LOCO Revision

7/24/2019 LOCO Revision

1/18

EXTERNAL ILIAC -> FEMORAL -> PROFUNDA FEMORIS

LUMBAR PLEXUS T12 L1-L4

GENITOFEMORAL passes through PSOAS

SACRAL PLEXUS L4-L5 S1-S4

LOCO revision

29 April 2015 22:00

Quick Notes Page 1


2/18

TERRIBLE TRIAD ACL, MED MENISCUS, MED COLATLAT COLAT STRONGER - ROUND VS FLAT

MEDIAL COLAT attaches to joint capsule (MM)

DAMAGE TO COMMON PERONEAL -> FOOT DROP (BROKEN FIBULA)

Quick Notes Page 2


3/18

CLAVICULAR BREAK -> BRACHIAL ARTERY DAMAGE

BRACHIAL PLEXUS C5-T1

LAMELLAR -> ORGANISED (CORTICAL/ TRABECULAR)

WOVEN -> IMMATURE/ HEALINGBONE TYPE 1 COLLAGEN

OSTEOCLAST FROM HAEMATOPOETIC BONE MARROW LINEAGE

BONE REMODELLING -> OC forms LEAK PROOF seal, secretes collagenase and HCl, ions secreted into IF, OBs

Quick Notes Page 3


4/18

fill lacuna with osteoid

NORMAL SERUM CALCIUM 2.2 - 2.6 mmol/L

PHOSPHATE necessary for formation of CALCIUM HYDROXYAPATITE via ALKALINE PHOSPHATASE

OPG = OSTEOPROTEGRIN decoy RANKL recepotor

Quick Notes Page 4


5/18

BONE LOSS PER YEAR = 0.7%

POST MENOPAUSE = 2 - 9%

T SCORE = compares bone density (SD) to 30 y/o matched for sex and ethnicity

Z SCORE = compares bone density (SD) to individual matched for age, sex, ethnicity

T SCORES - OSTEOPENIA -1 to -2.5, OSTEOPEROSIS -2.5 onwards

OP DX - low impact fractures (ESP NoF)

BONES with more TRABECULAR BONE more susceptible to OP due to high turnover & TRABECULAR bone

occupies more SA

TX = ALENDRONATE/ RESEDRONATE (BISPHOSPHONATES)

RALOXIFENE (OESTROGEN R modulator)

HRT

Calcium Vit D

TERIPARATIDE = recombinant PTH (given intermittently stimulates Obs more than Ocs)

BISPHOSPHONATES inhibit osteoclasts, are released locally during bone resorption, and modulate signalling

from OBS to OCS

SE = atypical fractures, giant osteoclasts, osteonecrosis of jaw

DENOSUMAB (RANK L mAb, acts osteoprotegrin)

OSTEOMALACIA Tx = Vit D, UV, Ca

COMPLICATION = OSTEOSARCOMA

TX = BISPHOSPHONATES

DE QUERVAIN'S TENOSYNOVITIS - thumb tendons - EXTENSOR POLLICIS LONGUS/ BREVIS, ABDUCTOR

Quick Notes Page 5


6/18

POLLICIS LONGUS

TRIGGER FINGER - FLEXOR TENDINOSIS

CARPAL TUNNEL - FLEXOR RETINACULUM AND CARPAL BONES -> MEDIAN N COMPRESSION

(hypothyroidism, pregnancy, idiopathic, diabetes)

DUPUYTREN'S - PALMAR APONEUROSIS (heavy drinking, smoking, diabetic, men)

TENNIS ELBOW - lateral epicondylitis (forearm extensors)

SHOULDER IMPINGEMENT - SUPRASPINATUS tendon

NSAIDs prevent HETEROTROPIC calcification of tendon in TENDONITISNSAIDS inhibit COX2 (prevents chondrocyte hypertrophy induced by prostaglandins)

TENDON HEALING - EXTRINSIC (peripheral fibroblasts, tendons without sheaths)

INTRINSIC (fibroblasts from within tendon, tendons WITH sheaths)

ENTHESES - fibrous/ fibrocartilaginous (gradient from tendon to cartilage to bone, moving enthesis)

FIBROUS ENTHESIS - sharpey's fibers (teeth)

ENTHESITIS - HLA B27 arthropathy associated, TX = RICE, NSAIDS, anti TNF

SLE - 95% pts ANA positive, homogeneous/ speckled

TX - NSAIDS, DMARDS, CORTICOSTEROIDS, IV IMMUNOGLOBULINS

RA joint distribution

Quick Notes Page 6


7/18

CARTILAGE TYPE II COLLAGEN (and IX/ XI)

