Term
| superficial fatty layer of anterior abdominal wall |
|
Definition
|
|
Term
| membranous layer of superficial fascia of anterior abdominal wall |
|
Definition
|
|
Term
| scarpa's fascia is continuous with what other fasciae? |
|
Definition
| Dartos in scrotum and Colles in peritoneum |
|
|
Term
| dermatome that enervates xiphoid process |
|
Definition
|
|
Term
| dermatome that enervates umbilicus |
|
Definition
|
|
Term
| dermatome that innervates skin superior to pubic symphysis |
|
Definition
|
|
Term
| dermatome that innervates skin overlaying pubic symphysis |
|
Definition
|
|
Term
| superficial nerves that arise near mid axillary line in abdomen |
|
Definition
| lateral cutaneous branches of the intercostal and subcostal nerves |
|
|
Term
| outer most abdominal muscle |
|
Definition
|
|
Term
| origin and insertion of external oblique |
|
Definition
origin: angles of lower ribs
insertion: outer ant half of iliac crest, pubic tubercle and crest, aponeurosis of ant rectus sheath |
|
|
Term
| actions of abdominal oblique |
|
Definition
| support abdominal wall, assists forced expiration, aids raising intraabdominal pressure and, with muscle of opposite side, abducts and rotates trunk |
|
|
Term
| innervation of external abdominal oblique |
|
Definition
|
|
Term
| origin and insertion of internal oblique |
|
Definition
orig: lumbar fascia, ant 2/3s of iliac crest and lat 2/3s of inguinal ring
insertion: costal margin, aponeurosis of rectus sheath (ant and post), conjoint tendon to pubic crest and pectineal line |
|
|
Term
| action of internal abdominal oblique |
|
Definition
| Supports abdominal wall, assists forced respiration, aids raising intraabdominal pressure & , with muscles of other side , abducts and rotates trunk. Conjoint tendon supports post wall of inguinal canal |
|
|
Term
| innervation of internal abd oblique |
|
Definition
| Ant primary rami (T7-12) (conjoint tendon ilioinguinal N (L1)) |
|
|
Term
| transversus abd orig and insert |
|
Definition
orig: Costal margin , lumbar fascia, ant two thirds of iliac crest and lat half of inguinal lig
insert: Aponeurosis of post and ant rectus sheath and conjoint tendon to pubic crest and pectineal line |
|
|
Term
| action of transversus abd |
|
Definition
| Supports abdominal wall, aids forced expiration and raising intraabdominal pressure. Conjoint tendon supports post wall of inguinal canal |
|
|
Term
| innervation of transversus abd |
|
Definition
| Ant primary rami(T7-12). Conjoint tendon ilioinguinal N (L1) |
|
|
Term
| the superficial ring is an opening in what muscular aponeurosis? |
|
Definition
|
|
Term
| medial crus of inguinal ring is part of what muscle? |
|
Definition
|
|
Term
| fibers that prevent the inguinal ring from spreading apart |
|
Definition
|
|
Term
| lateral crus of inguinal ring is part of which mucle? |
|
Definition
|
|
Term
| as the external abd oblique extends from inguinal ring to spermatic cord, what tissue layer does it become? |
|
Definition
| external spermatic fascia |
|
|
Term
| nerve that exits inguinal canal through superficial ring (but does not enter through deep ring) and supplies sensory to anterior external genitalia and medial thigh |
|
Definition
|
|
Term
| ligament that is the inferior border of the aponeurosis of external oblique |
|
Definition
|
|
Term
| ligament that is formed by medial fibers of inguinal ligament that turn posteriorly to attach to pectin pubis |
|
Definition
|
|
Term
| 2 things that comprise bone strength |
|
Definition
| bone quantitiy (BMD) and bone quality |
|
|
Term
| what is the T score parameter for osteoporsis? osteopenia? |
|
Definition
osteoporosis: 2.5
Osteopenia: 1 |
|
|
Term
| what online algorithm should be used to determine if you should treat osteopenic patients? |
|
Definition
|
|
Term
| recommendations for all pts in order to avoid osteoporosis |
|
Definition
intake of Ca and vit D
weight bearing exercise
fall prevention
avoid tobacco and EtOH excess |
|
|
Term
| what is the one anabolic agent used to treat osteoporosis? |
|
Definition
|
|
Term
| what is the general mechanism of action for all antiresorptive osteoporosis drugs? |
|
Definition
| inhibit osteoclast function |
|
|
Term
| drugs for osteoporosis in men |
|
Definition
| alendronate, risedronate, zoledronic acid, teriparatide |
|
|
Term
| how should estrogen be used in osteoporosis treatment? |
|
Definition
| only as a preventative measure in post men women |
|
|
Term
| MOA for estrogen in preventing osteoporosis |
|
Definition
| complex, including suppressing osteoclastogenic cytokine production in T cells and osteoblasts (such as Il1, Il6, TNFalpha) and inducing suppssion of Fas Ligand leading to osteoclast apoptosis |
|
|
Term
