Shared Flashcard Set

Details

MSK
Musculoskeletal
346
Anatomy
Graduate
04/23/2013

Additional Anatomy Flashcards

 


 

Cards

Term
The cervical spine nerve roots exit _____ the corresponding vertebra
Definition
above
Term
The thoracic and lumbar spine nerve roots exit ____ the corresponding vertebra
Definition
below
Term
C5 nerve root sensory distribution
Definition
lateral arm
deltoid patch
Term
C5 motor distribution
Definition
deltoid, biceps
Term
C5 reflex
Definition
biceps
Term
C6 sensory distribution
Definition
lateral forearm, thumb, index finger
Term
C6 motor distribution
Definition
biceps, Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis
Term
C6 reflex
Definition
brachioradialis
Term
C7 sensory distribution
Definition
middle finger
Term
C7 motor distribution
Definition
triceps
Flexor carpi radialis
Extensor Digitorum communis
Extensor indicis proprius
Extensor digiti minimi proprius
Term
C7 reflex
Definition
Triceps
Term
C8 sensory distribution
Definition
ulnar fingers
medial forearm
Term
C8 motor distribution
Definition
flexor digitorum superficialis
flexor digitorum profundus
interossei
Term
C8 has no reflex!
Definition
none
Term
T1 sensory distribution
Definition
medial arm
Term
T1 motor distribution
Definition
interossei
Term
T1 has no reflex
Definition
none
Term
L4 sensory distribution
Definition
medial leg and foot (medialis malleolus)
Term
L4 motor distribution
Definition
tibialis anterior
Term
L4 reflex
Definition
quadriceps (patellar)
Term
L5 sensory distribution
Definition
1st web space
Term
L5 motor distribution
Definition
Extensor hallucis longus (big toe)
Term
L5 reflex
Definition
none (posterior tibialis)
Term
S1 motor distribution
Definition
plantar flexors (gastroc)
Term
S1 sensory distribution
Definition
lateral heel
Term
S1 reflex
Definition
achilles
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
PMNs
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
Staph
Strep
Gram negs
Term
in 6 months - 3 yo, what orgs seen in osteomyelitis
Definition
H flu
Term
What orgs associated with implants in pts with osteomyelitis
Definition
coag neg Staph
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
squamous cell carcinoma
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
involucrum
Term
cloacae (fenestrations)
Definition
vascular pores which are attempts to revascularize
Term
sequestrum in chronic osteomyelitis seen on IHC
Definition
pink globules
Term
adult osteomyelitis involves
Definition
joints, vertebrae
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
Source
Degree
Term
Locations susceptible to resistance
Definition
poor soft-tissue coverage
vascularization (tibia) - bone is exposed
Term
Vascularization effects
Definition
degree of blood supply
grading of open fracture
Term
Type I open fracture
Definition
<1cm clean fracture
Term
Type II open fracture
Definition
>1cm w/o extensive soft tissue damage
Term
Type III open fracture
Definition
extensive damage (hi energy)
Term
Type IIIa open fracture
Definition
adequate soft tissue coverage
Term
Type IIIb open fracture
Definition
soft tissue loss, periosteal stripping, extensive contamination
Term
Type IIIc open fracture
Definition
arterial injury requiring repair
highest wound infection rate
Term
Seeding is affected by
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
painless
Term
deep dull aching pain on presentation; patient might have?
Definition
osteosarcoma
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
Benign xray findings
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
malignant xray findings
Definition
poorly defined margins
no rim of mature bone
extension through cortex
subperiosteal immature bone
broad/unidentifiable zone of transition (osteosarcoma)
Term
Aggressive features
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
Bone forming tumors
Definition
osteoid osteoma (benign)
Osteogenic sarcoma (malignant)
Term
Cartilage forming tumors
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
osteoid osteoma
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
osteosarcoma
Term
diaphyseal tumor
Definition
Ewing sarcoma
Term
most common benign tumor in kids
grows away from metaphysis, associated with congenital abnormality; painless, but may cause bursitis
Definition
osteochondroma
Term
prox mesoderm that produces skeletal muscle?
Definition
myotome
Term
LPM part that makes limb skeleton and sternum?
Definition
outter/somatic (parietal) layer
Term
two types of bone?
Definition
cortical and cancellous
Term
where are the haversian systems found?
Definition
compact cortical bone of the diaphysis
Term
what passes through the haversian canals
Definition
nutrients to bone cells
Term
what surrounds the haversian canals
Definition
lamellae
Term
how are woven/immature/fiber bone formed
Definition
reaction to injury/disease
Term
is immature laminated
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
osteoblasts
Term
which cells synthesize alkaline phosphatase; also have receptor for 1,25 dihydroxy vitamin D and PTH
Definition
osteoblasts
Term
which cells are large multinucleated cells that resorb bone; located in Howship lacunae
Definition
osteoclasts
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
periosteum
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
osteoblasts
Term
which cells are responsible for calcium homeostasis
Definition
osteocytes
Term
collagen synthesis, osteoid maturation and mineralization are the three components of.....
Definition
bone formation
Term
these cells are cuboidal, have high synthetic activity and secrete procollagen to form osteoid, also store Ca and Phosphate in mitochondrial granules
Definition
osteoblasts
Term
procollagen cleavage, collagen deposition and crosslinking are the three components of .....
Definition
osteoid maturation
Term
what is the lag time for mineralization?"
Definition
5-10 days
Term
nucleation, osteoblast controlled (alkaline phosphatase, lipids) and osteocytes are the three components of....
Definition
mineralization
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
bone resorption
Term
these cells secrete protons and collagenolytic enzymes (MMPs)
Definition
osteoclasts
Term
this process involves formation + resorption of bone
Definition
bone remodeling
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
bone fluid compartment
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
collagen I
Term
Which part of the paraxial mesoderm produces skeletal muscles?
Definition
Myotome
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
Apical ectodermal ridge
Term
What signal influences digit number and identity on the limb?
Definition
Sonic Hedgehog
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
Meningomyelocele
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
Osteoblasts
Term
What is Wolff’s law?
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
Polygenetic
Term
What increases the risk of a dislocated hip in an infant?
Definition
Breech birth
Term
