae (2)
34
Cranial sutures
1. **coronal** = parietal + frontal
2. **squamous** = parietal + temporal
3. **lamboid** = parietal + occipital
4. **occipitomastoid** = occipital bone + mastoid process
5. **sagittal** = atriculation between 2 parital bones
35
Motor Spinal Nerves
anterior / ventral roots
36
Sensory Spinal Nerves
posterior/dorsal roots
37
White Matter
**myelinated axons connecting to grey matter for impulses**
-bulk of the brain + superficial spinal cord
38
Grey Matter
**unmyelinated neurons that routes sensory/motor input to interneurons of CNS**
-major component of CNS
-nerve cell bodies
-glial cells (astroglia + oligodendrocytes)
-capillaries
-axons/dendrites
39
Motor Tracts
-**corticospinal tract** = voluntary
-**extra pyramidal** = basal ganglia
-**rubro/reticulospinal tracts**= smoothing of muscle activity
-**upper motor neurons (UMN)** = fibers from corticospinal tract that synapse with LMN in anterior horn of spinal cord
40
UMN vs LMN
**-UMN**
1. no atrphy
2. no fasiculations
3. spasicity
4. DTRS increased
5. contractures
6. EMG normal
**-LMN**
1. atrophy
2. fasiculations
3. flaccidity
4. DTRS decreased or absent
5. no contractures
6. EMG denervation
41
Wernicke's Aphasia (AREA 22)
**speech preserved with incorrect language content**
-rate, intonation and stress are normal
-substitutions of one word for another
-comprehension/repitition are poor
| "wacky wernicke"
42
Broca's Aphasia (AREA 44 + 45)
**unable to create gramatically correct + complex sentences**
-expressive, motor, nonfluent aphasia
-pts aware of inability to speak
-normal comprehension but some trouble understanding complex sentences
| "broken broca"
43
Limbic System
influences the formation of memory by integrating emotional states with stored memories of physical sensations
44
Telencephalon
-limbic
-cerebral cortex
-basal ganglia
-olfactory bulb
45
Diencephalon
**between brainstem and cerebrum**
-thalamus
-epithalamus
-subthalamus
-hypothalamus
46
Thalamus
| Diencephalon
**processing center of cerebral cortex**
-regulates functional activity if cortex via integration of afferent input to cortex (except olfaction)
-contributes to affectual expression
47
Epithalamus
| Diencephalon
conneciton between limbic system to other parts of the brain
48
Hypothalamus
| DIencephalon
**intergration center of ANS regulating body temperature and endocrine function**
-**anterior** = parasympathetic (maintenance)
-**posterior** = sympathetic (fight/flight)
-**behavioral** patterns
-**appestate** = feeding cneter
-**pleasure** center
49
Subthalamus
| Diencephalon
**controls motor functions**
-contains subthalamic nuclei + nerve tracts
50
Basal Ganglia
**large collections of nuclei that modify movement (min to min basis)**
-receives info via motor cortex
-sends to cortex via thalamus
-output = inhibitory (vs cerebellum - excitatory)
-works with cerebellum to balance / coordinate movement
51
Reticular System
-**ascending / activating** = provides input from all sensory organs to thalamus and cortex is repsonsible for arousal from sleep, wake, attention
-**descending** = projects to ANS; extrapyrimidal output to voluntary muscles via pontine tegmentum
52
Medulla
**controls autonomic function and relays signals between brain and spinal cord**
-CN 8 through 12
-**Medulla oblongata** = RR, BP, HR, reflex arcs, vomiting
53
Pons
**relays sensory information between cerebellum and cerebrum**
-CN 5, 6, 7
-regulates RR via pneumotaxic center
54
Archicerebellum
maintains equilibrium
55
Paleocerebellum
maintains muscle tone
