[Intro: 130 BPM. The track opens with a rapid drum fill that crashes into a high-energy groove. The brass section plays a soaring, triumphant riff. The Soul Singer lets out an energetic "Woo!" .] [Block 1: The fast groove drives hard. The singer bounces on the rhythm, spitting the symptoms with incredible soul.] Axillary nerve injury in Fractured surgical neck or anterior dislocation of humerus (Brass Stab) NEXT Radial nerve injury "Saturday night palsy" use of crutches, midshaft humerus fracture, repetitive pronation/supination of forearm so wrist drop, decrease grip strength (Brass Stab) NEXT Median nerve injury; hand of benediction. Proximal lesion due to supracondylar fracture Distal lesion is carpal tunnel syndrome (Brass Stab) NEXT Ulnar nerve injury. Proximal lesion due to fractured medial epicondyle so radial deviation of wrist on flexion Distal lesion in fractured hook of hamate (fall on outstretched hand) so ulnar claw on digital extension, loss of sensation over ulnar digits (Brass Stab) NEXT [Block 2: The brass gets even punchier, playing tight, syncopated hits behind the vocals.] Erb palsy, waiter's tip. C5-C6 during delivery, or due to trauma (Brass Stab) NEXT Klumpke palsy, claw hand C8-T1 during delivery, or on trying to grab a branch (Brass Stab) NEXT Winged scapula, Injury to long thoracic nerve (C5-C7); after mastectomy or stab wounds (Brass Stab) NEXT Common peroneal nerve injury, Trauma to lateral leg, fibular neck fracture so foot drop with “steppage gait" NEXT Superior gluteal nerve injury (Choir) MECHANISM Iatrogenic during I M injection, Trendelenburg sign. contralateral to side of hip drops due to abductor weakness (Brass Stab) NEXT [Block 3: A breakdown section. The drums drop to just a snapping hi-hat and the bassline. The singer gets gritty and rhythmic with the delivery.] Pudendal nerve injury during horseback riding or prolonged cycling; can be blocked during delivery at the ischial spine so decrease sensation in perineal and genital area can be fecal/urinary incontinence (Brass Stab) NEXT Slipped capital femoral epiphysis in Obese young adolescent with hip/knee pain; increase axial force on femoral head so epiphysis displaces relative to femoral neck NEXT In achondroplasia. activation of FGFR3 so decrease chondrocyte so decrease endochondral ossification so short limbs (Brass Stab) NEXT In osteoporosis. increase osteoclast activity (Brass Stab) NEXT In Osteopetrosis. Carbonic anhydrase II mutations so osteoclasts cannot generate acid so dense bones prone to fracture, pancytopenia (decrease marrow space) (Brass Stab) NEXT [Block 4: The full band jumps back in. The horns wail as the singer hits high, soulful notes on the dermatological and rheumatological diseases.] Osteitis deformans, Paget. increase osteoclast activity then increase osteoblast activity so formation of poor-quality bone (Brass Stab) NEXT In Osteoarthritis. osteophyte, subchondral cyst and sclerosis (Brass Stab) NEXT In Rheumatoid arthritis pannus formation, ankylosis (Brass Stab) NEXT Blindness in giant cell (temporal) arteritis due to Ophthalmic artery occlusion (Brass Stab) NEXT Albinism. Normal melanocyte but decrease melanin (Brass Stab) NEXT Vitiligo: Autoimmune melanocyte destruction (Brass Stab) NEXT Atopic dermatitis (Choir) MECHANISM Epidermal barrier dysfunction, genetic factors so environmental triggers of inflammation (Brass Stab) NEXT [Block 5: The climax. The tempo feels like it's rushing forward. The singer is soaring over the fast rhythm, delivering the complex neurological syndromes with absolute soul power.] Pemphigus vulgaris; IgG against desmoglein 1 and 3 in desmosomes so separation of keratinocytes in stratum spinosum from stratum basale; Nikolsky postive (Brass Stab) NEXT Bullous pemphigoid; IgG against hemidesmosomes so separation of epidermis from dermis; Nikolsky sign ⊖ (Brass Stab) NEXT Holoprosencephaly associated with SHH mutations (Brass Stab) NEXT Lissencephaly due to Failure of neuronal migration so brain lacking sulci and gyri (Brass Stab) NEXT Chiari I. Downward displacement of tonsils through foramen magnum (Brass Stab) NEXT Chiari II. Herniation of vermis, tonsils and medulla through foramen magnum (Brass Stab) NEXT Dandy-Walker. Agenesis of vermis so cystic enlargement of 4th ventricle (Brass Stab) NEXT Gerstmann syndrome. Lesion in the dominant parietal cortex so agraphia, acalculia, finger agnosia, left-right disorientation NEXT Hemispatial neglect syndrome. Lesion in the nondominant parietal cortex NEXT [Outro: The music starts to fade slightly, but the energy remains sky-high. The singer delivers with a massive, vocal run.] Klüver-Bucy. Bilateral amygdala lesions; seen in herpes encephalitis. disinhibition, including hyperphagia, hypersexuality, hyperorality seen (Brass Stab) NEXT Parinaud syndrome. Compression of dorsal midbrain due to pineal gland tumors so upward gaze palsy, nystagmus, light-near dissociation [Ending: total silence]
