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Cantilever bending A cantilever is a beam that is fixed at one end If a downward force is applied to one end of a cantilever arthritis treatment medicines celecoxib 100 mg purchase amex, tension will occur on the upper surface and compression on the lower. In the past this has usually involved the free body diagram for the hip, but other joints may be used as the basis for discussion. Basic underlying limitations Free body diagrams are a simple method for calculating the forces around a stationary structure or an element of that structure. It is important to realize the limitations of the method: the body must be in equilibrium the number of unknown forces must not be too great otherwise the problem becomes statically indeterminate the calculation only considers two dimensions. Underlying principles If a body is in equilibrium, the anticlockwise (positive) and clockwise (negative) moments must add up to zero If a body is in equilibrium, the sum of the vectors must add up to zero If a vector diagram is drawn, the result will be a closed polygon (triangle for three vectors). Forgetting to establish which component is the moving part and which the fixed; the direction of the vectors is decided by their attachment to the moving part and not the fixed part (an important point when looking at the femoral/tibial articulation or the patellofemoral articulation, respectively) Making the diagram too small. Free body diagrams for other joints Although the hip joint free body diagram is the most common one encountered in the exam, you should also be able to do similar diagrams for the ankle, knee, patellofemoral joint, elbow and shoulder. In this free body diagram, wm1 is the moment arm for the weight being carried and wm2 is the moment arm for the weight of the arm itself. Stiffness of constructs Another popular topic is the stiffness of constructs used for fixation of fractures. The working length of the pin will be the distance between its attachment to the bar and the point at which it reaches the bone the working length of an intramedullary nail will depend upon whether or not it is firmly wedged in the cortical bone near the fracture site. For an unreamed nail the working length will usually be the distance between the interlocking screws nearest the fracture but for a reamed nail the working length may be much shorter if the nail is firmly jammed in the bone at the isthmus on one or both sides of the fracture the working length of an intramedullary nail may differ for rotation and bending forces, as when the bone bends at the fracture site the nail may become fixed to the bone by three-point fixation For an external fixation device the working length is the distance between the two pins nearest to the fracture Shorter working lengths of devices increase the stiffness of the construct but, for any given bending or torsional force applied to the fractured limb, the stress within the fixation device and at the fixation points to bone increase with decreased working length. This topic allows an exploration of a number of different concepts, including working length of pins and fixation devices, the relationship between pin radius and stiffness and the effect of multiplanar fixation, etc. Basic science oral 4 Using a free body diagram can you explain why a patient with a painful left hip should use a walking stick in the right hand During the answer to this question various other permutations could be explored, such as the effect of a shortened femoral neck or the effect of an increased offset in a hip replacement. Basic science oral 5 How might resurfacing a patella during a knee replacement affect the joint reaction forces in the patellofemoral joint Kinematics of joints Knowledge of the kinematics of some specific joints and structures is frequently explored in the basic science oral. The most popular topics are the knee, the subtalar joint and the spine the wrist31 Anatomically the bones of the carpus are usually considered as two rows: proximal and distal Functionally the carpus can be considered as three columns: Central the distal row and the lunate Lateral the scaphoid Medial the triquetrum Palmarflexion range is greater than dorsiflexion Ulnar deviation range is greater than radial deviation the volar ligaments are important stabilizers Volar extrinsic ligaments pass from the radius and ulna to the carpal bones Volar intrinsic ligaments pass between the carpal bones the carpal bones form a double hinge Activity of the wrist muscles tends to cause the double hinge to buckle the tendency to buckle is resisted by the shape of the articular surfaces and the ligaments the lunate and scaphoid are narrower on their dorsal surfaces than on their volar surfaces, tending to force the wrist in to extension when compressed longitudinally. This is countered by the trapezium and trapezoid, which articulate with the dorsal aspect of the distal scaphoid Examination corner Basic science oral 1 How is the stiffness of a plate used for fracture fixation affected by its cross-sectional dimensions The answer should contrast the relative increase in stiffness with changes to width and thickness of the plate. Basic science oral 2 Candidate is shown an X-ray of a femur with an intramedullary nail in situ How does the working length of a nail affect the stiffness of the construct For a good mark the discussion could compare the theoretical working lengths for bending versus torsional forces. Basic science oral 3 You are applying an external fixation device to a fractured tibia but decide you would like to make the construct 485 Section 8: the basic science oral Flexion/extension rotation and radioulnar deviation occur around instant centres of rotation in the proximal part of the capitate About two-thirds of flexion occurs in the midcarpal joint with one-third in the radiocarpal joint About one-third of extension occurs in the midcarpal joint with two-thirds in the radiocarpal joint On radial deviation the scaphoid and proximal carpal row flex and on extension they extend. The kinematic model based on the rigid four bar mechanism is largely two-dimensional. The transepicondylar axis and the medial pivot mechanism More recent work has studied the rotation of the knee around the transepicondylar axis. The spherical radius of the femoral condyles, when viewed along the transepicondylar axis, has given rise to the concept of the single radius knee replacement.
