Term
| The cervical spine nerve roots exit _____ the corresponding vertebra |
|
Definition
|
|
Term
| The thoracic and lumbar spine nerve roots exit ____ the corresponding vertebra |
|
Definition
|
|
Term
| C5 nerve root sensory distribution |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| lateral forearm, thumb, index finger |
|
|
Term
|
Definition
| biceps, Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
triceps
Flexor carpi radialis
Extensor Digitorum communis
Extensor indicis proprius
Extensor digiti minimi proprius |
|
|
Term
|
Definition
|
|
Term
|
Definition
ulnar fingers
medial forearm |
|
|
Term
|
Definition
flexor digitorum superficialis
flexor digitorum profundus
interossei |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| medial leg and foot (medialis malleolus) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Extensor hallucis longus (big toe) |
|
|
Term
|
Definition
| none (posterior tibialis) |
|
|
Term
|
Definition
| plantar flexors (gastroc) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| L1 burst fracture affects |
|
Definition
| thoracolumbar area (kyphosis to lordosis; injury due to rigid to flexible transition) |
|
|
Term
| pars interarticularis is prone to |
|
Definition
| asymptomatic stress fracture leading to spondylolysis (accelerated disc slipping) |
|
|
Term
| cervical and lumbar spine are hi risk zones for _____ affecting the nucleus polposis through the annulus. The direction of protrusion is most often __________ into the vertebral canal. |
|
Definition
| disc herniation in the posterolateral direction |
|
|
Term
| lumbar HNPs affect which nerve root? |
|
Definition
| the traversing nerve root |
|
|
Term
| Intra-articular physes involved with mets |
|
Definition
distal fibula
radial neck
proximal humerus
proximal femur |
|
|
Term
| in kids, sites at risk for hematogenous osteomyelitis? |
|
Definition
prox humerus
prox tibia
distal femur
prox femur |
|
|
Term
| clinical presentation of osteomyelitis in kids |
|
Definition
pain
fever
tenderness
common sites involved |
|
|
Term
| diagnosis of osteomyelitis in kids |
|
Definition
| WBC, ESR, CRP, x-ray(late), blood cultures if positive, aspiration is the best |
|
|
Term
| what do you see on aspiration in osteomyelitis |
|
Definition
|
|
Term
| what percent of bone loss is necessary to observe radiographic bone mineral loss? |
|
Definition
| 30-40%; need 1-2 weeks to show changes |
|
|
Term
| types of imaging studies needed to evalutate osteomyelitis |
|
Definition
plain radiographs
3 phase bone scan
Leukocyte labeling imaging (best) - costly |
|
|
Term
| Treatment for osteomyelitis |
|
Definition
Antibiotics
Decompression (incision and drainage)
Debridement |
|
|
Term
| In infants what organisms seen in osteomyelitis |
|
Definition
|
|
Term
| in 6 months - 3 yo, what orgs seen in osteomyelitis |
|
Definition
|
|
Term
| What orgs associated with implants in pts with osteomyelitis |
|
Definition
|
|
Term
| How long to treat with Abx in osteomyelitis? |
|
Definition
| 4-6weeks, 1-2 of parenteral, oral or direct delivery |
|
|
Term
| Three main causes of antibiotic resistance in osteomyelitis? |
|
Definition
Mutation (Rifampin resist staph)
Gene acquisition (plasmids/Transposons exchange genetic material)
Survival of inherently resistant bacteria |
|
|
Term
| Three MOA of antibiotic resistance in osteomyelitis? |
|
Definition
Access prevention
Drug inactivation
Target Alteration (PBP2a) |
|
|
Term
| complications of Osteomyelitis |
|
Definition
sepsis/death - rare
infectious arthritis
resistance/recurrance (chronic osteomyelitis) |
|
|
Term
| Chronic osteomyelitis can lead to ______ in the sinus tract formation |
|
Definition
|
|
Term
| on radiograph, chronic osteomyelitis demonstrating local lucency with sterile sequestra |
|
Definition
| Brodie's Abscess (dead bone) |
|
|
Term
| New/immature bone that surrounds sequestrum in chronic osteomyelitis |
|
Definition
|
|
Term
|
Definition
| vascular pores which are attempts to revascularize |
|
|
Term
| sequestrum in chronic osteomyelitis seen on IHC |
|
Definition
|
|
Term
| adult osteomyelitis involves |
|
Definition
|
|
Term
| spread of vertebral hematogenous spread in osteomyelitis is through |
|
Definition
| venous plexus from pelvis (Batson's plexus) |
|
|
Term
| exogenous osteomyelitis is due to (field and seed)---- |
|
Definition
direct contamination from
1. open fractures
2. penetrating injuries
3. post-operative |
|
|
Term
| Field: host susceptibility to infection is due to |
|
Definition
| foundation, contamination, location, vascularization |
|
|
Term
| Foundation: Host resistance is due to |
|
Definition
| Malnutrition, AIDS, Diabetes, Vascular insufficiency |
|
|
Term
| Contamination effects that affect infection |
|
Definition
|
|
Term
| Locations susceptible to resistance |
|
Definition
poor soft-tissue coverage
vascularization (tibia) - bone is exposed |
|
|
Term
|
Definition
degree of blood supply
grading of open fracture |
|
|
Term
|
Definition
|
|
Term
|
Definition
| >1cm w/o extensive soft tissue damage |
|
|
Term
|
Definition
| extensive damage (hi energy) |
|
|
Term
|
Definition
| adequate soft tissue coverage |
|
|
Term
|
Definition
| soft tissue loss, periosteal stripping, extensive contamination |
|
|
Term
|
Definition