Quick Notes Page 7


8/18

NB: aggrecan = HA aggregates, ADAMTS-4 .: damages synovial fluid

Quick Notes Page 8


9/18

MICROSCOPIC CHANGES: chondrocyte necrosis, focal clumps, larger isogenic clusters, type I collagen not

type II, hyaline becomes fibrocartilage

SYNOVIOCYTES - TYPE A = MAE TYPE B = FIBROBLAST, no BM b/w synovium and subintima (allows free

passage of water)

Quick Notes Page 9


10/18

Quick Notes Page 10


11/18

SYNOVIAL FLUID - less viscous, neutrophils (mount respiratory burst)

Quick Notes Page 11


12/18

TRANSVERSE - DIRECT FORCE

SPIRAL/ OBLIQUE - TRANSMISSION/ TWISTING

CRUSH - COMPRESSION/ OP

BURST - VERTEBRA, HIGH FORCE

AVULSION - TRACTION from MUSCLE

IMPACTED - forcing bone ends togetherCOMMINUTED - Multiple fragments, high impact trauma

STRESS FRACTURE - FATIGUE (abnormal stress), INSUFFICIENCY (normal stress, poor bone)

PELVIC # - EMERGENCY, BLOOD LOSS

SARCOPENIA - muscle loss post age 30 (3 - 5% per year)

CAMPTOCORMIA - THORACOLUMBAR flexion due to sarcopenia

SPONDYLOSIS - OA of spine

OA - HEBERDEN's = DIPS BOUCHARD's = PIPS

PREMATURE OA - PREVIOUS MENISECTOMY, HAEMOCHROMATOSIS

Quick Notes Page 12


13/18

CORE TX - EXERCISE

DIET, NUTRICEUTICLES (CS and GLUCOSAMINE)

NSAID/ PARACETEMOL/ CAPSAICINCOX 2 - CELECOXIB

INTRA ARTICULAR - CORTICOSTEROID

Quick Notes Page 13


14/18

Quick Notes Page 14


15/18

MUSCLE - 40% body mass

NODAL OA = DIPS and PIPS

EROSIVE OA = DIPS

RF = IgM against IgG

Quick Notes Page 15


16/18

Stores glucose and potassium (and other ions)

Loss of motor neuron -> small angulated fibres

Infantile hypotonia - loss of type 1/2

DERMATOMYOSITIS - HELIOTROPE rash on eyelids, STREAKY rash elsewhere

SUBCUTANEOUS CALCIFICATIONS- AI condition, ANA positive/ anti-Jo1 (90%, 20 - 40%)

TX = prednisone, azathioprine, methotrexate (immune suppressants)

INCLUSION BODY MYOSITIS - old people, amyloid vacuoles on biopsy (contain beta amyloid,

hyperphosphorylated tau, apolipoprotein E, presenillin) muscle weakness in finger and wrist flexors,

dysphagia, knee extensor weakness

MUSCULAR DYSTROPHIES - X LINKED, proximal muscle weakness, raised CK

DUCHENNE/ BECKER - DYSTROPHIN lost, endomysial fibrosis in DUCHENNE, muscle undergoes

MYOPHAGOCYTOSIS, muscle later replaced with fat and fibrotic material

FIBROMYALGIA - women, AI, TCAs, SSRIs

RA - SCLERITIS, CARPAL TUNNEL, ATLANTO-AXIAL SUBLUXATION, IHD

METHOTREXATE = 1st choice RA drug

SE - liver problems, affects blood count

FOLIC acid antagonist, limits DNA and RNA synthesis (inhibits dihydrofolate reductase, thymidylate

synthetase)

SULFASALAZINE - Antibiotic (Tx of underlying UC)

HYDROXYCHLOROQUINE - Anti malarial, accumulates in lysozomes, blocks Toll-like R 9

Quick Notes Page 16


17/18

LEFLUNOMIDE - alternative to MTX, inhibits pyrimidine synthesis via inhibition of DIHYDROOROTATE

DEHYDROGENASE

AZATHIOPRINE - immune suppressant (transplant PTS), pro-drug, interferes with purine synthesis

GOLD salts - injections, 4 - 6 month latency, painful

Quick Notes Page 17


18/18

Documents

LOCO Revision