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Dysplasia in ulcerative colitis is detected in two-thirds of patients as a carpet lesion psoriatic arthritis vegan diet purchase celecoxib 100 mg mastercard. Cancer may develop in patients with long-standing, long segment ulcerative colitis. Spot radiograph of the splenic flexure demonstrates numerous punctate collections of barium surrounded by radiolucent halos (representative aphthoid ulcer identified by arrow). An aphthoid ulcer is shown in profile as a mound of edema, with a central barium collection (arrowhead). Spot radiograph of the cecum originally obtained with patient in prone position, but displayed anatomically. Spot radiograph of the descending colon shows broad-based sacculation (arrows) opposite numerous short linear ulcers. Spot radiograph of the transverse colon demonstrates barium filling of linear ulcers (arrows) on the superior wall. Deep knife-like cleft ulcers often form a transversely and longitudinally oriented pattern of fissuring, leaving rectangularshaped islands of mucosa between the fissures. Further extension of inflammation in the mesentery leads to extraluminal fissures, fistulas, and abscess formation. Submucosal inflammation is characterized radiologically by thick folds 174 Chapter 9: Colon. Spot radiograph of the distal descending colon shows a 5 cm in length by 3 mm in luminal diameter tapered narrowing (arrow). A long, tight irregular stricture (long arrow) is seen in the shortened descending colon. A short fistula (short arrow) goes from the descending to proximal sigmoid colon, bypassing the stricture. Luminal narrowing may be due to a variable combination of spasm, edema, inflammation, fat bunching, or fibrosis. Mucosal nodularity or ulceration within a stricture indicates an active inflammatory process. Once the inflammatory process spreads outside the serosa or adventitia of the colon, fistulas to bowel, urinary bladder, vagina, retroperitoneum, skin, or other organs may be seen. After inflammation heals, residual islands of reparative or hyperplastic tissue may assume a myriad of polypoid shapes, termed postinflammatory polyps. Spot radiograph of the sigmoid colon demonstrates ulceration (arrowheads), nodular mucosa (short arrow), and a small and large polyp (large arrows). Barium studies may be performed in patients with chronic symptoms, intermittent diarrhea, mild rectal bleeding, or if stool cultures are falsely negative. Similarly, in patients in whom flexible sigmoidoscopy is normal, barium enema may demonstrate a more proximal distribution of C. Spot radiograph of the descending colon shows shallow ovoid radiolucent elevations en face (arrowhead).