What is the syndrome where a patient has failure of separation of the vertebra (block vertebra)?
Definition
Klippel-Feil syndrome
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
Erb Palsy
Term
What is the longest bone without ossification centers at both ends?
Definition
Clavicle
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
Anterior
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
Brachial artery
Term
Muscle necrosis of the forearm flexors results in what?
Definition
Volkmann contracture
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
Knee extension
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
Dorsal foot
Term
What could cause injury to the superior gluteal nerve?
Definition
Polio or hip dislocation
Term
Damage to the C5 nerve results in a reflex change in what tendon?
Definition
Biceps tendon
Term
Damage to the C6 nerve results in a reflex change in what tendon?
Definition
Brachioradialis
Term
Damage to the S1 nerve results in a reflex change in what tendon?
Definition
Achilles
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
Type 1
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
Vitamin D deficiency
Term
Osteomalacia in children is known as what?
Definition
Rickets
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
Trabecular bone
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
Cement lines (“Mosaic”)
Term
What can Paget disease lead to?
Definition
Osteogenic sarcoma
Term
Vascular insult to growing bone can lead to what pathology?
Definition
Osteochondrosis
Term
What is the main blood supply of the femoral head?
Definition
Medial femoral circumflex artery
Term
What is Perthes disease?
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
Skin, URI, dental
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
Pain, fever, tenderness
Term
What are the most common bugs causing osteomyelitis in patients with implants?
Definition
Coagulase negative Staph
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
epiphyseal tumors
Definition
giant cell tumor
Term
metaphyseal tumors
Definition
osteogenic sarcoma (OGS)
non-ossifying fibroma (NOF)
endochondroma (fingers)
osteochondroma
chondrosarcoma
simple cyst
mets
myeloma
Term
diaphyseal tumors
Definition
osteoid osteoma
Ewings sarcoma
Mets
Myeloma
Term
most common hand tumor
Definition
endochrondroma
Term
tumors found in prepubescence
Definition
simple cyst, non-ossifying fibroma
Term
tumors found after 60 yo
Definition
chondrosarcoma
mets
myeloma
Term
where do metastases go?
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
brachial plexus (C5-T1)
Term
prior to gastrulation the embryo consist of ...
Definition
epiblast and hypoblast
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
6 weeks in utero
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
Apert syndrome
Term
what gene is responsible for limb patterning?
Definition
Hox gene (proximodistal axis)
Term
what gene is responsible for digit # and shape?
Definition
Shh (sonic hedgehog)
Term
what protein forms the post-axial border
Definition
ZPA
Term
longitudinal deficiency of post-axial border of the leg results in
Definition
fibular hemimelia
Term
preaxial longitudinal deficiency of post-axial border manifests in a short or absent radial bone and a shrunken thumb, called
Definition
radial hemimelia
Term
immovalbe joint development is differentiated into dense connective tissue ______ or cartilage _______
Definition
syndesmosis
syndchondrosis
Term
immovable joints form by
Definition
synarthrosis
Term
movable joints form by
Definition
diarthrosis
Term
movable joint development occurs when borders of the interzone differentiate into _____ that will line the future joint cavity
Definition
synovial membrane
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
sclerotome
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
myotomal hypomere
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
V-sign/Dermatomyositis
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
menisci
Term
medial and lateral menisci connected anteriorly by small transverse ligament are found where?
Definition
menisci of the knee
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
obdurator nerve
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
chondrosarcoma
Term
action/innervation of the flexor carpi radialis (FCR)
Definition
flex/abduct wrist
median nerve
Term
two causes of chronic infectious arthritis
Definition
TB
Lyme disease
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
what are link proteins?
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
complexity of tissue
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
plasminogen
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
Fc portion of IgG
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
Rheumatoid Arthritis
Term
this treatment for RA has rapid, potent suppresion of inflammation, but short efficacy and long term toxicity...what is it?
Definition
Corticosteroids
Term
what is the first line disease modifying agent (DMARD) for rheumatoid arthritis?
Definition
Methotrexate
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
anakinra
Term
what RA drug targets T cell co-stimulation
Definition
abatacept
Term
what RA drug targets B cells?
Definition
Riuximab
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
psoriatic arthritis
Term
what is the most common form of crystal-induced arthritis
Definition
gout
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
primary hyperuricemia
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
monoarticular arthritis
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
true!
Term
clinical diagnosis is not definitive for gout (true or false)
Definition
true!
Term
In gout:
we expect (left or right) shift on CBC
we expect (elevated or low?) CRP
Definition
left shift
elevated CRP
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
gout
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
gout
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
idiopathic
Term
pseudogout occurs when their is an initial damage to the _____ cartilage followed by mineral deposition w/n ______ cartilage matrix
Definition
articular
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
blue
Term
mineralization of articular cartilage and fibrocartilage (meniscus) is the definition of
Definition
chondrocalcinosis
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
amelia
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
the long thoracic nerve
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
radial nerve
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
forearm flexor muscles
Term
hand of benediction is due to injury to which nerve
Definition
median nerve
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
axillary nerve
Term
fusion of adjacent digits involveing the skin and in some cases bone
Definition
syndactyly
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
Supporting users have an ad free experience!