Orthopedics most common

MOST COMMON IN ORTHOPAEDICS
1.Most common bone to get fractured overall – Tibia
2.Most common bone to get fractured during childbirth / in a newly born child – Clavicle
3.Most common bone to get fractured during childhood – Greenstick fractures of forearm bones
4.Most common bone to get fractured during childhood around elbow – Supracondylar fracture humerus
5.Most common joint to undergo Spontaneous / Traumatic / Recurrent dislocation – Shoulder
6. Least common joint to undergo dislocation – Knee
7. Second most common joint to undergo recurrent dislocation – Patella
8. Most common ligament to undergo sprain – Anterior talofibular ligament
9. Strongest ligament of the body – Iiofemoral ligament / Ligament of Bigelow
10. Most common tendon to get injured – Tendo Achilles
11. Strongest tendon in the body – Tendo Achilles
12. Most common nerve to get injured – Radial Nerve
13. Best prognosis after nerve injury is seen in – Radial Nerve
14. Most common artery to get injured – Popliteal artery
15. Most common bone tumor – Metastasis / Secondaries
16. Most common benign bone tumor – Osteochondroma / Exostosis
17. Most common true benign bone tumor – Osteoid Osteoma
18. Most common primary malignant bone tumor – Multiple Myeloma
19.Second most common primary malignant bone tumor – Osteosarcoma

Stains

🌟All abut STAINS 🌟

1. Aldehyde Fuchsin
- can be used to stain pancreatic islet beta cell
granules
2. Alician Blue
- a Mucin stain (a category of histology stains,
listed below)
- can stain mucins and mucosubstances blue (due
to the copper in the stain)
3. Alizarin Red S
- can be used to identify calcium in tissue
sections
- used on the Dupont ACA analyzer to measure
serum calcium photometrically
4. Alkaline Phosphatase
- can be used to stain endothelial cells
5. Azan Stain
- can be used to differentiate osteoid from
mineralised bone
6. Bielschowsky Stain
- can be used to show reticular fibres
- used for showing neurofibrillary tangles and
senile plaques
- uses the chemical element silver (Ag)
7. Cajal Stain
- can be used on nervous tissue.
8. Congo Red
- used to stain amyloid fibres (to appear orange/
red).
9. Cresyl Violet
- will stain both neurons and glia
- bonds with acidic parts of cells such as
ribosomes , nuclei and nucleoli
0. Eosin
- commonly used for general histology staining
when paired with haematoxylin - see Hematoxylin
and Eosin (H&E)
1. Fontana-Masson
- uses the chemical element silver (Ag)
- stains argentaffin granules and melanin black -
while also staining nuclei pink/red and cytoplasm
light pink
- a specific example of a Melanin Stain (general
category of histology stains)
2. Giemsa Stain
- a Romanowski (also written "Romanowsky") type
stain
- used for peripheral blood smears, i.e. a thin
layer of blood smeared on a microscope slide and
used for bone marrow.
- used to study parasites and malaria
3. Golgi Stain
- can be used to stain neurons
4. Gomori Trichrome
- trichrome histology stains are formed from a
mixture of three dyes
- Gomori's trichrome stains connective tissue and
collagen (green or blue), muscle, keratin and
cytoplasm (red) and nuclei (grey/blue/black)
5. Heidenhain's AZAN trichrome stain
- trichrome histology stains are formed from a
mixture of three dyes
- can be used to distinguish cells from
extracellular components
- stains connective tissues, e.g. muscle fibres,
cartilage and bone matrices .
- a similar stain to Mallory Trichome (listed
below). These histology stains differ because
Heidenhain introduced azocarmine G in place of the
acid fuchsine of Mallory's stain. He also added
controlled destaining resulting in different colours
of cell nuclei (dark red), collagen (blue) and a
various of colours in cytoplasm.
6. Hematoxylin
- commonly used for general histology staining
when paired with eosin - see Hematoxylin and
Eosin (H&E)
7. Hematoxylin and Eosin (H&E)
- standard histology stain and the most frequently
used combination of stains used in the histology
lab for general purpose staining - often used for
routine tissue preparation
- Hematoxylin binds to acidic structures, staining
them blue-purple. Hence it binds and stains
nucleic acids ( DNA and RNA), so stains the nuclei
of cells blue.
- Eosin binds to and stains basic structures pink,
e.g. cytoplasm , muscle, connective tissue, colloid
and red blood cells are stained pink-red.
8. Iron Hematoxylin
- stains nuclei bluish/black.
9. Luna Stain
- can be used to demonstrate elastin and mast
cells
0. Luxol Fast Blue
- the alcohol soluble equivalent of Alician Blue
(see above)
- used to observe myelin (myelin stains blue to
blue/green, neurons to violet, red blood cells to
blue)
1. Mallory Trichrome
- trichrome histology stains are formed from a
mixture of three dyes
- used on connective tissue to indicate collagen
and reticular fibers.
- uses acid fuchsine followed by a solution
containing PTA, orange G and aniline blue.
2. Masson Trichrome
- trichrome histology stains are formed from a
mixture of three dyes
- can be used to distinguish between cellular
items & extracellular items
- can be used on connective tissue.
3. Melanin Stains
- a category of histology stains used to stain
melanin (which is located in the skin, eyes, and
melanomas)
- can be used to study melanin pigment in cells of
malignant melanoma
- Fontana-Masson (listed above) is a specific
example of a melanin stain.
4. Movat's Pentachrome Stain
- can be used to study connective tissue.
5. Mucicarmine
- a very specific Mucin Stain
- can be used to observe epithelial mucins

