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146 Cards in this Set
- Front
- Back
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what is slipped capital femoral epiphysis? Tx.
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obese boys with dull achy pain. Tx: emergent external fixation with screws
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what is Legg-calves-perthes? next best test.
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limp (femur head avascular necrosis) test: MRI
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what is osgood-schlatter? Tx:
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knee pain (tibial tubercle avascular necrosis). Tx: NSAID, rest and ice
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what is septic arthritis?
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joint pain (staph aureus)
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what is ankylosing spondylitis? Tx
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ligament ossification => verterbral body fusion, decrease lumbar curve, stiffer in morning, kyphosis, uveitis, HLA B-27. Tx: indomethacin or cox-2 inhibiting or TNF antagonist.
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what is cauda equina syndrome?
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'saddle anesthesia" can't feel butt, thigh, perineum
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where does bone cancer metastasis occur from?
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breast, lung, prostate, kidney
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what is costochondritis
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painful swelling of chest joints and bone attachments, worse with deep breath
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what would be positive on physical exam when a person has disk herniation?
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straight leg raise => shooting pain
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most common symptom of lumbar stenosis? what would be seen on an MRI?
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MRI "hourglass", low back pain
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what is ochronosis = alkaptonuria?
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kids with OA, black urine, homgentisic acid oxidase deficiency.
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what is osteitis fibrosis cystica?
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inflammation of bone with holes
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what is osteogenesis imperfecta?
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blue sclera, multiple broken bones
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what is osteomalacia = rickets?
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soft bones (waddling gait) craniotabes (soft skull) rachitic rosary (costochondral thickening) harrison's groove pigeon breast (sternum protrusion)
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what is osteomyelitis? Tx:
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infected bones. Tx: 6 weeks IV antibiotics
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what is osteonecrosis = legg-calve-perthes?
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wedge-shaped necrosis of femur head.
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what is osteopenia?
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lost bone mass
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what is osteopetrosis?
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decrease osteoclast activity => marble bones (obliterate own bone marrow)
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what is osteosclerosis?
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thick bones
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paget's disease of the bone: virus associated: pathogenesis: associated cancer: "quote" presentation labs
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"my hat does not fit", virus: paramyxovirus, pathogenesis: increase osteoclast/blast ---> flluffy bone RF for cancer: osteosarcoma presentation: increase CO, heart failure, deafness labs: inc. alkaline phosphatase alone.
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treatment of paget's disease?
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bisphosphonates
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Question
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Answer
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Name the layers of the epidermis from surface to base
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Corneum, Lucidum, Granulosum, Spinosum, Basalis
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What is another name for the tight junction. What is its function? what proteins is it composed of?
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Zona occludens. Prevents diffusion across paracellular space; composed of claudins and occludins
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What is another name for the intermediate junction? Where is it located? and What proteins is it composed of?
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Zona adherens; Surrounds perimeter just below zona occludens. Cadherins connect to actin
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What is another name for the desmosome? What are their function? What are its components?
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Macula adherens - small discrete sites of attachment; cadherins cnnect to IF. Desmoplakin, keratin
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Name the layers of the epidermis from surface to base
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Corneum, Lucidum, Granulosum, Spinosum, Basalis
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What is another name for the tight junction. What is its function? what proteins is it composed of?
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Zona occludens. Prevents diffusion across paracellular space; composed of claudins and occludins
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What is another name for the intermediate junction? Where is it located? and What proteins is it composed of?
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Zona adherens; Surrounds perimeter just below zona occludens. Cadherins connect to actin
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What is another name for the desmosome? What are their function? What are its components?
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Macula adherens - small discrete sites of attachment; cadherins cnnect to IF. Desmoplakin, keratin
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What is the name of the protein that makes up the gap junction?
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Connexon
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What is the function of a gap junction?
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Allows adjacent cells to communicate for electric and metabolic functions
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What is the function of the hemidesmosome?
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Connects cells to underlying extracellular matrix
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What is function of integrin?
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Maintains integrity of the basement membrane; binds to laminin in BM
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What ligaments are typically damaged in a common football injury (unhappy triad)?
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MCL and ACL (clipping from lateral side)
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What sign indicates tearing of ACL? torn MCL?
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Posterior anterior drawer sign - ACL. Abnormal passive abduction - MCL
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NAme the four rotator cuff muscles
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Supraspinatus, Infraspinatus, Teres minor, Subscapularis (SItS)
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What are the functions of the four rotator cuff mucles?
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Supraspinatus - helps deltoid abduct arm; Infraspinatus - laterally rotates arm; Teres minor - adducts and laterally rotates arm; Subscapularis - medially rotates and adducts arm
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What rotator cuff muscle is on the anterior side of the shoulder? What is its function?