arterial injury requiring repair
highest wound infection rate |
|
|
Term
|
Definition
virulence of organism
resistance |
|
|
Term
| infectious arthritis affects |
|
Definition
bacteria proliferate; rapidly growing joints (hips, knees)
causing incr joint fluid, see lots of PMNs |
|
|
Term
| hematogenous spread of infectious arthritis goes where? |
|
Definition
synovium
adjacent spread: osteomyelitis (bone), or soft tissue |
|
|
Term
| signs of infectious arthritis |
|
Definition
| Tumor, rubor, calor, dolor |
|
|
Term
| diagnosis of infectious arthritis |
|
Definition
| wbc > 50,000, glucose <50% fasting serum level in joint aspirate |
|
|
Term
| acute complications of infectious arthritis |
|
Definition
| osteomyelitis, joint dislocation |
|
|
Term
| long term complications of infectious arthritis |
|
Definition
growth deformity
angular or longitudinal
Arthritis |
|
|
Term
| treatment for infectious arthritis |
|
Definition
| surgical - early phase more important than with osteo |
|
|
Term
| classic organism seen in infectious arthritis (adult monoarticular septic arthritis) |
|
Definition
Neisseria gonorrhoeae
(most common is Staph aureus) |
|
|
Term
| prophylactic treatment for infectious arthritis |
|
Definition
| Cephalexin, Cephradine or Amoxicillin |
|
|
Term
| most benign bone tumors are painless or painfull? |
|
Definition
|
|
Term
| deep dull aching pain on presentation; patient might have? |
|
Definition
|
|
Term
| pathologic fracture is usually prodromic, pain before fracture; seen with what? |
|
Definition
chondrosarcoma
UBC
Giant Cell Tumor
Multiple Myeloma
Metastatic Carcinoma |
|
|
Term
| formulating your ddx: ask these question |
|
Definition
where is the lesion
how old is pt
intralesional matrix
what's the lesion doing to the bone
whats the bone doing to the lesion |
|
|
Term
|
Definition
narrow zone of transition bw lesion and normal bone (lucent lesion in proximal humerus)
well-defined, clear outline
surrounding rim (geographic)
not broken through the cortex
no periosteal new bone |
|
|
Term
|
Definition
poorly defined margins
no rim of mature bone
extension through cortex
subperiosteal immature bone
broad/unidentifiable zone of transition (osteosarcoma) |
|
|
Term
|
Definition
night pain that evolves into day pain, loss of function
"onion skinning" (layered periosteal reaction) --> Ewings Sarcoma
Cortical destruction |
|
|
Term
| Plain film should be accompanied by this to make a more clear diagnosis of bone tumors |
|
Definition
| MRI (T2 pathology - look for bright edematous features) |
|
|
Term
| potential problems with microscopic diagnosis in bone tumors |
|
Definition
immature bone (woven) vs tumor - can't distinguish
cartilage malignancy vs benign bone (endochondroma vs chondrosarcoma)
biopsy |
|
|
Term
|
Definition
osteoid osteoma (benign)
Osteogenic sarcoma (malignant) |
|
|
Term
|
Definition
Osteochondroma (exostosis) and Enchondroma (benign)
Chondrosarcoma (malignant) |
|
|
Term
young pts
benign cortical reaction, no periostitis
nidus seen on CT
biopsy - immature trabeculae, no atypia, fibrovascular tissue
relieved by aspirin |
|
Definition
|
|
Term
metaphysis most often
sunburst pattern
soft tissue extension
ill-defined borders on imaging
pain at night, growing soft tissue mass
atypical cells producing osteoid |
|
Definition
|
|
Term
|
Definition
|
|
Term
most common benign tumor in kids
grows away from metaphysis, associated with congenital abnormality; painless, but may cause bursitis |
|
Definition
|
|
Term
| prox mesoderm that produces skeletal muscle? |
|
Definition
|
|
Term
| LPM part that makes limb skeleton and sternum? |
|
Definition
| outter/somatic (parietal) layer |
|
|
Term
|
Definition
|
|
Term
| where are the haversian systems found? |
|
Definition
| compact cortical bone of the diaphysis |
|
|
Term
| what passes through the haversian canals |
|
Definition
|
|
Term
| what surrounds the haversian canals |
|
Definition
|
|
Term
| how are woven/immature/fiber bone formed |
|
Definition
| reaction to injury/disease |
|
|
Term
|
Definition
| no, its randomly organized |
|
|
Term
| what is found within the lamellae? |
|
Definition
| small lacunae with osteocytes |
|
|
Term
| what extends from the lacunae? |
|
Definition
| canaliculi with osteocyte processes |
|
|
Term
| what are the three principle cells types of bone |
|
Definition
| osteocyte, osteoblast, osteoclast |
|
|
Term
| which cells form the organic matrix of bone (osteoid) |
|
Definition
|
|
Term
| which cells synthesize alkaline phosphatase; also have receptor for 1,25 dihydroxy vitamin D and PTH |
|
Definition
|
|
Term
| which cells are large multinucleated cells that resorb bone; located in Howship lacunae |
|
Definition
|
|
Term
| what enzymes do osteoclasts use to excavate bone? |
|
Definition
| acid phosphatase, proteases |
|
|
Term
| what is the fibrovascular membrane on the outer surface of bone |
|
Definition
|
|
Term
| what activates osteoblasts in the adult |
|
Definition
| trauma or other pathologic stimuli |
|
|
Term
| where is cancellous bone found |
|
Definition
| at the ends of long bones |
|
|
Term
| what is the difference bw cancellous and cortical bone? |
|
Definition
| cancellous bone has no haversian systems |
|
|
Term
| what are the markers of bone formation |
