The lateral aspect of the foot is innervated by the sural nerve, which travels parallel to the short saphenous vein. During surgery on the short saphenous vein, there is a risk of damaging the sural nerve.

Cutaneous Sensation in the Foot

Cutaneous sensation in the foot is the ability to feel touch, pressure, temperature, and pain on the skin of the foot. Different regions of the foot are innervated by different nerves, which are responsible for transmitting sensory information to the brain. The lateral plantar region is innervated by the sural nerve, while the dorsum (excluding the 1st web space) is innervated by the superficial peroneal nerve. The 1st web space is innervated by the deep peroneal nerve, and the extremities of the toes are innervated by the medial and lateral plantar nerves. The proximal plantar region is innervated by the tibial nerve, while the medial plantar region is innervated by the medial plantar nerve and the lateral plantar region is innervated by the lateral plantar nerve. Understanding the innervation of the foot is important for diagnosing and treating conditions that affect cutaneous sensation in this area.

Ankylosing spondylitis is a condition that typically affects young men and causes lower back pain and stiffness that is worse in the mornings. It is a type of seronegative spondyloarthropathy that leads to inflammation of the lower axial skeleton. Sacroiliitis, which is inflammation of the sacroiliac joints, is a common sign on x-ray. Unlike many other rheumatological conditions, ankylosing spondylitis is more prevalent in men than women.

Intervertebral disc herniation is not the correct answer. This condition typically causes back pain and dermatomal leg pain that does not improve throughout the day or with exercise. It is usually caused by an injury rather than developing gradually without a clear cause.

Reactive arthritis is also an incorrect answer. This is another type of seronegative spondyloarthropathy that occurs after exposure to certain gastrointestinal and genitourinary infections, such as Chlamydia, Salmonella, and Campylobacter jejuni.

Rheumatoid arthritis is also not the correct answer. This is a chronic inflammatory condition that causes inflammation of the synovial tissue and is more common in women. It typically presents with symmetrical, polyarticular arthritis of the small joints.

Ankylosing spondylitis is a type of spondyloarthropathy that is associated with HLA-B27. It is more commonly seen in young males, with a sex ratio of 3:1, and typically presents with lower back pain and stiffness that develops gradually. The stiffness is usually worse in the morning and improves with exercise, while the patient may experience night pain that improves upon getting up.

Clinical examination of patients with ankylosing spondylitis may reveal reduced lateral and forward flexion, as well as reduced chest expansion. The Schober’s test, which involves drawing a line 10 cm above and 5 cm below the back dimples and measuring the distance between them when the patient bends forward, may also be used to assess the condition. Other features associated with ankylosing spondylitis include apical fibrosis, anterior uveitis, aortic regurgitation, Achilles tendonitis, AV node block, amyloidosis, cauda equina syndrome, and peripheral arthritis (which is more common in females).

The patient’s lab results suggest that they have osteomalacia, a condition caused by vitamin D deficiency that results in weak and soft bones. This deficiency leads to poor absorption of calcium in the gastrointestinal tract, which causes low serum calcium levels. In response, the body produces more parathyroid hormone (PTH) to compensate, which lowers serum phosphate levels and increases alkaline phosphatase (ALP) due to increased osteoclast activity.

Osteoporosis also causes weak bones, but it is not a metabolic disease and does not affect electrolyte and hormone levels. Paget’s disease, on the other hand, is characterized by bone pain and abnormal bone growth, but typically has normal calcium, phosphate, and PTH levels. Primary hyperparathyroidism causes high PTH levels, leading to high serum calcium and low serum phosphate levels, and can cause bone pain and fractures. Secondary hyperparathyroidism occurs in chronic kidney disease and is characterized by low serum calcium and high serum phosphate levels, with elevated PTH and ALP levels.