56
Neocerebellum
controls coordination
57
Dura Mater
-**superifical** = skull's inner periosteum
-**deep** = dura mater proper
-**tentorium cerebelli** = between/separates cerebellum and brainstem from occipital lobes of cerebrum
-**falx cerbi** = separates 2 hemispheres of the brain (in longitudinal fissure)
| outer meningeal layer
58
Arachnoid Mater
**middle meningeal layer**
-separated from pia mater by subarachnoid space
59
Pia Mater
**delicate, thin, fibrous tissue membrane attached to brain or spinal cord**
-outer surface = impermeable to fluid
-pierced by blood vessels traveling to brain and spinal cord
-capillaries nourish brain
60
Epidural meningeal space
if bleeding occurs, it will separate the periosteum from dura
61
Subdural meningeal space
enlarges as the brain atrophies
| below dura and above arachnoid
62
Subarachnoid meningeal space
major blood vessels and CSF
| between pia and arachnoid
63
Sympathetic NS
| ANS
**fight or flight**
-T1-L3 ateral grey of spinal cord
-noradrenaline
-increases HR, RR, dilate pupils
64
Parasympathetic NS
| ANS
**basal metabolism**
-brainstem and spinal cord
-ACh
-slows HR, RR and constricts pupils
65
C2 + C3
## Footnote
Dorsal Sensory Roots
posterior head and neck
66
C4 + T2
## Footnote
Dorsal Sensory Roots
adjacent to each other in upper thorax
67
T4 + T5
## Footnote
Dorsal Sensory Roots
nipple
68
T10
## Footnote
Dorsal Sensory Roots
umbilicus
69
Upper extremity
## Footnote
Dorsal Sensory Roots
-C5 = anterior shoulder
-C6 = thumb
-C7 = index and middle finger
-C7/8 = ring finger
-C8 = pinky
-T1 = inner forearm
-T2 upper inner arm
-T2/3 = axilla
70
Lower extremity
## Footnote
Dorsal Sensory Roots
-L1 = anterior upper inner thigh
-L2 = anterior upper thigh
-L3 = kneww
-L4 = medial malleolus
-L5 - dorsum of foot + toes 1-3
-S1 = toes 4+5 + lateral malleolus
-S3/C1 = anus
71
Radial Nerve
## Footnote
Brachial Plexus
-posterior cord
-triceps
-extensors
-sensory = dorsum of hand
-saturday night palsy
72
Median nerve
## Footnote
Brachial Plexus
-median and lateral branches of brachial plexus
-anterior interosseus
-palmar cutaneous branch
-all flexors except FCU and FDP
-pronator teres and quadratus
73
Ulnar Nerve
## Footnote
Brachial Plexus
-median branches brachial plexus
-FCU and medial FDP interssei
-adductor policis
-opponens digiti minimi
-abductor digiti minimi
-flexor digiti minimi brevis
74
Lateral Femoral Cutaneous Nerve
## Footnote
Lumbar Plexus
-L2+L3
-pure sensory
75
Sciatic nerve
## Footnote
Lumbar Plexus
-largest of all peripheral nerves
-runs posterior
-divides into peroneal and posterior tibial
76
Peroneal Nerve
## Footnote
Lumbar Plexus
-2 articular branches = accompnay superior and inferior lateral geniculars to knee
-third articular branch = point of division of common peroneal; ascends with recurrent tibial artery through tibials anterior to front of knee
-lateral sural cutaneous nerve = supplies ksin on posterior and lateral surfaces of leg
77
Tibial Nerve
## Footnote
Lumbar Plexus
-**motor** innervation = muscles of posterior compartment of leg (superficial + deep)
-**sensory** innervation = posterior aspect of leg and sole of foot
-terminates by bifurcating into medial and lateral plantar nerves in sole of foot
78
CN 1 - Olfactory
-**function** = smell
-**innervation** = anterior olfactory nucleus in olfactory tract
-**sensory**
79
CN 2 - Optic
-**function** = vision
-**innervation** = lateral geniculate nucleus in thalamus
-**sensory**
80
CN 3 - Oculomotor
-**function** = elevation/adduction of eye