|
Definition
alkaline phosphatase
osteocalcin |
|
|
Term
| what are the markers of bone resorption |
|
Definition
osteocalcin fragments
hydroxyproline
pyridinoline/deoxypyridinoline |
|
|
Term
| what are the bone density measurement tools? |
|
Definition
DEXA
Quantitative CT
Heel Ultrasound |
|
|
Term
| which cells are responsible for bone resorption? |
|
Definition
| osteoclasts and osteocytes |
|
|
Term
| which cells are responsible for bone formation |
|
Definition
|
|
Term
| which cells are responsible for calcium homeostasis |
|
Definition
|
|
Term
| collagen synthesis, osteoid maturation and mineralization are the three components of..... |
|
Definition
|
|
Term
| these cells are cuboidal, have high synthetic activity and secrete procollagen to form osteoid, also store Ca and Phosphate in mitochondrial granules |
|
Definition
|
|
Term
| procollagen cleavage, collagen deposition and crosslinking are the three components of ..... |
|
Definition
|
|
Term
| what is the lag time for mineralization?" |
|
Definition
|
|
Term
| nucleation, osteoblast controlled (alkaline phosphatase, lipids) and osteocytes are the three components of.... |
|
Definition
|
|
Term
| where are the bone formation sites? |
|
Definition
| cortical bone, trabecular bone, growth plates (physes) and periosteum |
|
|
Term
| where are the bone formation sites in kids |
|
Definition
| growth plates (physes) and periosteum |
|
|
Term
| this process links osteoblast initiation/osteoclast mediated and involves mineral dissolution and collagen degradation |
|
Definition
|
|
Term
| these cells secrete protons and collagenolytic enzymes (MMPs) |
|
Definition
|
|
Term
| this process involves formation + resorption of bone |
|
Definition
|
|
Term
| explain the trabecular bone remodeling process |
|
Definition
| osteoblasts @ bone surface secrete OAF to stimulate osteoclasts. Osteoclasts excavate bone to form howship lacuna. activated osteoblasts then invade the howship lacunae and deposit osteoid |
|
|
Term
| explain the cortical bone remodeling process |
|
Definition
| (comprised of BMU) hormonal trigger stimulates osteoblasts --> OAF --> cutting cone of osteoclasts --> osteoblasts |
|
|
Term
| this compartment is separated from ECF compartment, has bone lining cells/osteocytes and an ATP-ase pump transport system that maintains serum calcium level against concentration gradien |
|
Definition
|
|
Term
| hormonal control of calcium homeostasis is regulated by |
|
Definition
PTH(fine tuning)
1,25vit D (long term)
calcitonin (post-pradial buffering) |
|
|
Term
| elevated AP, haphazard, prominent cement lines with mosaic pattern of lamellar bone |
|
Definition
cell type is Osteoclast
Disease is Paget's |
|
|
Term
| what is responsible for coordinating myofibrils for coordinated muscle contractions |
|
Definition
| T-tubule uniform distribution |
|
|
Term
| tensile strength of bone is due to? |
|
Definition
|
|
Term
| Which part of the paraxial mesoderm produces skeletal muscles? |
|
Definition
|
|
Term
| Which part of the lateral plate mesoderm forms the limb skeleton and sternum? |
|
Definition
| The outer somatic (parietal) layer |
|
|
Term
| What influences news cells to be added to the distal end of the limb bud? |
|
Definition
|
|
Term
| What signal influences digit number and identity on the limb? |
|
Definition
|
|
Term
| Derivatives of the dorsal muscle mass and ventral muscles are generally what types of muscles? |
|
Definition
Dorsal muscle mass – extensors & abductors
Ventral muscles – flexors & adductors |
|
|
Term
| What vertebral malformation contains spinal cord and neural tissue? |
|
Definition
|
|
Term
| What are the major types of immature bone? |
|
Definition
| Non-lamellar, fiber, and woven |
|
|
Term
| What cell type becomes an osteocyte when it is surrounded by matrix? |
|
Definition
|
|
Term
|
Definition
| For every change in the form or the function of a bone there follows a definite change in its architecture |
|
|
Term
| What is a typical MSK complication of Sickle-Cell Disease? |
|
Definition
| Avascular necrosis of the head of the femur |
|
|
Term
| What type of genetic disorder (single gene, multiple genes, etc.) is club foot? |
|
Definition
|
|
Term
| What increases the risk of a dislocated hip in an infant? |
|
Definition
|
|
Term
| What is the syndrome where a patient has failure of separation of the vertebra (block vertebra)? |
|
Definition
|
|
Term
| What is the disorder where a patient has failure of formation of their femur? |
|
Definition
| Proximal femoral focal deficiency |
|
|
Term
| What is the functional loss from an injury to the lower trunk of the brachial plexus? |
|
Definition
| Inability to internally rotate shoulder, extend elbow, wrist, and MCP; loss of all intrinsic muscles movement and sensory loss in median arm and forearm |
|
|
Term
| What is the functional loss from an injury to the upper roots of the brachial plexus? |
|
Definition
| Winged scapular, loss of shoulder abduction and external rotation, elbow flexion and external rotation, and wrist and MCP extension |
|
|
Term
| Depression of the scapula (coracoid process) results in what type of brachial plexus injury? |
|
Definition
|
|
Term
| What is the longest bone without ossification centers at both ends? |
|
Definition