Lab Values for Bone Disorders

When it comes to bone disorders, certain lab values can provide important information about the condition. In cases of osteoporosis, calcium, phosphate, alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels are typically normal. However, in osteomalacia, calcium and phosphate levels are decreased while ALP and PTH levels are increased. Primary hyperparathyroidism, which can lead to osteitis fibrosa cystica, is characterized by increased calcium and PTH levels but decreased phosphate levels. Chronic kidney disease can result in secondary hyperparathyroidism, which is marked by decreased calcium levels and increased phosphate and PTH levels. Paget’s disease, on the other hand, typically shows normal calcium and phosphate levels but increased ALP levels. Finally, osteopetrosis is associated with normal levels of calcium, phosphate, ALP, and PTH. By analyzing these lab values, healthcare professionals can better diagnose and treat bone disorders.

The shoulder abductor is the supraspinatus.

The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

ANCA Associated Vasculitis: Types, Symptoms, and Management

ANCA associated vasculitis is a group of small-vessel vasculitides that are associated with anti-neutrophil cytoplasmic antibodies (ANCA). These include granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome), and microscopic polyangiitis. ANCA associated vasculitis is more common in older individuals and presents with symptoms such as renal impairment, respiratory symptoms, systemic symptoms, vasculitic rash, and ear, nose, and throat symptoms.

To diagnose ANCA associated vasculitis, first-line investigations include urinalysis for haematuria and proteinuria, blood tests for renal impairment, full blood count, CRP, and ANCA testing. There are two main types of ANCA – cytoplasmic (cANCA) and perinuclear (pANCA) – with cANCA being associated with granulomatosis with polyangiitis and pANCA being associated with eosinophilic granulomatosis with polyangiitis and other conditions.

Once suspected, ANCA associated vasculitis should be managed by specialist teams to allow an exact diagnosis to be made. The mainstay of management is immunosuppressive therapy. Kidney or lung biopsies may be taken to aid the diagnosis.

Regular monitoring of a patient’s full blood count is important when taking Azathioprine, as it is an immunosuppressant drug that may cause myelosuppression. Patients should also be educated on signs of infection to watch out for. However, Citalopram, paracetamol, and salbutamol are not known to cause myelosuppression. Although beclometasone dipropionate is a steroid, the small and localized dose in an inhaler makes it highly unlikely to have contributed to the patient’s myelosuppression.

Azathioprine is a medication that is converted into mercaptopurine, which is an active compound that inhibits the production of purine. To determine if someone is at risk for azathioprine toxicity, a test for thiopurine methyltransferase (TPMT) may be necessary. Adverse effects of this medication include bone marrow depression, nausea and vomiting, pancreatitis, and an increased risk of non-melanoma skin cancer. If infection or bleeding occurs, a full blood count should be considered. It is important to note that there may be a significant interaction between azathioprine and allopurinol, so lower doses of azathioprine should be used. However, azathioprine is generally considered safe to use during pregnancy.

The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

If the superior gluteal nerve is damaged, it can result in a positive Trendelenburg sign. This nerve is responsible for providing innervation to the gluteus minimus and gluteus medius muscles, which are important for abducting and medially rotating the lower limb, as well as preventing pelvic drop of the opposing limb. For example, when standing on only the right leg, the right gluteus minimus and gluteus medius muscles stabilize the pelvis. However, if the right superior gluteal nerve is damaged, the right gluteus minimus and gluteus medius muscles will not receive proper innervation, leading to instability and a drop in the left pelvis when standing on the right leg. On the other hand, the inferior gluteal nerve innervates the gluteus maximus muscles, which are responsible for extending the thigh and performing lateral rotation.

The Trendelenburg Test: Assessing Gluteal Nerve Function

The Trendelenburg test is a diagnostic tool used to assess the function of the superior gluteal nerve. This nerve is responsible for the contraction of the gluteus medius muscle, which is essential for maintaining balance and stability while standing on one leg.

When the superior gluteal nerve is injured or damaged, the gluteus medius muscle is weakened, resulting in a compensatory shift of the body towards the unaffected side. This shift is characterized by a gravitational shift, which causes the body to be supported on the unaffected limb.