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Subscapularis; lateral rotation and abduction of arm
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What nerve roots comprise the axillary nerve? What does the axillary nerve innervate?
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C5, C6; teres minor and deltoid muscle, glenohumeral joint, skin of superolateral arm (inf. part of deltoid)_
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What nerve roots comprise the radial nerve? What does it innervate?
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C5-C8; All muscles of posterior compartments of arm and forearm; skin of posterior and inferolateral arm, posterior forearm, and drosum of hand lateral to axial line of digit 4
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What nerve roots comprise the musculocutaneous nerve? What does it innervate?
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C5-C7; Muscles of anterior compartment of arm (biceps, brachialis), skin of lateral aspect of forearm
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What nerve roots comprise the ulnar nerve? What does it innervate?
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C8, T1; Forearm anterior muscles: flexor carpi ulnaris (flexes hand at wrist) and ulnar half of flexor digitorum profundus (flexes DIP 4 and 5), most intrinsic muscles of hand (interossei and lumbricles), skin of hand medial to axial line of digit 4
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What nerve roots comprise the median nerve? What does it innervate?
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C6-C8, T1; Muscles of anterior forearm compartment; five intrinsic muscles in thenar half of palm and palmar skin
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What nerve is injured with a fractured surgical neck of humerus, dislocation of humeral head? Motor deficit and sensory deficit
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Axillary; Motor: arm abduction at shoulder; Sensory: over deltoid muscle
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What nerve is injured with a fracture at midshaft of humerus, or by compression of axilla by back of a chair or crutches?
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Radial; Motor: wrist extension, finger extension at MCP joints, supination, thumb extension and abduction; Sensory: posterior arm and dorsal hand and dorsal thumb
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What sign signifies radial nerve damage?
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Wrist drop
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What is damaged with a fracture of supracondylar humerus? Motor and sensory deficits?
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Proximal median lesion; Motor: opposition of thumb; Sensory: dorsal and palmar aspects of lateral 3.5 fingers, thenar eminence
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What nerve is injured when opposition of thumb is a motor deficit?
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Median nerve - proximal lesion
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What nerve is injured when there are problems with lateral finger flexion and wrist flexion?
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Median nerve - distal lesion
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What causes a median nerve distal lesion?
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Carpal tunnel syndrome; dislocated lunate; wrist slashing
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What nerve is injured when you lose sensation in the dorsal and palmar aspects of the lateral 3.5 fingers and the thenar eminence?
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Proximal lesion of median nerve
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What are signs of a distal lesion of the median nerve?
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"Pope's blessing" Ulnar deviation of wrist upon wrist flexion
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What can cause a proximal lesion of the ulnar nerve?
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Fracture of medial epicondyle of the humerus
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What are the motor deficits of a proximal ulnar nerve lesion?
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Loss of medial finger flexion and wrist flexion
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What nerve is damaged when sensation is lost in the medial 1.5 fingers and in the hypothenar eminence?
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Ulnar nerve
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What causes a distal lesion of the ulnar nerve?
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Fracture of hook of hamate (falling onto outstretched hand) and slashing of wrist
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What does a claw hand signify?
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Distal lesion of the ulnar nerve
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What motor deficits are seen with a distal lesion of the ulnar nerve?
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Abduction and adduction of fingers (interossei) Adduction of thumb, Extension of 4th and 5th fingers (lumbricales)
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What is a sign of a proximal lesion of the ulnar nerve?
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Radial deviation of wrist upon wrist flexion
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What is the typical cause of injury to the musculocutaneous and motor and sensory deficits?
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Upper trunk compression; flexion of arm at elbow; Lateral forearm
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Why does Erb Duchenne palsy occur and what can cause this?
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Traction or tear of the upper trunk of the brachial plexus (C5 and C6 roots); follows blow to shoulder or trauma during delivery; violent stretch between head and shoulder
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What are the physical findings in Erb-Duchenne palsy?
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"waiter's tip" limb hangs by side (paralysis of abductors), medially rotated (paralysis of lateral rotators), forearm is pronated (loss of biceps)
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Why does Klumpke's palsy occur and what can cause this? What is the thoracic outlet syndrome?
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Problem with inferior trunk of brachial plexus (C8, T1) - Sudden upward pull of the arm; Thoracic outlet syndrome: cervical rib compresses subclavian artery and inferior trunk
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What are the physical findings of the thoracic outlet syndrome?
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1. Atrophy of the thenar and hypothenar eminences 2. Atrophy of the interosseous muscles 3. Sensory deficits on the medial side of the forearm and hand 4. Disappearance of the radial pulse upon moving the head towards the opposite side.