-**innervation** = oculomotor and edinger nuclei in midbrain
-**motor**
81
CN 4 - Trochlear
-**function** = depression of adducted eye (SO4)
-**innervation** = trochlear in midbrain
-**motor**
82
CN 5 - Trigeminal
-**function** = facial sensation / mastication
-**innervation** = principal in pons, spinal in medulla, mesencephalic in pons/midbrain
-**both**
83
CN 6 - ABducens
-**function**: abduction of eye (LR6)
-**innervation**: abducent in pons
-**motor**
84
CN 7 - Facial
-**function**: facial expression, taste, sensation (anterior 2/3 tongue)
-**innervation**: motor, solitary, superior salivatory in pons
-**Both**
85
CN 8 - Vestibulocochlear
-**function**: balance and hearing
-**innervation**: vestibular and cochlear in medulla
-**sensory**
86
CN 9 - Glossopharyngeal
-**function**: taste, salivation, pharynx (posterior 1/3 tongue)
-**innervation**: nucleus ambiguus, solitary, inferior salivatory in medulla
-**Both**
87
CN 10 - Vagus
-**function**: swallow, speech, GI, cardiac, RR
-**innervation**: nucleus ambiguus, solitary, dorsal motor vagal
-**both**
88
CN 11 - Accesory spinal
-**function**: pharynx, larynx, SCM, trapezius
-**innervation**: nucleus ambiguus in medulla + spinal accessory in cervical cord
-**motor**
89
CN 12 - Hypoglossal
-**function**: tongue movement
-**innervation**: hypoglossal in medulla
-**motor**
90
Anterior group muscles of hip
-iliopsoas
-tensor fasciae latae
91
Posterior group muscles of hip
-gluteus max
-gluteus min
-gluteus medius
-piriformis
92
Anterior group muscles of thigh
quadriceps femoris + sartorius
93
Medial group muscles of thigh
-pectineus
-adductor longus
-adductor brevis
-gracilis
-adductor magnus
94
Posterior group muscles of thigh
-biceps femoris
-semitendinosus
-semimembranosus
95
Quadriceps
**extension and stability of patella from superiorly**
-rectus femoris
-vastus medialis
-vastus intermedius
-vastus lateralis
96
Hamstrings
-biceps femoris
-semitendinosus
-semimembranosus
97
Iliotibial band
causes hip pain + most common L extremnity injury (esp athletes)
98
Anterior group muscles of the leg
-tibialis anterior
-extensor digitorum longus
-extensor hallucis longus
99
Posterior group muslces of the leg
-**superficial**
1. gastrocnemius
2. soleus
-**deep**
1. tibialis posterior
2. flexor digitorum longus
3. flexor hallucis longus
100
Lateral group muscles of leg
-peroneus longus and peroneus brevis
101
Extensor digitorum brevis
## Footnote
Dorsum Foot
**dorsiflexion of digits**
-**innervation** = deep peroneal nerve (S1-S2)
102
Extensor hallucis brevis
## Footnote
Dorsum Foot
**dorsiflexion of 1st digit**
-**innervation**: deep peroneal nerve (S1-S2)
103
Plantar Aponeurosis
## Footnote
Sole Foot
maintains longitudinal arch of foot and protects nerves/BV
104
Lumbriclas (4)
## Footnote
Sole Foot
**plantar flexion of 2-5th digits**
-**innervation**: medial plantar nerve (1st digit) + lateral plantar nerve (2-4th digits)
105
Ventricles
make and transport CSF
106
Lumbar Plexus
**anterior + within psoas**
-T12-L4
**Lately Suzie's In Heat Inappropriately Ill Gaining Lots of Fun Cuz of Fuckboys**
(Lumbar = subcostal, iliohypogastric, ilioinguinal, genitofemoral, Lateral femoral cutaneous, Obturator, Femoral)
107
Obturator Nerve
## Footnote
Lumbar Plexus
**L2, L3, L4**
-**sensory**: skin medial thigh, hip, knee joints
-**motor**: adductor muscles
108
Femoral Nerve
## Footnote
Lumbar Plexus
**L2, L3, L4**
-**sensory**: thigh, leg, foot
-**motor**: anterior thigh muscles (quads)
109
Lateral Femoral Cutaneous Nerve
## Footnote
Lumbar Plexus