|
|
Term
| What is the function of the deltoid muscle? |
|
Definition
| Abduction, internal rotation, and external rotation |
|
|
Term
| What is the most common type of glenohumeral joint dislocation? |
|
Definition
|
|
Term
| What should you be concerned about when a patient comes in with a supracondylar fracture of the humerus – anterior displacement of the proximal fragment? |
|
Definition
|
|
Term
| Muscle necrosis of the forearm flexors results in what? |
|
Definition
|
|
Term
| What is the mechanism of fracturing the lateral condyle of the humerus? |
|
Definition
| Fall on outstretched hand with valgus thrust |
|
|
Term
| Development of avascular necrosis of what carpal bones may occur due to fracture or dislocation? |
|
Definition
| Lunate (dislocation) and scaphoid (fracture) |
|
|
Term
| Carpal tunnel syndrome can lead to what deficits? |
|
Definition
| Numbness or hypesthesia in the radial 3.5 digits and may lead to atrophy of the thenar muscles with loss of thumb function |
|
|
Term
| The claw hand is caused by what? |
|
Definition
| Low lesion of the median and ulnar nerves |
|
|
Term
| Swan neck deformity is caused by what? |
|
Definition
| Spasm or contracture of the intrinsic muscles producing hyperextension of the PIP joint and a flexion deformity of the DIP joint |
|
|
Term
| Anterior dislocation of the femoral head puts a patient at risk for what? |
|
Definition
| Damage to anterior/medial structure (femoral vessels and nerve), obturator nerve, and femoral avascular necrosis |
|
|
Term
| What are the major muscles involved in hip abduction? |
|
Definition
| Gluteus minimus and medius |
|
|
Term
| What would you see when the Gluteus minimus and medius muscles aren’t working correctly? |
|
Definition
| Trendelenburg sign (Pelvic sag away from affected side) |
|
|
Term
| What is the difference between Trendelenburg and Coxalgic gaits? |
|
Definition
Trendelenburg - weak abductors
Coxalgic – way to decrease force across joint |
|
|
Term
| When a patient has an LCL injury, what else should you check? |
|
Definition
| Peroneal nerve and distal vessels |
|
|
Term
| What makes up the unhappy triad? |
|
Definition
| ACL, MCL, and medial meniscus |
|
|
Term
| If a patient has a patellectomy performed, what action would be difficult for the patient? |
|
Definition
|
|
Term
| What are the five P’s for compartment syndrome? |
|
Definition
| Pain, pallor, paresthesias, pulselessness, and paralysis |
|
|
Term
| An injury to the peroneal nerve would cause sensory deficits in what area? |
|
Definition
|
|
Term
| What could cause injury to the superior gluteal nerve? |
|
Definition
|
|
Term
| Damage to the C5 nerve results in a reflex change in what tendon? |
|
Definition
|
|
Term
| Damage to the C6 nerve results in a reflex change in what tendon? |
|
Definition
|
|
Term
| Damage to the S1 nerve results in a reflex change in what tendon? |
|
Definition
|
|
Term
| A C6-7 herniated nucleus pulposis results in what motor weakness? |
|
Definition
| Triceps (affects exiting C7 nerve) |
|
|
Term
| What is the most abundant form of collage in bone? |
|
Definition
|
|
Term
| What are secreted by osteoclasts to break down bone? |
|
Definition
| Protons and collagenolytic enzymes (MMPs) |
|
|
Term
| What hormones control calcium homeostasis? |
|
Definition
| PTH (fine tuning), 1,25-dihydroxyvitamin D (long term), and calcitonin (post-prandial buffering) |
|
|
Term
| What are the three major methods to evaluate bone formation/resorption? |
|
Definition
| Bone biopsy (1), urine/serum markers (alk phos, osteocalcin) (2), and bone density measures (DEXA, quantitative CT, or Heel ultrasound) (3) |
|
|
Term
| What skeletal pathologies will not result in serum calcium abnormalities? |
|
Definition
| Osteoporosis, osteogenesis imperfect, osteopetrosis, and Paget disease |
|
|
Term
| PTH binding to receptors on osteoblasts result in the release of what hormone? |
|
Definition
| Osteoclast activating factors (OAFs) |
|
|
Term
| Hyperparathyroidism caused by an adenoma will result in what electrolyte imbalances? |
|
Definition
| Hypophosphatemia, hypercalcemia, elevated to normal alk phos -> leads to stones, groans, moans, and psychiatric overtones |
|
|
Term
| Hyperparathyroidism can also lead to bone pathology? |
|
Definition
| Osteitis fibrosa cystica (subperiosteal bone resorption and brown tumors) |
|
|
Term
| What are hereditary forms of hypoparathyroidism? |
|
Definition
| Albright hereditary osteodystrophy and end organ resistance to PTH |
|
|
Term
| What is the most common etiology of osteomalacia? |
|
Definition
|
|
Term
| Osteomalacia in children is known as what? |
|
Definition
|
|
Term
| What is the clinical presentation of osteomalacia in adults? |
|
Definition
| Bone pain, local tenderness, and pathologic fractures |
|
|
Term
| What is the typical presentation of postmenopausal osteoporosis? |
|
Definition
| Distal radius fractures and vertebral fractures |
|
|
Term
| What is the typical presentation of age-related osteoporosis? |
|
Definition
| Proximal femur fractures and vertebral fractures |
|
|
Term
| What type of mature bone is involved in postmenopausal osteoporosis? |
|
Definition
|
|
Term
| How do steroids induce secondary osteoporosis? |
|
Definition