| what are the safety issues with estrogen preventative therapy for osteoporosis? |
|
Definition
| breast cancer, stroke, CVD, venous thromboembolism (VTE) |
|
|
Term
| which drugs are approved to prevent vertebral, hip, and non-vertebral fractures? |
|
Definition
bisphosphonates: alendronate, risedronate, zoledronic acid
Also, denosumab |
|
|
Term
| what type of fractures does calcitonin prevent? |
|
Definition
|
|
Term
| what type of fractures does raloxifene prevent? |
|
Definition
|
|
Term
| what type of fractures does ibandronate prevent? |
|
Definition
|
|
Term
| what type of fractures does aledronate prevent? |
|
Definition
| vertebral, non vertebral, and hip |
|
|
Term
| what type of fractures does risedronate prevent? |
|
Definition
| vertebral, non vertebral, hip |
|
|
Term
| what type of fractures does zoledronic acid prevent? |
|
Definition
| vertebral, non verteral, hip |
|
|
Term
| what type of fractures does denosumab prevent? |
|
Definition
| vertebral, non vertebral, hip |
|
|
Term
| what type of fractures does teriparatide prevent? |
|
Definition
|
|
Term
| what is calcitonin approved for in osteoporosis treatment? |
|
Definition
| only postmenopausal osteoporosis |
|
|
Term
| how is calcitonin administered? |
|
Definition
| 200 units nasal spray daily or 100 IM every other day |
|
|
Term
| adverse effectes of calcitonin |
|
Definition
| rhinitis, rarely epistaxis, nausea and flushing when injected |
|
|
Term
| how effective is calcitonin as an anti-osteoporosis measure/ how should you use it? |
|
Definition
| very weak, 2nd or 3rd line; use to relieve pain from vertebral fractures |
|
|
Term
|
Definition
| prevention and treatment of osteoporosis |
|
|
Term
|
Definition
|
|
Term
| what is the mechanis of raloxifen and what advantage does it have? |
|
Definition
| it is a selective estrogen receptor modulator (SERM), estrogenic activity in bone, but prevents increased risk of breast cancer associated with estrogen while maintaining bone benefits |
|
|
Term
| what are the risks of raloxifene? |
|
Definition
| does not prevent hot flashes and has same increased risk of VTE as estrogen |
|
|
Term
| What is the efficacy of raloxfene/how is it commonly used in osteo therapy? |
|
Definition
| 2nd line (only decreases risk of vertebral fractures and has no effect on hip or other fractures) |
|
|
Term
| what drugs are considered first line treatment of postmenopausal osteoporosis? |
|
Definition
| bisphosphonates: alendronate, risedronate, zoledronic acid, but not ibandronate (no nonvert or hip prevention) |
|
|
Term
| how is zoledronic acid administered? |
|
Definition
|
|
Term
|
Definition
| bind to bone mineral and concentrate at sites of resorption, get taken up by osteoclasts and bind proteins nec for osteoclast fxn |
|
|
Term
| what is the order of affinity for bone among bisphosphonates? |
|
Definition
|
|
Term
| enzyme that bisphosphonates inhibit |
|
Definition
| farnesyl pyrophosphate synthase (FPPS) |
|
|
Term
| what is the order of inhibition potency of FPPS by bisphosphonates? |
|
Definition
|
|
Term
| what is the absorption of bisphosphonates like? how does this affect drug dosing? |
|
Definition
| poorly absorbed, but you only need a little bit. It is important that directions are closely followed in OP: take in morning on empty stomach, avoid other drugs at least 30min after |
|
|
Term
| how are bisphosphonates metabolized in the body? |
|
Definition
| they are not; bisphosphonate that does not bind to bone is rapidly excreted in urine |
|
|
Term
| when should you avoid bisphosphonates? |
|
Definition
| pts with creatinine clearance below 30-35mL/min |
|
|
Term
| what are side effects of bisphosphonates? |
|
Definition
| esophageal irritation (if oral), acute phase rxn (IV), adverse renal effects (IV), hypcalcemia, musculoskeletal pain, a fib, esophageal cancer, osteonecrosis of jaw (ONJ), atypical femur fractures |
|
|
Term
| patient starts taking bisphosphonates but develops flu like symptoms shortly after starting; what do you do? |
|
Definition
| warn them that this is common and symptoms should resolve in a few days |
|
|
Term
| what is osteonecrosis of the jaw? |
|
Definition
| exposed necrotic bone in maxillofacial region, not healing w/in 8wks, in pts with no history of craniofascial radiation, appears as areas of exposed yellow or white hard bone with smooth or ragged borders |
|
|
Term
| what are some risk factors for ONJ? |
|
Definition
| dental extractions, bisphosphonates, cancer, chemo, corticoid use, immunosuppression, hypercoagulability |
|
|
Term
| characteristics of atypical femur fracture |
|
Definition
| transverse noncomminuted fracture, cortical hypertrophy |
|
|
Term
|
Definition