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What muscles does the radial nerve innervate?
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Brachioradialis, Extensors of the wrist and fingers, Supinator, and Triceps (radial nerve innervates the BEST)
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What muscles comprise the thenar muscles?
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Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
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What muscles comprise the hypothenar muscles?
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Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi
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What are the functions of the dorsal interosseous muscles, palmar interosseous muscles, lumbricles?
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Dorsal interosseous - abduct fingers, Palmar interosseous - adduct fingers (DAB, PAD), Lumbricles - flex at the MP joint
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What nerve is injured with anterior hip dislocation?
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Obturator
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What are the motor deficit and sensory deficit with obturator nerve damage?
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Thigh abduction; medial thigh
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What injury causes femoral nerve damage?
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Pelvic fracture
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Motor deficit and sensory deficit of femoral nerve damage
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Motor deficit: thigh flexion and leg extension; Sensory deficit: Anterior thigh and medial leg
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What nerve is injured with trauma to the lateral aspect of the leg or fibula neck fracture?
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Common peroneal (fibular)
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What are the motor deficit and sensory deficit with common peroneal nerve damage?
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Motor: foot eversion and dorsiflexion; toe extension - "Foot drop" resulting in high stepping gait and inability to stand on heels; Sensory: Anterolateral leg and dorsal aspect of foot)
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What injury can cause damage to the tibial nerve?
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Knee trauma
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What are the motor and sensory deficits of tibial nerve damage?
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Foot inversion and plantarflexion (gastrocnemius, soleus, plantar muscles); toe flexion; Sole of foot
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What is the cause of injury of the superior gluteal nerve?
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Posterior hip dislocation or poliomyelitis
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Damage to the superior gluteal nerve causes what motor deficit?
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Thigh abduction (positive Trendelenburg sign) and ability to pull pelvis down.
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What would you see with a postiive Trendelenburg sign with a right superior gluteal nerve deficit?
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When left foot off gorund, left hip falls downward
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What is the cause of injury to the inferior gluteal nerve?
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Posterior hip dislocation\
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Damage to the inferior gluteal nerve causes what motor deficit?
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Can't jump, climb stairs, or rise from seated position (gluteus maximus) Pt. leans body trunk backwards at heel strike to compensate
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What are the two calcium channels involved in muscle contraction and where are they located?
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Dihydropyridine receptor: in T-tubules which are coupled to Ryanodine receptors on Sarcoplasmic reticulum.
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What bands shorten or stay the same during muscle contraction?
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H (myosin only) and I band (actin only) shortening. A band (total length of myosin) remains the same length. A band is Always the same length.
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What are features of Type I muscle?
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Slow twitch; red fibers due to incrased mitochondria and myoglobin concentration (inc. oxidative phosphorylation) --> sustained contraction. "One slow red ox"
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What are features of Type II muscle?
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Fast twitch; white fibers due to decreased mitochondria and dec. myoglobin concentration (inc. anaerobic glycolysis); weight training results in hypertrophy of fast-twitch muscle fibers
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When does ADP release from the myosin head?
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Immediately after the power-stroke state
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In smooth muscle contraction, what occcurs after Ca increases in the cytoplasm?
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Ca2+ binds to calmodulin and activates myosin light chain kinase (MLCK) which phosphorylates myosin. Myosin-P and actin undergo cross-bridge formation to contract
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What kind of bone is endochondral ossification used to form? And what is the process behind it?
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Longitudinal bone growth. Cartilaginous model of bone is firstg made by chondrocytes. Osteoclasts and osteoblasts later replace with woven bone and remodel to lamellar bone.
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What is the source of osteoblasts?
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Mesenchymal stem cells in the periosteum
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What is membranous ossification used to form? And what is its process?'
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Flat bone growth (skull, facial bones, and axial skeleton) Woven bone formed directly without cartilage. Later remodeled to lamellar bone.
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Question
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Answer
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what is common cause of Dwarfism ("Achondroplasia")
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-defect in proliferation zone of ossification center -defective longitudinal bone growth → short limbs -FGF-R3 constitutively active, but this inhibits chondrocyte proliferation
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how is bone being affected in osteoporosis
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=Loss of Bone matrix or Osteoid. reduction in mainly trabecular bone (spongy) and interconnections w/ nrl bone mineralization and lab values -spongy bone is turning weak & porous.
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difference btw Type 1 & 2 Osteoporosis
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difference btw Type 1 & 2 Osteoporosis: -Type 1 is post-menopausal -caused b/c low estrogen allows incr bone resorption -b/c Estrogen inhibits Osteoclasts, but induces Osteoblasts
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how does Estrogen affect bone?