Term translated as "puff of smoke arthritis pain toes discount celecoxib 200 mg on line," referring to the angiographic appearance of the collateral arteries (lenticulostriate, thalamoperforate). Usually nonspecific etiology, but can be associated with neurofibromatosis, radiation angiopathy, atherosclerosis, and sickle cell disease; usually children adults in Asia. Also known as encephalotrigeminal angiomatosis, neurocutaneous syndrome associated with ipsilateral "port wine" cutaneous lesion and seizures; results from persistence of primitive leptomeningeal venous drainage (pial angioma) and developmental lack of normal cortical veins, producing chronic venous congestion and ischemia. Hemorrhagic lesion Subdural hematoma Crescentic extra-axial hematoma located in the potential space between the inner margin of the dura and outer margin of the arachnoid membrane. Subdural hematomas usually result from trauma/ stretching/tearing of cortical veins where they enter the subdural space to drain in to dural venous sinuses; subdural hematomas do cross sites of cranial sutures; with or without skull fracture. Acute epidural hematoma with high attenuation is seen in the right frontal region with compression of the right frontal lobe. Subdural hematoma on the left is seen associated with subfalcine herniation rightward. Axial image shows diffuse high attenuation in the basal cisterns and subarachnoid space from acute hemorrhage. Contrast enhancement in the intracranial subarachnoid space (leptomeninges) usually is associated with significant pathology (inflammation and/or infection vs neoplasm). Postcontrast axial image shows a subdural empyema on the left (arrows) and low attenuation of the anterior right frontal lobe from cerebritis. Axial postcontrast image shows diffuse abnormal contrast enhancement of the basal meninges and subarachnoid space, as well as several ring-enhancing lesions. Axial postcontrast images show abnormal enhancement involving the brain and falx from sarcoid granulomas. Multiple (myeloma) or single (plasmacytoma) wellcircumscribed or poorly defined lesions involving the skull and dura; low to intermediate attenuation; usually show contrast enhancement, with bone destruction. Single or multiple well-circumscribed or poorly defined lesions involving the skull, dura, and/or leptomeninges; low to intermediate attenuation; may show contrast enhancement, with or without bone destruction. Well-circumscribed, lobulated lesions; low to intermediate attenuation; usually shows contrast enhancement (usually heterogeneous); locally invasive associated with bone erosion/destruction, encasement of vessels and nerves; skull base/clivus common location, usually in the midline. Lobulated lesions, low to intermediate attenuation, with or without matrix mineralization; can show contrast enhancement (often heterogeneous); locally invasive associated with bone erosion/destruction, encasement of vessels and nerves, skull base/petrous/ occipital synchondrosis common location, usually off midline. Destructive lesions involving the skull base and calvarium; low to intermediate attenuation, usually with matrix mineralization/ossification; often shows contrast enhancement (usually heterogeneous). May have variable destructive or infiltrative changes involving single or multiple sites of involvement. Myeloma/plasmacytoma Malignant plasma cell tumor; may have variable destructive or infiltrative changes involving the axial and/or appendicular skeleton. Lymphoma Leukemia Extra-axial lymphoma may have variable destructive or infiltrative changes involving single or multiple sites of involvement. Axial image shows a destructive tumor involving the right occipital bone and condyle and right mastoid bone.
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Ortega, 61 years: Retinal detachment occurs when the sensory retina is separated from the retinal pigment epithelium. Furthermore, delayed use of thrombolytics has been less successful, especially if thrombus has been present for more than 7 days. In addition, many patients with severe extrathoracic injuries, such as head trauma, may have elevated troponin levels. If, despite these various maneuvers, satisfactory double contrast views of the duodenum cannot be obtained, the fluoroscopist should proceed to the single contrast portion of the study rather than prolong the examination, as it is usually possible to obtain adequate single contrast views of the duodenal bulb using prone or upright compression techniques.
Chenor, 65 years: Tumors can be associated with destructive changes of adjacent bone; show variable degrees and patterns of contrast enhancement. Comments Congenital malformation involving lack of separation of neuroectoderm from surface ectoderm with resultant localized failure of bone formation. Inherited progressive neurodegenerative disorders consisting of multiple types: infantile, late infantile, juvenile (Batten disease), early juvenile, adult dominant, adult recessive, and progressive epilepsy with mental retardation. Placing a patient in the erect position may reduce the size of the hiatal hernia, facilitating passage of the catheter.
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