| fully human MAB against RANK ligand; inhibits osteoclast formation , thus decreasing bone resorption |
|
|
Term
| administration of denosumab |
|
Definition
| 60mg injection every 6 months |
|
|
Term
| safety issues for denosumab |
|
Definition
| URI, UTI, skin rxnz, hypocalcemia, musc skel pain, ONJ, AFF |
|
|
Term
|
Definition
| bisphosph still preferred 1st line, but could be used in high fracture risk pts (older, difficulty with dosing, renal problems) |
|
|
Term
|
Definition
| recombinant PTH; normally pth stimulates osteoclasts (throught osteoblasts) but when given intermittantly, stimulates osteoblasts more |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypercalcemia, muscle cramps, nausea, dizziness, osteosarcoma |
|
|
Term
| what are contraindications for using teriparatide in osteoporosis pts? |
|
Definition
| pts with increased risk of bone cancer (pagets, unexplained alk phos elevation), history of radiation to skeleton |
|
|
Term
| what are the recommendations to avoiding osteosarcoma from teriparatide? |
|
Definition
| no more than 2yrs on teriparatide in a pts lifetime |
|
|
Term
| when do you use teriparatide? |
|
Definition
| post menopausal women with unusually severe osteoporosis or failed to respond to bisphosph |
|
|
Term
| 65 yo woman with t score 2.6, in total hip upon routine DEXA, history of severe gastroparesis due to long standing poorly controlled diabetes. Tx options? |
|
Definition
|
|
Term
| 68 yo woman with new onset back pain was found to have acute T12 vertebral compression fracture. DEXA 3.8 in spine. uses prednisone for RA. Tx options? |
|
Definition
| calcitonin for pain, could do bis or teriparatide |
|
|
Term
| how is the skin a barrier to viruses? |
|
Definition
| outer layer is dense, viruses can't replicate there |
|
|
Term
|
Definition
| neutrophils + necrotic debris +/- microorgs |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| localized collection of put within tissue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| staph aureus and streptococcus |
|
|
Term
| what staph species are coagulase negative? |
|
Definition
| staph epi and staph saprophyticus |
|
|
Term
| streptococci catalase test |
|
Definition
|
|
Term
|
Definition
|
|
Term
| test to determine type of strep |
|
Definition
| hemolysis (alpha, beta, or gamma) |
|
|
Term
| group A strep has what kind of hemolysis? |
|
Definition
|
|
Term
| primary reservoir of s aureus |
|
Definition
|
|
Term
| people with staph aureus infections most likely got it from what source? |
|
Definition
|
|
Term
| pyogenic infections with abscesses is most likely what bacteria? |
|
Definition
|
|
Term
| s aureus can cause what kind of toxin mediated presentation? |
|
Definition
| TSS, scalded skin syndrome, food poisoning |
|
|
Term
|
Definition
|
|
Term
|
Definition
| boil; large painful raised nodules, can see pus excreted, base of neck is most common |
|
|
Term
|
Definition
| deep dermis and subcu tissue |
|
|
Term
| staph impetigo is commonly seen in whom? |
|
Definition
|
|
Term
| infection of bone or joints is most likely from what organism? |
|
Definition
|
|
Term
| staphylococcal disease caused by super antigens |
|
Definition
| STSS, staph food poisoning |
|
|
Term
| toxins that cause staphylococcal scalded skin syndrome (exfoliating) |
|
Definition
|
|
Term
| who is most commonly affected by SSSS? why? |
|
Definition
| infants <1yo; they possess a receptor for exfoliating toxin that is no longer expressed in most adults |
|
|
Term
| two types of STSS; what are their causes? |
|
Definition
menstrual: superabsorbant tampons (not made anymore), produce TSST-1 (superag)
non menstrual: surgical wounds, skin leisons, peritoneal dialysis catheters, caused by TSST-1 and SEB (both superags) |
|
|
Term
| toxic shock syndrome caused by which organism is more likely to reveal blood cultures, staph or strep? |
|
Definition
|
|
Term
| most common staph type of prosthatic device infections |
|
Definition
|
|
Term
|
Definition
|
|
Term
| describe the surface virulence factors of GAS |
|
Definition
M protein: antiphagocytic
LTA: adhesion, stimulate inflammation
fibronectin binding protein: adhesion
hyaluronic acid capsule: antiphagocytic |
|
|
Term
| describe the extracellular virulence factors of GAS |
|
Definition
streptolysins O and S (lyse cells)
streptokinase: lyse clots
C5a peptidase (prevent complement)
DNAases/streptodornase (break down DNA)
Hyaluronidase (break down H acid)
SPEA, b, C (produce fever, nec fasc, STSS) |
|
|
Term
A 24-y.o. male was brought to local ER because of severe pain and swelling that had developed that day in his left thigh. The pain had progressed rapidly; before seeking treatment, he developed a high fever, became extremely weak, and was unable to walk without assistance.