**L2 + L3**
-**sensory** = skin lateral thigh
110
Genitofemoral nerve
## Footnote
Lumbar Plexus
**L1 + L2**
-**sensory**: skin scrotum,, labia major, anterior thigh
-**motor**: cremaster muscle
111
Lumbosacral trunk
L4 and L5
112
Subcostal nerve
## Footnote
Lumbar Plexus
T12
113
Iliohypogastric nerve
## Footnote
Lumbar Plexus
T12 - L1
114
Ilioinguinal nerve
## Footnote
Lumbar PLexus
L1
115
Sacral plexus
**L4-S4**
-caudal to lumbar plexus + mostly posterior structures
**Some Love Calm Surfing In Peak Flow Think Peace**
(sacral = lumbosacral [trunk], common [fibular of sciatic], superior [gluteal], inferior [gluteal], posterior femoral cutaneous, tibial [part of sciaitc], pudendal)
116
Sciatic nerve
## Footnote
Sacral Plexus
thickest nerve in the body
-**motor**: hamstring
| L4 - S3
117
Tibial Nerve Branch (sciatic)
## Footnote
Sacral Plexus
**ventral rami L4-S2**
-**sensory**: posterior leg and sole of foot
-**motor**: posterior leg and foot
118
Common fibular / peroneal branch (sciatic)
## Footnote
Sacral PLexus
**dorsal rami L4 - S3**
-**sensory**: anterior/lateral leg + dorsum foot
-**motor**: lateral tib. anterior and toe extension
119
Superior gluteal nerve
## Footnote
Sacral Plexus
L4, L5, S1
-**motor**: gluteus med/min + tensor fasciae latae
120
Inferior gluteal nerve
## Footnote
Sacral plexus
L5, S1, S2
-**motor**: gluteus maximus
121
Posterior femoral cutaneous nerve
## Footnote
Sacral Plexus
S1, S2, S3
-**sensory**: inferior buttocks, posterior thigh + popliteal fossa
122
Pudendal nerve
## Footnote
Sacral PLexus
**S2, S3, S4**
-**sensory**: external genitalia and anus
-**motor**: muscles of perineum
123
Deep veins emptying into IVC
-plantar
-tibial
-fibular
-popliteal
-femoral
-ext/common iliac
124
Superficial veins
-**dorsal venous arch** = foot
**-great sapphenous** = empties into femoral
-**lesser sapphenous** = empties into popliteal
125
Dorsalis pedis
**forms when anterior tibial passes under superior extensor retinaculum**
-where pulse is felt
-deep branch joins plantar arch
-gives rises to lateral tarsal artery
126
Lateral Plantar artery
**most of plantar arch**
-gives rise to plantar metatarsal and proper plantar digital arteries
127
Loss of dorsalis pedis pulse:
-PVD (Burger's or DM)
-occluded BV (gangrene)
-autoamputation of 1st toe
128
DVT
**thrombus forms in deep veins of leg/thigh**
-600k cases annually
-1/3 form PE (15% death)
-160 / 100k incidence
129
Untreated proximal DVT
-30-50% risk for PE
-15% mortality
130
Treated DVT
<8% risk for PE
<2% mortality
131
Symptomatic non fatal PE
20/100k
132
Fatal PE
50/100k
133
Virchow's Triad
**factors contributing to thrombosis**
-venous stasis
-hypercoagulability
-endothelium damage
134
Principal VTE factors
-immoblization
-trauma
-surgery
-infection
-post partum period
135
Other VTE risk factors
-incr. 2x when older than 50 y/o
-obesity
-malignancy (20-30%)
-previous VTE (25%)
-varicose veins
-dehydration
-hormonal therapy
136
DVT signs/symptoms
-asymptomatic
-pain/tenderness
-erythema
-acute swelling
-pallor (phlegmasia alba)
-cyanosis (phlegmasia cerulea)
137
PE signs/symptoms
-dyspnea/tachypnea
-diaphoresis
-hemoptysis
-low grade fever
-pleuritic CP
-cough
-hypotension
-coma
CXR and EKG
138
Venogrpahy for DVT
**ex gold standard**
-20% failure
-contraindication in allergy and decreased renal function
139
Duplex Ultrasound for DVT
**primary method for diagnosis**
-comfortable, inexpensive, no risk
-sensitive for distal DVT
-less sensitive for proximal DVT
140
Superficial veins affectd by DVT
greater + lesser sapphenous