| Osteoblast precursor inhibition, impaired calcium absorption in gut and kidney, and secondary hyperparathyroidism |
|
|
Term
| What are associated findings in osteogenesis imperfect type 1? |
|
Definition
| Blue sclera, hearing loss, and tooth abnormalities |
|
|
Term
| What are present on histology in a Paget disease patient? |
|
Definition
|
|
Term
| What can Paget disease lead to? |
|
Definition
|
|
Term
| Vascular insult to growing bone can lead to what pathology? |
|
Definition
|
|
Term
| What is the main blood supply of the femoral head? |
|
Definition
| Medial femoral circumflex artery |
|
|
Term
|
Definition
| Avascular necrosis of the femoral head between ages 5-10 |
|
|
Term
| What are potential etiologies for osteonecrosis of the adult hip? |
|
Definition
| Idiopathic, steroids, alcohol, trauma, hemoglobinopathies, glycogen storage disease |
|
|
Term
| What are the most common sources causing hematogenous osteomyelitis? |
|
Definition
|
|
Term
| What bones/areas are most likely to be affected by hematogenous osteomyelitis? |
|
Definition
Children – metaphysis
Adult – Vertebral bodies; spread to joints more common than in children |
|
|
Term
| What is the clinical presentation of an osteomyelitis? |
|
Definition
|
|
Term
| What are the most common bugs causing osteomyelitis in patients with implants? |
|
Definition
|
|
Term
| Chronic osteomyelitis can lead to what complications? |
|
Definition
| Sinus tract formation, squamous cell carcinoma, Brodie’s abscess |
|
|
Term
| What are the major sources of infection causing infectious arthritis? |
|
Definition
| Skin, dental, respiratory, and GI/GU surgeries |
|
|
Term
| What are the most common organisms causing infectious arthritis? |
|
Definition
| Staph aureus and Neisseria gonorrhoeae |
|
|
Term
| what congenital abnormality is associated with osteochondroma? |
|
Definition
| autosomal dominant disease = multiple hereditary exostoses; metaphyseal tumor |
|
|
Term
|
Definition
|
|
Term
|
Definition
osteogenic sarcoma (OGS)
non-ossifying fibroma (NOF)
endochondroma (fingers)
osteochondroma
chondrosarcoma
simple cyst
mets
myeloma |
|
|
Term
|
Definition
osteoid osteoma
Ewings sarcoma
Mets
Myeloma |
|
|
Term
|
Definition
|
|
Term
| tumors found in prepubescence |
|
Definition
| simple cyst, non-ossifying fibroma |
|
|
Term
|
Definition
chondrosarcoma
mets
myeloma |
|
|
Term
|
Definition
prostate
breast
kidney
thyroid
lung |
|
|
Term
| Lateral plate mesoderm part that makes smooth muscle and CT of the gut? |
|
Definition
| inner/splanchnic (visceral) layer |
|
|
Term
| hindlimb bud forms in association with which nerves |
|
Definition
| lumbosacral plexus (L2-S2) |
|
|
Term
| forelimb bud forms in association with which nerves |
|
Definition
|
|
Term
| prior to gastrulation the embryo consist of ... |
|
Definition
|
|
Term
| the site of gastrulation is the |
|
Definition
| primitive streak and node |
|
|
Term
| unfused neural arch results in |
|
Definition
meningocoele
meningomyelocoele (cyst contains cord) |
|
|
Term
| by what time frame do limb buds develop? |
|
Definition
|
|
Term
| what process separates digit rays? |
|
Definition
| programmed cell death due to AER regression |
|
|
Term
| failure of separation of digit rays results in |
|
Definition
| polydactyly(multifactorial) or syndactyly(autosomal dominant) |
|
|
Term
| syndactyly (autosomal dominant) is associated with what condition |
|
Definition
|
|
Term
| what gene is responsible for limb patterning? |
|
Definition
| Hox gene (proximodistal axis) |
|
|
Term
| what gene is responsible for digit # and shape? |
|
Definition
|
|
Term
| what protein forms the post-axial border |
|
Definition
|
|
Term
| longitudinal deficiency of post-axial border of the leg results in |
|
Definition
|
|
Term
| preaxial longitudinal deficiency of post-axial border manifests in a short or absent radial bone and a shrunken thumb, called |
|
Definition
|
|
Term
| immovalbe joint development is differentiated into dense connective tissue ______ or cartilage _______ |
|
Definition
syndesmosis
syndchondrosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| movable joint development occurs when borders of the interzone differentiate into _____ that will line the future joint cavity |
|
Definition
|
|
Term
| failure to form an ossification center in the spine or an improper subdivision of sclerotomes causes |
|
Definition
| hemivertebrae --> one cause of scoliosis |
|
|
Term
| spinal cord derived from this embryonic structure |
|
Definition
|
|
Term
| sternum derived from this embryonic structure |
|
Definition
| somatic lateral plate mesoderm |
|
|
Term
| trunk muscle is derived from this embryonic structure |
|
Definition
| myotomal epimere and hypomere |
|
|
Term
| limb muscle is derived from this embryonic structure |
|
Definition
|
|
Term
| erythematous scaly eruption or dusky purple patches over the extensor surfaces of the knuckles (metacarpophalangeal and/or interphalangeal joints), elbows, and knees |
|
Definition
| Gottron's sign/Dermatomyositis |
|
|
Term
| lilac or violaceous eyelid discoloration with periorbital edema |
|
Definition
| Heliotrope rash (“racoon eyes”)/Dermatomyositis |
|
|
Term
| erythema of the chest and shoulders |
|
Definition
| Shawl sign/Dermatomyositis |
|
|
Term