He had been in good health, but the day before this illness, he had a minor injury to his leg while playing soccer. This started as a small area of redness at the site of injury on his left thigh, but is now more grayish.
VS T 104 F, P 138/min, BP 70/40 PE; moderate stress due to pain; appeared acutely ill. Left thigh is purplish and swollen.
CT showed edema of soft tissues.
What do you think?
|
|
Definition
Ddx: staph aureus, C perf, gram - bact, s aur and s pyogenes
S pyogenes is most common bact to cause these symptoms in immunocompetant pts. |
|
|
Term
| two most common causes of nec fasc |
|
Definition
|
|
Term
| what is impetigo, what is the current most common cause? |
|
Definition
superficial infection of skin, colonization followed by minor trauma, yellow crusts
s aureus is most common cause (also GAS) |
|
|
Term
|
Definition
| invasive, reddening, butterfly-shaped infection of skin by strep |
|
|
Term
| sequelae from non-suppurative post streptococcal infection |
|
Definition
| acute glomerulonephritis, rheumatic fever |
|
|
Term
|
Definition
| most are penicillin sensitive (unlike staph) |
|
|
Term
| most common cause of hematogenous osteomyelitis |
|
Definition
|
|
Term
| is you suspect bone infection, what should you do before treatment? |
|
Definition
|
|
Term
| osteomyelitis in sexually active pts can be caused by |
|
Definition
|
|
Term
| osteomyelitis in diabetics and drug addicts can be caused by |
|
Definition
|
|
Term
| osteomyelitis in sickle cell disease can be caused by what? |
|
Definition
|
|
Term
| prosthatic joint replacements can become colonized by what bacterial strains? |
|
Definition
|
|
Term
| TB can infect what type of bone commonly? |
|
Definition
|
|
Term
|
Definition
| bulge or protrusion of an organ through muscle that normally contains it |
|
|
Term
| majority of hernias are what kind? |
|
Definition
|
|
Term
| least frequent and most complicated hernia |
|
Definition
|
|
Term
| what percentage of inguinal hernias are indirect, direct? |
|
Definition
|
|
Term
|
Definition
| blood supply is complicated or cut off, leads to necrosis (this is emergency) |
|
|
Term
| which type of hernia is the most likely to strangulate? |
|
Definition
|
|
Term
|
Definition
| both direct and indirect components |
|
|
Term
|
Definition
| contains antimesenteric portion of small bowel (knuckle of bowel caught between space in muscles, hard to feel but very painful) |
|
|
Term
|
Definition
| contains Meckel's diverticulum |
|
|
Term
|
Definition
| hernia at inferior lumbar triangle |
|
|
Term
|
Definition
| hernia at superior lumbar triangle |
|
|
Term
|
Definition
| can be replaced within surrounding musculature (w/o surgery) |
|
|
Term
|
Definition
| cannot be reduced, most commonly occurs in large hernias through small openings that obstruct blood flow and prevent reduction |
|
|
Term
| What is the risk of a direct hernia incarcerating? |
|
Definition
| low, these rarely incarcerate |
|
|
Term
|
Definition
| formed by the periosteum and fascia along superior ramus of pubis |
|
|
Term
| borders of hesselbach's triangle, what kind of hernia is here? |
|
Definition
| lateral border of rectus sheath, inguinal ligament, inferior epigastric vessels; direct hernias |
|
|
Term
| acquired umbilical hernias can present as a result of what disorders? |
|
Definition
| cirrhosis, ascites, obesity, malnutrition |
|
|
Term
| what are the boundaries of the area where femoral hernias take place? |
|
Definition
| inguinal ligament, lower border of pubic bone, femoral vein |
|
|
Term
| femoral hernias are more common in women or men? why? |
|
Definition
| women; they have a larger gap due to shape and angle of pelvis |
|
|
Term
|
Definition
| transversalis fascia is sewn to poupart's ligament |
|
|
Term
|
Definition
| 4 layer suture to close the inguinal floor |
|
|
Term
|
Definition
| transversalis fascia sewn to cooper's ligament (used in femoral hernias |
|
|
Term
|
Definition
| prosthatic patch placed over defect, tension free with less pain and lower recurrance rate |