141
Deep veins affectd by DVT
-iliac
-femoral
-popliteal
-tibial
142
PVD/PAD/PAOD
**occlusive disease of lower extremity**
-**common cause** = atherosclerosis
-**other cause**s: arteritis, embolism, aneurysm
-**arterial narrowing** --> decr. blood flow = pain
-decr. supply, incr. demand (fails to satisfy metabolic requirements)
-**predictor** of coronary/CV risk
-**prevalence**: 10-25% >55y/o
-4x more likely to die w/in 10 years
-**ABPI** <0.9
143
Symptomatic PVD survivial rate
22%
144
Asymptomatic PVD survival rate
78%
(70-80% of pts w PVD)
145
Critical limb ischemia (rest pain)
## Footnote
PVD
**1-2% of pts w/ PVD**
-low ABPI values
-25% mortality
-alive w/ 2 limbs = 50%
-amputation = 25%
-cardiovasc. mortality = 25%
-gangrene/ischemic ulcers
146
Typical PVD Pt
-diabetic (3-4x)
-smoker (2.5-3x)
-HTN (>50 + male + fam hx)
-hypercholesterolemia, AF, IHD, CVA, homocysteinuria
147
PVD Risk Factors
-age > 70
-age 50-59 w/ hx of DM or smoking
-age 40-49 w/ DM or one other RF
-leg symptoms suggestive of claudication w/ exertion or sichemic pain at rest
-abnormal L ext pulse
-atherosclerosis at other sites ((coronary, carotid, RAD)
148
Intermittent Claudication
## Footnote
PVD
**reproducible pain on exercise which is relieved by rest/leg elevation**
-chronic PVD
-sore legs at night relieved by hanging legs over bed
-10-35% of pts
149
Other signs/symptoms of PVD
-burning/aching feet (esp at night)
-cold skin/feet
-increased infections
-non healing ulcers
-asymptomatic
150
Critical Stenosis
## Footnote
PVD
impending acute ischemic limb
60% + of pts
151
Abdominal aorta and iliac
## Footnote
PVD
30% butt/hip claudication
+/- impotence = Leriche's syndrome
152
Common femoral
## Footnote
PVD
thigh claudication
153
Superficial femoral
## Footnote
PVD
60% upper 2/3 calf claudication
154
Popliteal
## Footnote
PVD
lower 1/3 calf claudication
155
Posterior Tibial
## Footnote
PVD
foot claudication
156
Diagnosis of PVD
-**invasive (gold standard)** = IV DSA ; intervention while imaging w/ iodine based dye
-**non invasive** = CT/MR angiogram
157
Treatment of PVD
-**risk factor modification**: smoking cessation, decr. BP/BSL/lipids
-**exercise**: claudication rehab program (45-60 min 3x a week for 12 weeks)
-**med management**: antiplatelets (aspirin, clopidogrel), phosphdiesterase inhibitor (cilostazol), foot care
158
Percutaneous Coronary Intervention (PCI)
## Footnote
PVD
**angioplasty+ stent for significant comorbidities whose life expectancy is less than 1-2 years**
-poor response to rehab/meds
-disabled by claudication (poor quality of life)
-low risk w/ high success
159
Bypass Surgery
## Footnote
PVD
**reverse sapphenous vein for femoro-popliteal bypass**
-aorto-iliac or femoro-popliteal
-cochrane review = not enough evidence than bypass>PCI
160
Amputation to treat PVD
last resort
161
6 P's of Ischemic Limb
## Footnote
PVD
-pain
-pallor
-pulseless
-parasthesia
-perishing cold (poikilothermia)
-paralysis
162
DDx Leg Pain: Vascular
DVT or PVD
163
DDx Leg Pain: neurospinal
-disc disease
-spinal stenosis (pseudoclaudication)
164
DDx Leg Pain: Neuropathic
-DM
-chronic ETOH
165
DDx Leg Pain: musculoskeletal
-osteoarthritis
-chronic compartment syndrome
166
Physical exam (PVD)
-**inspection** = thick shiny skin, hair loss/brittle nails, pallor, ulcers
-**palpation**: cool temp, irregular pulse, slow capillary refill, poor sensation
-**auscultation**: femoral bruits
-ABPI = systolic ankle BP/sys. brachial BP
-**Buerger's test **= elevate leg 45 degrees (observe for pallor), elevate 90 degree dependent position look for red flushed foot