To perform the Trendelenburg test, the patient is asked to stand on one leg while the physician observes the position of the pelvis. In a healthy individual, the gluteus medius muscle contracts as soon as the contralateral leg leaves the floor, preventing the pelvis from dipping towards the unsupported side. However, in a person with paralysis of the superior gluteal nerve, the pelvis on the unsupported side descends, indicating that the gluteus medius on the affected side is weak or non-functional. This is known as a positive Trendelenburg test.

It is important to note that the Trendelenburg test is also used in vascular investigations to determine the presence of saphenofemoral incompetence. In this case, tourniquets are placed around the upper thigh to assess blood flow. However, in the context of assessing gluteal nerve function, the Trendelenburg test is a valuable tool for diagnosing and treating motor deficits and gait abnormalities.

Methotrexate inhibits dihydrofolate reductase to suppress the immune system and manage Crohn’s disease. This medication is taken once weekly and prescribed with folic acid. Methotrexate blocks the production of nucleotides, which impairs cell replication, particularly in rapidly replicating immune cells, leading to a reduced autoimmune response. Binding to steroid receptors, inhibiting dihydropteroate synthetase, and mimicking the shape of purines are incorrect answers. These mechanisms of action belong to other medications used to manage different conditions.

Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

The patient is experiencing pins and needles and pain in the thumb and index finger, which worsens at night. These symptoms are indicative of carpal tunnel syndrome, which occurs when the median nerve is compressed due to increased pressure in the carpal tunnel. The distribution of the patient’s symptoms aligns with the area supplied by the median nerve.

The inferior lateral cutaneous nerve does not innervate the thumb and index finger, so it cannot explain the patient’s symptoms. Damage to the musculocutaneous nerve would cause weakness in the upper arm flexors and impaired sensation in the lateral forearm, but not in the thumb and index finger.

The radial nerve is responsible for wrist extension, and damage to it would result in wrist drop and altered sensation in the dorsum of the hand. The ulnar nerve causes clawing of the hand and paraesthesia in the medial two fingers when damaged, which is not consistent with the patient’s symptoms.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

The aortic arch can be located at the Angle of Louis (Manubriosternal angle) on the surface. The oesophagus is situated at the back and is less susceptible to damage.

The sternal angle is a significant anatomical landmark located at the level of the upper sternum and manubrium. It is characterized by several structures, including the upper part of the manubrium, left brachiocephalic vein, brachiocephalic artery, left common carotid, left subclavian artery, lower part of the manubrium, and costal cartilages of the 2nd ribs. Additionally, the sternal angle marks the transition point between the superior and inferior mediastinum, and is also associated with the arch of the aorta, tracheal bifurcation, union of the azygos vein and superior vena cava, and the crossing of the thoracic duct to the midline. Overall, the sternal angle is a crucial anatomical structure that serves as a reference point for various medical procedures and diagnoses.

Chlorphenamine is a medication.

Antihistamines for Allergic Rhinitis and Urticaria

Antihistamines, specifically H1 inhibitors, are effective in treating allergic rhinitis and urticaria. Sedating antihistamines like chlorpheniramine have antimuscarinic properties that can cause dry mouth and urinary retention. On the other hand, non-sedating antihistamines like loratadine and cetirizine are less likely to cause drowsiness. However, there is some evidence that cetirizine may still cause some level of drowsiness compared to other non-sedating antihistamines. Overall, antihistamines are a valuable treatment option for those suffering from allergic rhinitis and urticaria.

The ulna serves as the insertion point for the brachialis muscle, while the remaining muscles are inserted onto the radius.

Anatomy of the Radius Bone

The radius bone is one of the two long bones in the forearm that extends from the lateral side of the elbow to the thumb side of the wrist. It has two expanded ends, with the distal end being the larger one. The upper end of the radius bone has articular cartilage that covers the medial to lateral side and articulates with the radial notch of the ulna by the annular ligament. The biceps brachii muscle attaches to the tuberosity of the upper end.

The shaft of the radius bone has several muscle attachments. The upper third of the body has the supinator, flexor digitorum superficialis, and flexor pollicis longus muscles. The middle third of the body has the pronator teres muscle, while the lower quarter of the body has the pronator quadratus muscle and the tendon of supinator longus.