Muscles

Some important muscles and their special names :

Quadrilateral - thyrohyoid.
Straplike - sternohyoid & Sartorius.
Straplike with tendinous intersections - rectus abdominis.
Fusiform - biceps, digastrics etc.
Oblique Fasciculi
Triangular - adductor longus, temporalis.
Shawl muscle - Trapezius.
Guthrie’s muscle - Sphincter urethrae.
Laughing/Smiling muscle - Zygomaticus major.
Unipennate (fibres arranged to insert in a diagonal direction onto the tendon allowing great strength ) - Flexor policis longus, extensor digitorum longus, peroneus tertius.

Multipennate (multiple rows of diagonal fibres, with a central tendon which branches into two or more tendons) - Subscapularis, deltoid.

Circumpennate - Tibialis anterior.
Spiral or Twisted fasciculi - Trapezius, Pectoralis major, Latisimus dorsi, Supinator.
Cruciate muscles - Sternocleidomastoid, Adductor magnus, Masseter.
Subcutaneous muscles - Platysma, Palmaris brevis.
Longest muscle - Sartorius (tailor muscle).
Smallest muscle - Stapedius.
Climbing muscle - Latissimus dorsi (broadest muscle of Back).
Boxer’s muscle - Serratus anterior.
Locking muscles - Popliteus.
Casser’s perforated muscle - Coracobrachialis.
Coiter’s muscle - Corrugator supercilli.
Cowl muscle - Trapezius.
Rider’s muscle - Adductor muscle of thigh.

Valsalva’s muscle - Muscle of Tragus.
Sommering’s muscle - Levator glandulae thyroideae.
Thelle’s muscle - Superficial transverse perinea muscle.
Toynbee’s muscle - Tensor tympani.
Wilson’s muscle -Sphincter urethrae.
Wrinkler muscles of eyebrow - Corrugator supercilli (Coiter’s muscle).
Sibson’s muscle - Scaleneus minimus.
Gavard’s muscle - Oblique fibres in the muscular coat of stomach.
Oehl’s muscle - Strands of muscle fibres in the chordae tendinae of the left A-V valve.