| erythema in a V-shaped distribution over the anterior neck and chest |
|
Definition
|
|
Term
| fibrocartilaginous structures that provide padding to the articulating surfaces of the tibia and femur. They are malleable enough to accommodate the change in shape of the knee joint during flexion and extension. |
|
Definition
|
|
Term
| medial and lateral menisci connected anteriorly by small transverse ligament are found where? |
|
Definition
|
|
Term
| define endochondrial ossification |
|
Definition
| chondrocytes form a cartilage model → osteoclasts and osteoblasts replace the cartilaginous model with woven bone → woven bone is subsequently remodeled into lamellar bone |
|
|
Term
| action of the Adductor longus/brevis/magnus |
|
Definition
| adduction and flexion of the hip |
|
|
Term
| innervation of the adductor muscles of the thigh |
|
Definition
|
|
Term
| action/innervation of the pronator quadratus |
|
Definition
pronates forearm
median nerve (ant interosseous nerve) |
|
|
Term
xray of this tumor shows: radiolucent lesion with reactive thickening of the cortex
- intralesional speckled calcification (either a diffuse “salt and pepper” or more discrete/punctate “popcorn” pattern) suggestive of cartilage |
|
Definition
|
|
Term
| action/innervation of the flexor carpi radialis (FCR) |
|
Definition
flex/abduct wrist
median nerve |
|
|
Term
| two causes of chronic infectious arthritis |
|
Definition
|
|
Term
| 5 deep extensors of forearm and innervations |
|
Definition
suppinator (deep radial nerve)
abductor pollicis longus (PIN of radial nerve)
extensor pollicis brevis (PIN)
extensor indicis (PIN) |
|
|
Term
| mechanical properties of articular cartilage |
|
Definition
low friction gliding surface
load distribution
stiffness to compression/resilieance
durability |
|
|
Term
| biologic properties of articular cartilage |
|
Definition
3D chondrocyte protection and support
influence cellular responses (signal transduction)
lacks innervation
lacks blood supply (relies on diffusion) |
|
|
Term
| components of articular cartilage |
|
Definition
| type II, XI, IX, VI collagen |
|
|
Term
| function of type II collagen in articular cartilage |
|
Definition
| collagen chains form the primary structure |
|
|
Term
| function of type XI(11) collagen in articular cartilage |
|
Definition
| forms fibrils with type II collagen. influences type II fibril diameter |
|
|
Term
| function of type IX(9) collagen in articular cartilage |
|
Definition
| on the surface. organizes and stabilizes overall meshwork |
|
|
Term
| what are the components of cartilage? |
|
Definition
ground substance(water,proteoglycan,glycoproteins)
fibers(type I,II collagen)
cells(chondrocytes, chondrogenic cells, chondroblasts) |
|
|
Term
| what is the dominant form of proteoglycan |
|
Definition
| aggrecan (combines w/hyaluronan to form big proteoglycan molecules) = 'bottle brush apperance' |
|
|
Term
| what are the three main types of cartilage |
|
Definition
hyaline (articular)
elastic
fibrocartilage |
|
|
Term
| components of Proteoglycans |
|
Definition
| keratin sulfate, chondroitin 4-sulfate, chondroitin-6-sulfate |
|
|
Term
| what is hyaluronan (hyaluronic acid) |
|
Definition
very long/minimal charge
links proteoglycans together to form aggregates
made on the cell surface from cytoplasmic sugars |
|
|
Term
|
Definition
small proteins that help stabilize proteoglycans aggregates
associate with proteoglycans and hyaluronan in the cytoplasm |
|
|
Term
| function of proteoglycans |
|
Definition
| lets cartilage resist compression; collagen matrix prevents molecules from swelling to full volume; matrix is always pressurized |
|
|
Term
| what hinders cartilage repair |
|
Definition
|
|
Term
| why is cartilage repair limited in superficial lesions? |
|
Definition
1. articular and fibrocartilage do not have perichondrium
2. chondrocytes can't migrate easily to fill defects
3. no hemorrhage (no inflammatory response, no platelets to release growth factors) |
|
|
Term
| what is the mechanism of cartilage repair in deep lesions? |
|
Definition
| by differentiation of primitive mesenchymal stem cells --> fibrocartilage is formed |
|
|
Term
| why is the repaired cartilage in deep lesions not as durable as the original hyaline cartilage |
|
Definition
| because it contains a variable percentage of type I and type II collagen |
|
|
Term
| what are the three types of synovium |
|
Definition
areolar(looks like lung)
fibrous(looks linear)
adipose(looks like bubbles) |
|
|
Term
| what's in synovial fluid? |
|
Definition
| its essentially dialysate of blood plasma: low protein, lots of albumin, hyaluronan, phosphlipids,(type B synoviocytes add glycoproteins), (chondrocytes add AP), plasminogen |
|
|
Term
| what component of synovium and cartilage prevents clots from forming? |
|
Definition
|
|
Term
| what is the function of synovial fluid |
|
Definition
lubrication
nutrient transport
waste removal |
|
|
Term
| what is the role of lubricin in synovial fluid |
|
Definition
| bound to surface of cartilage for lubrication |
|
|
Term
| what are the potential alterations in synovial fluid |
|
Definition
non-inflamm (trauma, osteoarthritis)
inflamm (RA, gout)
sepsis |
|
|
Term
| What are some key extra-articular manifestations of RA? |
|
Definition
premature CAD
skin nodules