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how does Estrogen affect bone? -inhibits Osteoclasts, induces Osteoblasts
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spontaneous vertebral crush Fx, acute back pain, loss of height, kyphosis, femoral neck Fx, distal radius Fx esp w/ minor trauma are all indicative of what disease?
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Osteoporosis -Prophylaxis = wt bearing excercise and Ca ingestion before 30 and forever
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Tx of Osteoporosis
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-Estrogen &/or Calcitonin -Bisphosphonates -Pulsatile PTH if severe
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how does different admin of PTH affect bone formation/resorption
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Continuous PTH → bone resorption Pulsatile PTH → bone formation
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thick, dense bones prone to Fx, pancytopenia, nrl Ca, nrl PO4, nrl ALP
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thick, dense bones prone to Fx, pancytopenia, nrl Ca, nrl PO4, nrl ALP: Osteopetrosis -failure of nrl bone resorption → thick, dense bones prone to Fx -abnrl Osteoclast function, due to defic of Carbonic Anhydrase II
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Erlenmeyer Flask bones, cranial n impingement, thick/dense bones susceptible to Fx, Carbonic Anydrase II defic
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Osteopetrosis -defic of Carbonic Anhydrase II → bad osteoclast function -NRL Ca, NRL PO4, NRL ALP
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low vit D can lead to what bone d/o and what lab changes
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low vit D can lead to what bone d/o and what lab changes: -Osteomalacia in adults, Rickets in children -defective mineralization/calficiation of osteoid → soft bones -decr Vit D -decr Ca -incr PTH -nrl/incr ALP
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hyperparathyroidism can lead to what bone d/o
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hyperparathyroidism can lead to -Osteitis Fibrosa Cystica -Brown Tumors = cystic spaces lined by osteoclasts, filled w/ fibrous stroma & sometimes blood, inflamm cells, hemosiderin & giant cells -incr PTH, incr Ca, decr PO4, incr ALP
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weird lab values in Osteitis Fibrosa Cystica & why
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weird lab values in Osteitis Fibrosa Cystica: -incr PTH, incr Ca, decr PO4, incr ALP -caused by Hyperparathyroidism -cystic spaces are lined by osteoclasts, filled w/ fibrous stroma & sometimes blood & inflamm cells w/ hemosiderin & giant cells
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incr deposition of bone, abrnl bone architecture, long bone 'chalk-stick' Fx, can progress to Osteosarcoma
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Paget's Disease ("Osteitis Deformans") -incr Osteoclast activity early on, then incr Osteoblast activity later -NRL: Ca, PO4, PTH -incr ALP
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pt w/ bone pain, HA, ~hearing loss, incr head size, head x-ray shows "Cotton Wool Spots" w/ Mosaic Lamellar Bones
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Paget's disease ("Osteitis Deformans") -incr osteoclast activity early on, incr osteoblast activity later -can → high-output heart failure -can → Osteosarcoma -NRL: Ca, PO4, PTH -incr ALP
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Cotton Wool Spots on x-ray incr hat size HA, hearing loss, incr ALP only
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Paget's disease ("Osteitis Deformans") -NRL: Ca, PO4, PTH -incr ALP -initially high osteoclast activity, but changes to high osteoclast activity so that theres high bone formation
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nrl: Ca, PO4, ALP, PTH in pt w/ less bone mass vs pt w/ thick dense bones
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nrl: Ca, PO4, ALP, PTH: pt w/ less bone mass -Osteoporosis pt w/ thick dense bones -Osteopetrosis (prone to Fx however)
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decr Ca, decr PO4, incr PTH, nrl/incr ALP
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decr Ca, decr PO4, incr PTH, nrl/incr ALP -Osteomalacia or Rickets
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incr PTH, incr Ca, decr PO4, incr ALP
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incr PTH, incr Ca, decr PO4, incr ALP -Osteitis Fibrosa Cystica
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nrl: PTH, Ca, PO4 but incr ALP
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nrl: PTH, Ca, PO4 but incr ALP -Paget's diseae ("Osteitis Deformans")
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Polyostotic Fibroous Bone Dysplasia, Precocious puberty, Unilateral Pigmented Skin lesions (incl cafe-au-lait spots & Coasts of Maine spots)
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Polyostotic Fibroous Bone Dysplasia, Precocious puberty, Unilateral Pigmented Skin lesions (incl cafe-au-lait spots & Coasts of Maine spots): McCune-Albright Syndrome -a Polyostotic Fibrous Dysplasia -bone is replaced by fibroblasts, collage, irreg bony trabeculae
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bone replaced by fibroblasts, collagen, irreg bony trabeculae
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Polyostotic Fibrous Dysplasia
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pain in mainly wt-bearing joints after use (ie @ end of day) that improves w/ rest
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Osteoarthritis -mechanical wear & tear -destruction of articular cartilage -subchondral cysts & sclerosis, osteophytes, eburnation, Heberden's Nodes (DIP), Bouchard's Nodes (PIP)
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difference btw Heberden's nodes and Bouchard's nodes and what are these found in?