IOC

INVESTIGATION OF CHOICE:
• Single Bone Metastasis – CT
• Multiple Bone Metastasis – Bone scan
• Spine Metastasis – MRI
• Avascular necrosis- MRI
• Bone Density/Osteoporosis- DEXA (Dual energy x ray absorptiometry)
• Aneurysm/ AV Fistula- Angiography
• Dissecting Aneurysm (Stable) - MRI (Unstable)-Trans oesophageal USG
• Pericardial Effusion- Echocardiography
• Lobulated pericardial effusion- MRI > CT
• Minimum Pericardial Effusion- Echocardiography 
• Ventricular Function- Echocardiography
• Radiotherapy/Chemotherapy induced cardiotoxicity- Endomyocardial Biopsy
• Pulmonary Embolism- CECT> Pulmonary Angiography > V/Q Scan
• Interstitial lung disease(Sarcoidosis)- HRCT
• Bronchiectasis- HRCT scan
• Solitary Pulmonary Nodule- High resolution CT (HRCT)
• Posterior Mediastinal Tumor- MRI
• Pancoast Tumor (Superior Sulcus Tumor) – MRI
• Minimum Ascites/Pericardial effusion/Pleural effusion – USG
• Traumatic Paraplegia- MRI
• Posterior Cranial Fossa – MRI
• Acute Haemorrhage- CT
• Chronic Haemorrhage- MRI
• Intracranial Space Occupying Lesion- MRI
• Primary brain tumour- contrast MRI (Gold standard however remains to be biopsy)
• Metastatic brain tumor- (Gadolinium) contrast enhanced MRI
• Temporal Bone-CT
• SAH Diagnosis- unenhanced CT
• SAH aetiology- 4 vessel MR Angiography > CT Angiography > DSA
• Nasopharyngeal angiofibroma- CECT scan
• Acoustic neuroma- Gadolinium DTPA enhanced MRI
• Obstetrics- USG
• Calcifications- CT
• Blunt abdominal Trauma- CT
• Acute Pancreatitis- CT
• GERD- pH manometer > endoscopy
• Dysphagia- Endoscopy
• Congenital hypertrophic pyloric stenosis- USG
• Extrahepatic biliary atresia- perioperative cholangiogram
• Obstructive Jaundice/GB Stones- USG
• Diverticulosis – barium enema
• Diverticulitis – CT scan
• Renal TB (early) – IVP (Late)- CT
• Posterior Urethral Valve- MCU
• Ureteric stone- non contrast CT
• Renal Artery Stenosis- Percutaneous Angiography
• Extraintestinal Amoebiasis- ELISA
• Discrete swelling(solitary nodule) of thyroid- FNAC

Osteoporosis

Osteoporosis: DEXA scan
Basics
T score: based on bone mass of young reference population
T score of -1.0 means bone mass of one standard deviation below that of young reference population
Z score is adjusted for age, gender and ethnic factors
T score
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis

Babies

Its time for babies! So a list of some babies
1) Blueberry muffin baby (indicates extramedullary
hematopoiesis) - Characteristic of Congenital rubella
syndrome, also in metastaic neuroblastoma
2) Harlequin baby - Harlequin Ichthyosis (autosomal
recessive, ABCA12 gene mutation)
3) Collodion baby - Lamellar Ichthyosis (autosomal
recessive, TGM1 gene mutation)
4) Frog faced Baby - Anencephaly
5) Floppy baby - Infant botulism
6) Grey Baby - Chloramphenicol side effect
(Immature hepatic glucuronidation enzymes)
7) Bronze baby - Conjugated hyperbillirubinemia
8) Blue Baby - Methemoglobinemia
9) Battered Baby (Caffey's whiplash shaken baby
syndrome) - Child abuse
10) Cyclops Baby (single median eye with/without
probocosis) - Holoprosencephaly (sonic hedgehog -shh gene mutation)

Diabetes drugs

Sulfonylureas (glyburide, glipizide, glimepiride)
- Increase insulin secretion
- Adverse effects: hypoglycemia, weight gain

Glucosidase Inhibitors (acarbose and miglitol)
- Reduce absorption of carbohydrates in the upper small intestine
- Can lower HbA1c levels by 0.5% to 1.0%
- Adverse effects: GI intolerance and flatulence

Thiazolidinediones (rosiglitazone and pioglitazone)
- Increase insulin sensitivity in muscle, adipose tissue, and the liver
- Can lower HbA1c levels by 0.5% to 1.3%

Biguanide (metformin)
- Decrease hepatic glucocose production and enhance insulin mediated glucose uptake in muscle and adiopose cells
- Adverse effects: transient abdominal pain, diarrhea, and nausea
- Risk of lactic acidosis if receiving IV contrast dye
- In adults, demonstrated normalizing blood glucose levels, decrease cholesterol levels, and reduce hypertension