The lower end of the radius bone is quadrilateral in shape. The anterior surface is covered by the capsule of the wrist joint, while the medial surface has the head of the ulna. The lateral surface ends in the styloid process, and the posterior surface has three grooves that contain the tendons of extensor carpi radialis longus and brevis, extensor pollicis longus, and extensor indicis. Understanding the anatomy of the radius bone is crucial in diagnosing and treating injuries and conditions that affect this bone.

The patient in the vignette is experiencing impaired hip extension and lateral rotation, making it difficult for them to rise from a seat and climb stairs. These symptoms are consistent with inferior gluteal nerve palsy, which can be caused by nerve entrapment or compression. The inferior gluteal nerve runs anterior to the piriformis and can be damaged during hip replacement surgery or by sitting for prolonged periods with a wallet in a rear pocket.

Other nerves that can be affected in the lower limb include the femoral nerve, which supplies the lower limb extensively and can be injured by direct trauma or compression. Lateral femoral cutaneous nerve compression can cause meralgia paresthetica, which leads to burning, tingling, and numbness in the front and lateral aspect of the thigh. The obturator nerve is rarely injured but can cause medial thigh sensory changes, weak hip adduction, and a wide-based gait if damaged. The superior gluteal nerve innervates the gluteus medius and minimus and can be assessed with tests that assess hip abductor and stabilizer function.

Overall, understanding the anatomy and function of these nerves can help diagnose and manage lower limb nerve injuries.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteral lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

Guttate psoriasis is frequently seen after a streptococcal infection, with group-A streptococcus being the likely culprit. The condition is characterized by the appearance of small, teardrop shaped red lesions. Scarlet fever, which is also caused by group-A streptococcus, presents with a rough rash, fever, swollen lymph nodes, and a red tongue. Pityriasis rosea, on the other hand, typically follows a viral infection and is identified by a single scaly patch followed by a widespread salmon-pink rash. Acne vulgaris and impetigo are not commonly associated with a streptococcal sore throat.

Guttate psoriasis is a type of psoriasis that is more commonly seen in children and adolescents. It is often triggered by a streptococcal infection that occurred 2-4 weeks prior to the appearance of the lesions. The condition is characterized by the presence of tear drop-shaped papules on the trunk and limbs, along with pink, scaly patches or plaques of psoriasis. The onset of guttate psoriasis tends to be acute, occurring over a few days.

In most cases, guttate psoriasis resolves on its own within 2-3 months. There is no clear evidence to support the use of antibiotics to treat streptococcal infections associated with the condition. Treatment options for guttate psoriasis include topical agents commonly used for psoriasis and UVB phototherapy. In cases where the condition recurs, a tonsillectomy may be necessary.

It is important to differentiate guttate psoriasis from pityriasis rosea, which is another skin condition that can present with similar symptoms. Guttate psoriasis is typically preceded by a streptococcal sore throat, while pityriasis rosea may be associated with recent respiratory tract infections. The appearance of guttate psoriasis is characterized by tear drop-shaped, scaly papules on the trunk and limbs, while pityriasis rosea presents with a herald patch followed by multiple erythematous, slightly raised oval lesions with a fine scale. Pityriasis rosea is self-limiting and resolves after around 6 weeks.

The pisiform bone is in close proximity to both the ulnar nerve and artery. Additionally, the capitate bone is in articulation with the lunate, scaphoid, hamate, and trapezoid bones, indicating a close relationship between them.

The Capitate Bone: Largest of the Carpal Bones

The capitate bone is the largest of the carpal bones and is located centrally in the wrist. It has a rounded head that fits into the cavities of the lunate and scaphoid bones. The bone also has flatter articular surfaces for the hamate medially and the trapezoid laterally. At the distal end, the capitate bone primarily articulates with the middle metacarpal. Overall, the capitate bone plays an important role in the structure and function of the wrist joint.