entrapment neuropathy
osteopenia
Sjogren's syndrome |
|
|
Term
| the 1987 revised criteria for RA includes: |
|
Definition
morning stiffness
>3 joints involved
hand joints
symmetric disease
rheumatoid nodules
rheumatoid factor
radiologic changes |
|
|
Term
| Rheumatoid factor is characterized by IgM autoantibodies directed against what portion of IgG |
|
Definition
|
|
Term
| Although sensitive for RA, RF is not _____ |
|
Definition
| specific; can be seen in chronic infections, incl chronic lung disease |
|
|
Term
| What antibodies in RA can be detected by ELISA? |
|
Definition
| Anti-filaggrin Antibodies |
|
|
Term
| What do Anti-CCP (cyclic citrullinated peptide)Abs in RA target |
|
Definition
| amino acid: citrulline (modified arginine residue) |
|
|
Term
| When is detection of Anti-CCP Abs useful? |
|
Definition
| early diagnosis of polyarthritis (seronegative) and hepatitis C; it is associated with severity and probable course of RA disease |
|
|
Term
| Synovial fluid containing 5k-50k wbc, PMN predominance, cloudy fluid with cholersterol crystals denotes what disease |
|
Definition
|
|
Term
| this treatment for RA has rapid, potent suppresion of inflammation, but short efficacy and long term toxicity...what is it? |
|
Definition
|
|
Term
| what is the first line disease modifying agent (DMARD) for rheumatoid arthritis? |
|
Definition
|
|
Term
| What do most biologic therapies for RA target? |
|
Definition
| TNF-alpha(Etanercept, Infliximab, Adalimumab, Certolizumab, Golimumab) |
|
|
Term
| What RA drug targets IL-1? |
|
Definition
|
|
Term
| what RA drug targets T cell co-stimulation |
|
Definition
|
|
Term
| what RA drug targets B cells? |
|
Definition
|
|
Term
| Patients with these factors are likely to have a poor prognosis in RA |
|
Definition
earlier onset
hi titers of RF and CCP
elevated WESR
extra-articular disease |
|
|
Term
| What are the Seronegative Spondyloarthropathies |
|
Definition
ankylosing spondylitis
reactive arthritis
psoriatic arthritis
enteropathic arthritis (assoc with IBD) |
|
|
Term
| What some common features of Seronegative spondyloarthropathies |
|
Definition
HLA-B27
axial skeleton involvement
variable peripheral joint involvement
inflammatory eye disease |
|
|
Term
| what is the classic triad in reactive arthritis |
|
Definition
arthritis
conjunctivitis
urethritis/diarrhea |
|
|
Term
| reactive arthritis is strongly associated with |
|
Definition
bacterial pathogens
frequently with HIV |
|
|
Term
| reactive arthritis is usu preceded by what? |
|
Definition
| non-gonococcal urethritis and conjuntivitis |
|
|
Term
| this arthritis presents with axial disease +/- peripheral joints, asymmetric and follows skin and nail changes |
|
Definition
|
|
Term
| what is the most common form of crystal-induced arthritis |
|
Definition
|
|
Term
| monosodium urate crystals are seen in gout is due to overproduction of urate despite dietary intake and also due to defective renal urate handling. This cause is called |
|
Definition
|
|
Term
| what type of joint is the site of crystal formation in gout |
|
Definition
| synovial joints (MSU crystals precipitate in joint) |
|
|
Term
| what binds to crystals to induce acute inflammatory cascade in gout |
|
Definition
IgG initially
complement then binds when activated by inflammatory response |
|
|
Term
| what phagocytizes monosodium urate crystals in gout |
|
Definition
| PMNs; lysosomal mediated cell rupture, crystal chemotactic factor and PMN cytoplasm contents are released into synovial fluid which amplifies inflammatory reponse |
|
|
Term
| the most common presentation in gout, in addition to pain/swelling, limited joint range of motion is ... |
|
Definition
|
|
Term
| monoarticular arthritis in gout most commonly involves which peripheral joint? |
|
Definition
| classic "podagra": 1st MTP joint (metatarsophalangeal joint) |
|
|
Term
| some common inciting factors in gout include: |
|
Definition
family history (40%)
alcoholism
obesity
HTN
CAD and hypertriglyceridemia
myeloproliferative states
meds (diuretics, IV heparin, cyclosporin) |
|
|
Term
| definitive diagnosis of gout includes |
|
Definition
1. presence of MSU crystals engulfed by PMNs in synovial fluid aspirate
2. Negatively birefringent needle-shaped crystals |
|
|
Term
| Yellow = what type of birefringence |
|
Definition
| negative birefringence seen in gout |
|
|
Term
| Blue = what type of birefringence |
|
Definition
| positive birefringence seen in pseudogout |
|
|
Term
| uric acid levels are not diagnostic of gout (true or false) |
|
Definition
|
|
Term
| clinical diagnosis is not definitive for gout (true or false) |
|
Definition
|
|
Term
In gout:
we expect (left or right) shift on CBC
we expect (elevated or low?) CRP |
|
Definition
|
|
Term
| what test will give us a definitive diagnosis of gout? |
|
Definition
| joint aspirate. also r/o infection, and allows cell count (hi WBC mimics septic arthritis and 20-80k PMNs in gout) |
|
|
Term
| the #1 extra-articular manifestation of gout is: |
|
Definition
| Nephrolithiasis (1000x greater than general population!) |
|
|
Term
| tumor lysis syndrome, or acute nephropathy, due to high transient levels of uric acid with precipitates in distal tubules/collecting duct blocks the urine outflow and tubule function. This is an extra-articular manifestation of |