-**pallor at 20 degrees** = severe PVD
167
Salter Harris Fx 1
**fx of physis**
-hypertrophic zone
-increased width of physis
-undistrubed grwoth
-**dx by presentation** = point tenderness at epiphyseal plate
| (same)
168
Salter Harris Fx 2
**fx of metaphysis + physis**
-epiphysis not involved
-most common
-minimal shortening/rare functional limitations
| (above)
169
Salter Harris Fx 3
**fx of epiphysis + physis**
-hypertrophic zone and split down
-damage to reproductive layer
-rarely physical deformity
-good prognosis
-**Tillaux FX** = SH3 prone to diability
| (below)
170
Salter Harris Fx 4
**fx of epiphysis, physis + metaphysis**
-similar to SH3 (intraarticular)
-chronic diability
-premature focal fusion (joint deformity)
| (through)
171
Salter Harris Fx 5
**epiphyseal plate only**
-growth disturbances
-poor prognosis
-difficult dx in teens (made after premature closure. ofplate)
-only 2% of SH fx
| (crush)
172
Germinal layer of cartilage
epiphysis
173
Route of Cartilage growth
epiphysis --> metaphysis
174
Route of neovascularization
metaphysis --> epiphysis
175
Damage to vascular supply...
disrupts bone growth
176
Damage to cartilage...
vascular interruption is not permanent
177
SH Fx prone to chronic disability
SH 3 + 4
178
Normal femur neck angle
125 dgerees
179
Coxa Vara
NOF angle <120 degrees
| women + short llmbs
180
Coxa Valga
NOF angle >135 degrees
181
Trochanteric Anastomosis
**supplies NOF and head**
-superior gluteal
-inferior gluteal
-medial circumflex
-lateral circumflex
| "retinacular arteries"
182
Subcapital Fx
| (NOF)
close to femoral head
| common in elderly
183
Cervical Fx
| (NOF)
midpoint neck
184
Basal Fx
| (NOF)
**close to shaft**
-partly intra + extra capsular
-better union than subcapital FX
185
Complete Fx
| (NOF)
**vascular interruption to head of femur**
-round ligament isnt strong enough to prevent avascular necrosis
186
Nonunion of NOF Fx due to
**synovial fluid**
-bathes fragments + inhibits osteogenesis
187
Patella stability maintained by:
-**superiorly**: quadriceps
-**inferiorly**: patellar ligament
-**laterally**: lateral condyle of femnur
-**medially**: vastus medialis
188
Patellar dislocation
**comes out of joint by awkward twist motion**
-pulled laterally to remain in line with muscle
-women >men (shallow/wide hips)
-genu valgum (knock kneed)
189
Patella Fx: Direct MOI
**direct blow/fall/MVA (dashboard)**
-small amount of tissue + femur contact drives force to patella
-considerable communition = little displacement
190
Patella Fx: Indirect MOI
**jumping, rapid flexion against fully contracted quadricep muscles**
-less communited
-displaced/transverse
191
Tib Fib Fx
**-1 bone**: little displacement (intact bone acts as splint)
-**both bones**: distal fragment pulled up by proximal fragment (by gastrocnemius and soleus)
-**tibia fx:** usually open
-**ischemic necrosis w/ delayed union/nonunion** = tibial nutreint artery torn in distal 1/3 fx
192
Distal leg Fx
**common and usually indirect MOI**
-Potts
-Dupuytrens
193
Pott's Fx
## Footnote
Distal leg fx
**medial + lateral malleolus fx**
-ankle rolled in or out beyond ROM
-severe ankle sprain mayb pull bone off with ligament
-forcible ankle eversion
-**symptoms** = severe ankle pain, unable to bear weight, tenderness at malleoli
194
Dupuytren's Fx
## Footnote
Distal Leg Fx
**fx of distal fibula (lateral malleolus) + talus thrust upwards between tibia and fibula**
-rupture of tib fib ligamanets
-diastasis of syndesmosis
-lateral dislocation. oftalus