The tricep muscle, which gets its name from the Latin word for three-headed muscles, is responsible for extending the elbow. It is made up of three heads: the long head, which originates from the infraglenoid tubercle of the scapular; the lateral head, which comes from the dorsal surface of the humerus; and the medial head, which originates from the posterior surface of the humerus. These three heads come together to form a single tendon that inserts onto the olecranon process of the ulna.

Anatomy of the Triceps Muscle

The triceps muscle is a large muscle located on the back of the upper arm. It is composed of three heads: the long head, lateral head, and medial head. The long head originates from the infraglenoid tubercle of the scapula, while the lateral head originates from the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve. The medial head originates from the posterior surface of the humerus on the inferomedial side of the radial groove and both of the intermuscular septae.

All three heads of the triceps muscle insert into the olecranon process of the ulna, with some fibers inserting into the deep fascia of the forearm and the posterior capsule of the elbow. The triceps muscle is innervated by the radial nerve and supplied with blood by the profunda brachii artery.

The primary action of the triceps muscle is elbow extension. The long head can also adduct the humerus and extend it from a flexed position. The radial nerve and profunda brachii vessels lie between the lateral and medial heads of the triceps muscle. Understanding the anatomy of the triceps muscle is important for proper diagnosis and treatment of injuries or conditions affecting this muscle.

Third space fluid loss is a common occurrence in patients with severe burns. This happens when fluid leaks into the area surrounding cells, leading to symptoms such as edema, tachycardia, and hypotension.

It is unlikely that neurogenic shock is the cause of these symptoms. Neurogenic shock is typically caused by damage to the autonomic pathways in the central nervous system, which is usually the result of spinal cord or central nervous system trauma.

While secondary bacterial infections and sepsis are important considerations in patients with major burns, it is unlikely that this patient has an infection since the burns occurred only 30 minutes ago.

Severe pain may explain the tachycardia, but it does not account for the hypotension.

Smoke inhalation can cause coughing, shortness of breath, and burns around the airway, but it is unlikely to be the cause of the hypotension and tachycardia in this patient.

First Aid and Management of Burns

Burns can be caused by heat, electricity, or chemicals. Immediate first aid involves removing the person from the source of the burn and irrigating the affected area with cool water. The extent of the burn can be assessed using Wallace’s Rule of Nines or the Lund and Browder chart. The depth of the burn can be determined by its appearance, with full-thickness burns being the most severe. Referral to secondary care is necessary for deep dermal and full-thickness burns, as well as burns involving certain areas of the body or suspicion of non-accidental injury.

Severe burns can lead to tissue loss, fluid loss, and a catabolic response. Intravenous fluids and analgesia are necessary for resuscitation and pain relief. Smoke inhalation can result in airway edema, and early intubation may be necessary. Circumferential burns may require escharotomy to relieve compartment syndrome and improve ventilation. Conservative management is appropriate for superficial burns, while more complex burns may require excision and skin grafting. There is no evidence to support the use of antimicrobial prophylaxis or topical antibiotics in burn patients.

The axillary nerve is responsible for supplying the deltoid and teres minor muscles, which allow for flexion, extension, abduction, and external rotation of the shoulder joint. Damage to this nerve can result in a loss of sensation over the ‘regimental badge’ area of the upper arm and impaired shoulder movement.

The biceps brachii, brachialis, and coracobrachialis muscles are innervated by the musculocutaneous nerve and are responsible for forearm flexion and shoulder adduction. Damage to this nerve would cause sensory impairment of the lateral aspect of the forearm.

The serratus anterior muscle is innervated by the long thoracic nerve and is responsible for stabilizing and upwardly rotating the scapula. Damage to this nerve would cause ‘winging’ of the scapula.

The supraspinatus and infraspinatus muscles are innervated by the suprascapular nerve and are responsible for initiating the first 15 degrees of abduction at the shoulder joint and externally rotating the shoulder, respectively.

The trapezius muscle is innervated by the accessory nerve and the ventral rami of the C3 and C4 spinal nerves. It acts to rotate and stabilize the scapula to enable movements of the upper limb.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

If a patient exhibits a positive Froment’s sign, it suggests that they may have ulnar nerve palsy. The ulnar nerve is responsible for controlling finger adduction and abduction. Meanwhile, the median nerve is responsible for thumb abduction and wrist pronation, while the radial nerve controls wrist extension.