|
Definition
|
|
Term
| tophi are most commonly found in these areas of the body (in gout) |
|
Definition
| ears cartilage, olecranon bursa, achilles, ulnar border of arm, pretibial region |
|
|
Term
| juxtaarticular erosions + symmetric joint space loss with tophi are characteristic of |
|
Definition
|
|
Term
| acute treatment of gout includes |
|
Definition
| rest, ice, NSAIDS, oral corticosteroids, colchicine and intra-articular aspiration/steroid injection |
|
|
Term
| how does colchicine work in gout? |
|
Definition
| it inhibits PMN microtubular formation and migration; decreases PMN chemotatic factor release |
|
|
Term
| how to chronically treat gout? |
|
Definition
| decrease endogenous production (Allopurinol) and increase urinary excretion (Probenicid) |
|
|
Term
| how does Allopurinol work? when is it given? |
|
Definition
| blocks purine degradation at rate limiting step, blocks enzyme xanthine oxidase; give AFTER acute attack |
|
|
Term
| How does Probenicid work? |
|
Definition
| blocks renal tubular reabsorption of uric acid, promotes urinary excretion |
|
|
Term
| what precautions must physician take when prescribing Probenicid? |
|
Definition
| pts with nephrolithiasis or elevated urinary acid levels |
|
|
Term
| what deposits are seen in Pseudogout? |
|
Definition
| calcium pyrophosphate deposition (also known as CPPD) |
|
|
Term
| the most common cause of pseudogout |
|
Definition
|
|
Term
| pseudogout occurs when their is an initial damage to the _____ cartilage followed by mineral deposition w/n ______ cartilage matrix |
|
Definition
|
|
Term
| ______ crystals are the offenders in pseudogout |
|
Definition
| calcium pyrophosphate dihydrate crystals |
|
|
Term
| describe the process of inflammatory response in pseudogout (hint: similar to gout) |
|
Definition
crystals incite inflammation
1. phagocytosis by PMNs --> cells lyse and spill into synovium
2. synovial fluid proteins and IgG induce complement
3. amplified inflammatory response |
|
|
Term
| where does pseudogout present |
|
Definition
| knees, wrists, elbows, shoulders, pubic symphysis |
|
|
Term
| diagnosis of pseudogout is confirmed by |
|
Definition
joint aspirate (CPPD crystals, engulfed by PMNs)
clinical picture (acute attacks, during stress/illness)
chondrocalcinosis on Xray |
|
|
Term
| CPPD crystals positive test is what color birefringence |
|
Definition
|
|
Term
| mineralization of articular cartilage and fibrocartilage (meniscus) is the definition of |
|
Definition
|
|
Term
| pseudogout is treated with |
|
Definition
rest, ice, NSAIDs, colchicine (less effective)
joint aspiration/intraarticular steroids
no effective maintenance therapy |
|
|
Term
| congenital absence of a limb likely resulting from failure of limb outgrowth |
|
Definition
|
|
Term
| hyperextension at MCP joint, flexion at IP joints of 4th and 5th digits; loss of abduction/adduction of digits and flexion of MCP joints; wasted hypothenar eminence and also loss of adduction of thumb |
|
Definition
| injury to the ulnar nerve (claw hand involving digits 4 and 5) |
|
|
Term
| which muscles attach to the corocoid proccess? |
|
Definition
coracobrachialis
pectoralis minor
short head of biceps brachii |
|
|
Term
| winged scapula is due to injury of |
|
Definition
|
|
Term
| pectoralis major(clavicular part), deltoid (anterior part), coracobrachialis, biceps brachii |
|
Definition
| flexion of shoulder joint |
|
|
Term
| this injury causes weakness of supination and forearm flexion |
|
Definition
| injury to musculocutaneous nerve |
|
|
Term
| muscles attaching to the greater trochanter of the humerus |
|
Definition
| supraspinatus, infraspinatus, teres minor |
|
|
Term
| wrist drop is due to injury of this nerve |
|
Definition
|
|
Term
| abduction of the shoulder joint is from these muscles |
|
Definition
| supraspinatus, deltoid, serratus anterior |
|
|
Term
| wrist drop can also occur when there in injury to the posterior cord. this causes loss of function of which muscles |
|
Definition
| extensors of the arm, forearm and hand |
|
|
Term
| which muscles attach to the medial epicondyle of the forearm |
|
Definition
|
|
Term
| hand of benediction is due to injury to which nerve |
|
Definition
|
|
Term
| lateral rotation of the shoulder joint is from which muscles |
|
Definition
| infraspinatus, teres minor and posterior part of the deltoid |
|
|
Term
| paralyzed short intrinsic muscles of the hand and weakened long flexor tendons to the digits is _____ paralysis |
|
Definition
| Klumpke's paraylsis (lower trunk injury; results in claw hand) |
|
|
Term
| injury to this nerve causes deltoid muscle wasting |
|
Definition
|
|
Term
| fusion of adjacent digits involveing the skin and in some cases bone |
|
Definition
|
|
Term
| together, the flexor carpi radialis, extensor carpis radialis longus and brevis do what? |
|
Definition
| abduction at the wrist (radiocarpal joint) |
|
|
Term
| adducted, internally rotated shoulder; pronated and extended elbow is what lesion |
|
Definition
| Erb-Duchenne Palsy (upper trunk injury; results in waiter's tip hand) |
|
|
Term
| what structures pass through the carpal tunnel? |
|
Definition
| 4 FDS tendons, 4 FDP tendons, 1 FPL tendon and the median nerve |
|
|