-up and out foot diaplcement
195
Syndesmosis
**fibrous tissue cord/ligament**
-**ankle ring**= tibial plafond, medial malleolus, deltoid ligaments, syndesmosis, calcaneus, lateral collateral ligaments, lateral malleolus
-**fx of single part** = usually stable
-**fx >1 part** = unstable
-no true movement
-ex. distal tib fib joint
196
Syndesmosis Injury
**tear/strain of anterior tib fib ligament
-high ankle sprain**
-football, skiing, basketball
-slow to heal + tender to palpate
-painful external rotation on foot
-**MOI**: excessive dorsi/plantar flexion
-**stress test**: kleiger's
-incorrectly treated at lateral ankle sprain (diff MOI/treatment)
-**symptoms**: + external rotation test, severe pain, "squeeze" test = pain @ syndesmosis
197
Wevber Classification
**level of fib fx relative to syndesmosis**
-describes lateral malleolus fx + integrity of syndesmosis
198
Weber A
**below syndesmosis (intact)**
-usually stable
-medial malleolus fx
-reduction, cast, ORIF usually needed
199
Weber B
**level of syndesmosis (intact / partial tear)**
-possible medial fx or deltoid damage
-variable stability
-may require oRIF
200
Weber C
**above syndesmosis (damaged)**
-unstable widening of joint
-medial fx or deltoid injury
-ORIF required
201
Foot Fx
**MTB stress fx**
-**March fx**: distal 1/3 MTB
-applied load >ability to heal
-commonly 2+3rd MTB
-minimal displacement (interosseous muscles act as splint)
202
SCFE
**posterior + medial displacement of femoral capital epiphysis on NOF**
-sudden or gradual defromation of subcapital growth plate
-**incidence**:
1. 3/100k white
2. 7/100k blacks
3. L>R
4. males: 12-16 y/o
5. females: 10-14 y/o
6. bilateral = 25%
203
Mechanical Etiology SCFE
-obesity
-decreased anteversion
-changes. inphyseal plate
204
Inflammatory Etiology SCFE
synovial inflammation
205
Hormonal Etiology SCFE
-obesity
-hypogonadism
-hypothyroidism
-renal osteodystrophy
-growth hormone therapy
206
SCFE symptoms
-limp
-pain (knee, gron, femur)
-decreased internal rotation
-lateral rotation aggravated when hip flexed
207
Hip Fx
-high incidence >65 y/o
-320k admissions/year
-15-20% die within 1 year of fx
-F>M
-**risk factors:**
1. >65 y/o
2. MS/parkinsons
3. osteoporosis
4. hyperthyroid/hypogonadism
5. caffeine, smoking, alcohol
6. low Ca2+ or vitamin D
7. eating disorders
8. steroids, anti convulsants, diuretics
208
Intracapsular Hip Fx
**risk for nonunion / avascular necrosis (decreased blood supply to femoral head)**
-**subcapital** = most common fx (Xray: increased density at femoral head)
-transcervical
-basicervical
| I summon trashy boys
209
Extracapsular Hip FX
intertrochanteric + subtrochanteric
| EatIng Subway
210
Pauwel's Classification
**the more vertical the line of angle increases risk for nonunion (avascular necrosis)**
-incr. shear stress across fx
211
Garden 1
## Footnote
Hip FX Classification
incomplete fx of NOF
212
Garden 2
## Footnote
Hip FX Classification
complete fx w/o displacement
213
Garden 3
## Footnote
Hip FX Classification
complete fx w/ partial displacement
214
Garden 4
## Footnote
Hip FX Classification
complete fx w/ full dispalcement
215
Achilles Tendon Rupture
**largest and most powerful tendon in the body formed by gastrocnemoius and soleus**
-18/100k
-adults 4050 y/o, M>F, athletic
-snap in heels w/ pain
-**25% **have previous Achilles inflammation
-seen w/ **steroid/quinolone use, inflammatory arthritis**
-**diagnosis**: weak plantarflexion, gap in tendon, + Thompson test
-**Xray** if avulsion suspected
-**US/MRI** reveals tendon degeneration