Nerve signs are used to assess the function of specific nerves in the body. One such sign is Froment’s sign, which is used to assess for ulnar nerve palsy. During this test, the adductor pollicis muscle function is tested by having the patient hold a piece of paper between their thumb and index finger. The object is then pulled away, and if the patient is unable to hold the paper and flexes the flexor pollicis longus to compensate, it may indicate ulnar nerve palsy.

Another nerve sign used to assess for carpal tunnel syndrome is Phalen’s test. This test is more sensitive than Tinel’s sign and involves holding the wrist in maximum flexion. If there is numbness in the median nerve distribution, the test is considered positive.

Tinel’s sign is also used to assess for carpal tunnel syndrome. During this test, the median nerve at the wrist is tapped, and if the patient experiences tingling or electric-like sensations over the distribution of the median nerve, the test is considered positive. These nerve signs are important tools in diagnosing and assessing nerve function in patients.

Trapezius is not related to the mnemonic for the carpal bones.

Carpal Bones: The Wrist’s Building Blocks

The wrist is composed of eight carpal bones, which are arranged in two rows of four. These bones are convex from side to side posteriorly and concave anteriorly. The trapezium is located at the base of the first metacarpal bone, which is the base of the thumb. The scaphoid, lunate, and triquetrum bones do not have any tendons attached to them, but they are stabilized by ligaments.

In summary, the carpal bones are the building blocks of the wrist, and they play a crucial role in the wrist’s movement and stability. The trapezium bone is located at the base of the thumb, while the scaphoid, lunate, and triquetrum bones are stabilized by ligaments. Understanding the anatomy of the wrist is essential for diagnosing and treating wrist injuries and conditions.

The scaphoid bone’s blood supply is only through the tubercle, and a fracture in this area can lead to avascular necrosis. It attaches to the trapezium and trapezoid bones at the greater and lesser multangular ends, respectively.

The scaphoid bone has various articular surfaces for different bones in the wrist. It has a concave surface for the head of the capitate and a crescentic surface for the lunate. The proximal end has a wide convex surface for the radius, while the distal end has a tubercle that can be felt. The remaining articular surface faces laterally and is associated with the trapezium and trapezoid bones. The narrow strip between the radial and trapezial surfaces and the tubercle gives rise to the radial collateral carpal ligament. The tubercle also receives part of the flexor retinaculum and is the only part of the scaphoid bone that allows for the entry of blood vessels. However, this area is commonly fractured and can lead to avascular necrosis.

Celecoxib inhibits COX-2 in a reversible manner, while aspirin inhibits both COX-1 and COX-2 irreversibly. Celecoxib is classified as a selective NSAID that works by reducing the production of prostaglandins.

Understanding Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and COX-2 Selective NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that work by inhibiting the activity of cyclooxygenase enzymes, which are responsible for producing key mediators involved in inflammation such as prostaglandins. By reducing the production of these mediators, NSAIDs can help alleviate pain and reduce inflammation. Examples of NSAIDs include ibuprofen, diclofenac, naproxen, and aspirin.

However, NSAIDs can also have important and common side-effects, such as peptic ulceration and exacerbation of asthma. To address these concerns, COX-2 selective NSAIDs were developed. These medications were designed to reduce the incidence of side-effects seen with traditional NSAIDs, particularly peptic ulceration. Examples of COX-2 selective NSAIDs include celecoxib and etoricoxib.

Despite their potential benefits, COX-2 selective NSAIDs are not widely used due to ongoing concerns about cardiovascular safety. This led to the withdrawal of rofecoxib (‘Vioxx’) in 2004. As with any medication, it is important to discuss the potential risks and benefits of NSAIDs and COX-2 selective NSAIDs with a healthcare provider before use.

The bone located at the base of the thumb is called the trapezium. In certain cases, it may be removed to relieve symptoms of osteoarthritis in the thumb. To remember the carpal bones in order from lateral to medial, you can use the mnemonic ‘Sam Left The Party To Take Curtis Home’, which stands for scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate.