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Heberden's = DIP Bouchard's = PIP -in osteoarthritis -pain w/ use that improves w/ rest
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(+)anti-CCP Ab
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-this is one of the Rheumatoid Factors present in Rheumatoid Arthritis -MOST specific, ~sensitive -SPARES DIP
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Pannus formation, nodules of fibrinoid necrosis & palisading histiocytes, ulnar deviation, subluxation
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Rheumatoid Arthritis -difference in hand involvment btw this & Osteoarthritis is that this SPARES the DIP, only involves MCP & PIP
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hand involvment in Rheumatoid vs Osteoarthritis
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RA: -MCP & PIP -SPARRING of DIP Osteoarthritis -PIP & DIP
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what does saying "can't see, can't spit, can't climb up shit" remind you of?
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Sjogren's Syndrome -triad of: Xerophthalamia (dry eyes, conjunctivitis), Xerostomia (dry mouth, dysphagia), Arthritis -(+)SS-A (Ro) or SS-B (La) -Females, 40-60 vs Sicca Syndrome: Xerophthalamia, Xerostomia, vaginal dryness, chronic bronchitis, reflux esophagitis, NO arthritis
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dry eyes, dry mouth, dry nasal & vaginal secretions, chronic bronchitis, reflux esophagitis, no arthritis c/w
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dry eyes, dry mouth, dry nasal & vaginal secretions, chronic bronchitis, reflux esophagitis, no arthritis c/w -Sicca Syndrome
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how could a disease presenting w/ bilateral hilar lymphadenopathy, bell's palsy, noncaseating granulomas cause Hypercalcemia?
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-this is Sarcoidosis, and the macrophages forming those granulomas can be converting Vit D to its active form -Tx = steroids
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joint pain & stiffness in shoulders & hips, fever, malaise, wt loss in pt >50
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Polymyalgia Rheumatica -a/w high ESR and Temporal Arteritis, nrl CK (NO muscle disease) Tx = Prednisone
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white, painless oral plaque in HIV(+) pt that can't be scraped off, and what virus a/w?
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white, painless oral plaque in HIV(+) pt that can't be scraped off Hairy Leukoplakia -a/w EBV
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m/c malignant primary bone tumor in kids
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Osteosarcoma
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malignant bone neoplasm in metaphysis of kid
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Osteosarcoma
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bone tumor w/ sunburst pattern in metaphysis
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Osteosarcoma
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m/c malignant primary bone tumor in adults
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Multiple Myeloma
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m/c benign bone tumor
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Osteochondroma
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mature bone tumor w/ shiny white cap, arising from metaphysis
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Osteochondroma -that 'shiny white cap' is cartilaginous cap
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location of mass t(11;22)
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Ewing's Sarcoma -m/c in Diaphysis of bone -anaplastic small blue cells
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epiphyseal mass w/ 'soap bubble' appearance on x-ray
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Giant Cell Tumor (Osteoclastoma) -spindle-shaped cells w/ multinucleated giant cells
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mass w/ spindle-shaped cells w/ multinucleated giant cells in epiphysis
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Giant Cell Tumor
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Onion-skin appearance of bone
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Ewing's Sarcoma -in diaphysis!
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bone tumor that may be hamartoma
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Osteochondroma
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Codman's Triangle on x-ray
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Osteosarcoma
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a/w Gardner's syndrome
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Osteoma
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diaphyseal bone mass w/ glistening appearance
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Chondrosarcoma
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Loss of Bone matrix/osteoid
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Osteoperosis
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More osteoclastic than Osteoblastic activity
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Osteoperosis
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Loss of Mineralization/Soft Bones
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Osteomalacia
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Decreased Osteoclastic activity
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Osteopetrosis
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Too much bone obliterates BM. Bone too tick and Infelxible
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Osteoperosis
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Loss of bone mass. Bone matrix and mineralization are both lost
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Osteopenia
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Osteitis Deformans
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Paget’s disease. Increased osteoclastic activity. Increased Calcium and ALP
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Scarring of bone. Occurs in inflammatory bone disease.Increased Bone density
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Osteosclerosis
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