Carpal Bones: The Wrist’s Building Blocks

The wrist is composed of eight carpal bones, which are arranged in two rows of four. These bones are convex from side to side posteriorly and concave anteriorly. The trapezium is located at the base of the first metacarpal bone, which is the base of the thumb. The scaphoid, lunate, and triquetrum bones do not have any tendons attached to them, but they are stabilized by ligaments.

In summary, the carpal bones are the building blocks of the wrist, and they play a crucial role in the wrist’s movement and stability. The trapezium bone is located at the base of the thumb, while the scaphoid, lunate, and triquetrum bones are stabilized by ligaments. Understanding the anatomy of the wrist is essential for diagnosing and treating wrist injuries and conditions.

If a patient is unable to adduct their thigh after an anterior hip dislocation, it is likely due to damage to the obturator nerve. This nerve supplies the hip adductor muscles and sensation to the medial thigh. In contrast, damage to the femoral nerve would result in an inability to flex the hip or extend the knee, making it an unlikely cause for this specific symptom. Compression of the inferior gluteal nerve can cause piriformis syndrome, while compression of the lateral femoral cutaneous nerve can lead to meralgia paresthetica, but neither of these would affect the patient’s ability to adduct their leg. Damage to the superior gluteal nerve would result in a positive Trendelenburg’s sign.

Lower limb anatomy is an important topic that often appears in examinations. One aspect of this topic is the nerves that control motor and sensory functions in the lower limb. The femoral nerve controls knee extension and thigh flexion, and provides sensation to the anterior and medial aspect of the thigh and lower leg. It is commonly injured in cases of hip and pelvic fractures, as well as stab or gunshot wounds. The obturator nerve controls thigh adduction and provides sensation to the medial thigh. It can be injured in cases of anterior hip dislocation. The lateral cutaneous nerve of the thigh provides sensory function to the lateral and posterior surfaces of the thigh, and can be compressed near the ASIS, resulting in a condition called meralgia paraesthetica. The tibial nerve controls foot plantarflexion and inversion, and provides sensation to the sole of the foot. It is not commonly injured as it is deep and well protected, but can be affected by popliteal lacerations or posterior knee dislocation. The common peroneal nerve controls foot dorsiflexion and eversion, and can be injured at the neck of the fibula, resulting in foot drop. The superior gluteal nerve controls hip abduction and can be injured in cases of misplaced intramuscular injection, hip surgery, pelvic fracture, or posterior hip dislocation. Injury to this nerve can result in a positive Trendelenburg sign. The inferior gluteal nerve controls hip extension and lateral rotation, and is generally injured in association with the sciatic nerve. Injury to this nerve can result in difficulty rising from a seated position, as well as difficulty jumping or climbing stairs.

A mastectomy patient experiences winged scapula due to paralysis of the serratus anterior muscle, which is innervated by the long thoracic nerve. This nerve is often affected by rib injuries. The other nerves mentioned do not play a role in this disorder as they do not innervate this muscle. Damage to the musculocutaneous nerve would affect arm flexion, while damage to the axillary nerve would affect arm abduction. Damage to the thoracodorsal nerve would affect raising the trunk with the upper limb, and damage to the accessory nerve would affect neck movement.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

Osteogenesis imperfecta is caused by a defect in type 1 collagen, which is found in the skin, tendons, vasculature, and bones. This abnormality results in fragile bones, leading to multiple fractures, as seen in a child with deafness, blue sclera, and fractures. Type 2 collagen is present in cartilage and is not typically affected in osteogenesis imperfecta. Type 3 collagen is the primary component of reticular fibers, which are also not typically affected in this condition. Type 4 collagen makes up basement membranes, which are also not typically affected in osteogenesis imperfecta.

Understanding Osteogenesis Imperfecta

Osteogenesis imperfecta, also known as brittle bone disease, is a group of disorders that affect collagen metabolism, leading to bone fragility and fractures. The most common type of osteogenesis imperfecta is type 1, which is inherited in an autosomal dominant manner and is caused by decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides.

This condition typically presents in childhood, with individuals experiencing fractures following minor trauma. Other common features include blue sclera, deafness secondary to otosclerosis, and dental imperfections. Despite these symptoms, adjusted calcium, phosphate, parathyroid hormone, and ALP results are usually normal in individuals with osteogenesis imperfecta.

Overall, understanding the symptoms and underlying causes of osteogenesis imperfecta is crucial for proper diagnosis and management of this condition.

If a patient is experiencing difficulty abducting their arm after a humeral neck fracture, it may be due to damage to the axillary nerve. This nerve is commonly affected by anterior shoulder dislocations and surgical neck fractures of the humerus. The axillary nerve provides sensation to the area over the deltoid muscle, known as the regimental area. It is important to note that the skin over the olecranon is supplied by the radial nerve, while the intercostobrachial nerve supplies the skin over the axilla. The musculocutaneous nerve is responsible for supplying sensation to the skin over the palmar surface of the lateral forearm. Damage to the axillary nerve would not specifically affect the C6 dermatome.

Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

Temporal arteritis, space occupying lesions, migraines, and tension headaches all cause headaches, but they differ in their specific symptoms and causes. Temporal arteritis causes pain in the inflamed temporal artery, which can also lead to jaw pain and temporary vision loss. Space occupying lesions can cause severe morning headaches with vomiting. Migraines are characterized by hours-long headache attacks preceded by an aura and changes in mood, appetite, and sleepiness. Tension headaches cause a band-like pain around the head and are often associated with stress.

Temporal arteritis is a type of large vessel vasculitis that often occurs in patients over the age of 60 and is commonly associated with polymyalgia rheumatica. This condition is characterized by changes in the affected artery that skip certain sections while damaging others. Symptoms of temporal arteritis include headache, jaw claudication, and visual disturbances, with anterior ischemic optic neuropathy being the most common ocular complication. A tender, palpable temporal artery is also often present, and around 50% of patients may experience symptoms of PMR, such as muscle aches and morning stiffness.

To diagnose temporal arteritis, doctors will typically look for elevated inflammatory markers, such as an ESR greater than 50 mm/hr or elevated CRP levels. A temporal artery biopsy may also be performed to confirm the diagnosis, with skip lesions often being present. Treatment for temporal arteritis involves urgent high-dose glucocorticoids, which should be given as soon as the diagnosis is suspected and before the temporal artery biopsy. If there is no visual loss, high-dose prednisolone is typically used, while IV methylprednisolone is usually given if there is evolving visual loss. Patients with visual symptoms should be seen by an ophthalmologist on the same day, as visual damage is often irreversible. Other treatments may include bone protection with bisphosphonates and low-dose aspirin, although the evidence supporting the latter is weak.

Hydralazine has the potential to cause drug-induced lupus, which is the most likely explanation for the patient’s symptoms. Lupus is characterized by respiratory symptoms, arthralgia, fatigue, and a malar rash (butterfly rash), and the patient has no prior history of these symptoms but has tested positive for anti-histone antibodies. Other drugs that can induce lupus include procainamide, isoniazid, and methyldopa.

Leukaemia, on the other hand, would present with abnormal full blood count results and a more gradual onset, making it less likely in this case.

Pneumonia and parvovirus B19 are also less likely causes, as the patient’s lack of fever and positive anti-histone antibodies do not align with these conditions.

Drug-induced lupus is a condition that differs from systemic lupus erythematosus in that it does not typically involve renal or nervous system complications. This condition can be resolved by discontinuing the medication that caused it. Symptoms of drug-induced lupus include joint and muscle pain, skin rashes (such as a malar rash), and pleurisy. Patients with this condition will test positive for ANA, but negative for dsDNA. Anti-histone antibodies are found in 80-90% of cases, while anti-Ro and anti-Smith are only present in around 5%. The most common causes of drug-induced lupus are procainamide and hydralazine, while less common causes include isoniazid, minocycline, and phenytoin.