|
|
Term
| when is laproscopic hernia indicated over other repairs? |
|
Definition
| recurrant hernia (we want to operate in a different tissue plane) or bilateral inguinal hernias (fix both sides at the same time with less problem of recurrance) |
|
|
Term
| surgical complications for hernia repair |
|
Definition
| recurrance, infection, neuralgia, bladder injury testicular injury, vas def injury, |
|
|
Term
| what nerves can be damaged inhernia repair? |
|
Definition
| illioinguinal, genitofemoral |
|
|
Term
| how can hernia repair result in injury to testicle or vas def? |
|
Definition
| you often take the cremasteric fascia off to separate from hernia sac |
|
|
Term
| keratinocytes with prominant centrioles are in what layer? |
|
Definition
| stratum basalum (rapdily dividing cells) |
|
|
Term
| mutations in proteins that affect coiled dimers of keratinocytes result inwhat phenotype? |
|
Definition
| blistering, esp hands and feet |
|
|
Term
| simplex form of epidermolysis bullosa has mutations in what genes? |
|
Definition
|
|
Term
| dystrophic form of epidermolysis bullosa has mutations in what genes? |
|
Definition
|
|
Term
| what is the phenotypic difference between simplex and dystrophic forms of epidermolysis bullosa? |
|
Definition
simplex blistering reveals underlying vasculature, increased risk for systemic infections
dystrophic has solid base of epidermis that acts as a barrier to pathogens (less systemic infections) |
|
|
Term
| how are we starting to treat epidermolysis bullosa? |
|
Definition
| culture keratinocytes and transfect with normal cDNA, transplant sheets |
|
|
Term
| 2 histological features of keratinocytes from stratum granulosum |
|
Definition
| lamellar bodies and keratinocyte granules |
|
|
Term
| ichthyosiform erythroderma pathology |
|
Definition
| loss of lamellar bodies, reduction in keratinocyte granules, appearance of lysosome-like structures |
|
|
Term
| 2 isoforms of ichtyosiform erythroderma and what's the diff? |
|
Definition
mild: thick stratum corneum, some keratinocyte granules persist
severe: interlocking mass irregularly organized, no keratohyalin granules |
|
|
Term
| clinical diff btw mild and severe ichthyosiform erythroderma? |
|
Definition
mild has thick skin, therapeutically corrected with retinoic acid.
severe form has interlocking stratum corneum, usually lethal at birth (force of the birth causes stillborn infant) |
|
|
Term
| cells that contain birbeck's granules; what are they? |
|
Definition
| langerhans cells; these are envaginations of the plama membrane which can sample antigens from the environment and then represent on the surface to signal T cells, contain clathrin coats for cytosis |
|
|
Term
| what cell of the skin is a victem in HIV infections? what does this result in? |
|
Definition
| langerhans cells; noninfectious (most common) are seborrheic dermatitis, papular urticaria, Reiter's syndrome, psoriasis; infectious: herpes, candidiasis, cytomegalo and pappiloma viruses |
|
|
Term
| melanocytes are derivatives of what embryological tissue? |
|
Definition
|
|
Term
| what is the precursor molecule for all types of melanin? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| critical enzyme in creating melanin from tyrosine |
|
Definition
|
|
Term
| what test do you do to albino children; what information does this give you? |
|
Definition
| test tyrosinase; if tyrosinase + usually get better. If tyrosinase -, don't get better and are susceptible to blindness and skin cancer |
|
|
Term
| what tests should you do to assess blistering disorders? |
|
Definition
histology: look inside blister for lymphocytes
direct immuno fluorescence: see if Abs against human abs stain at basement membrane
do western blott to figure out what the ag is
do EM ultrastructural analysis, look at keratinocyte, dermis and BM |
|
|
Term
| the loss of what type of bone causes increased fractures with age? |
|
Definition
|
|
Term
| why do we have increased osteoclast function as we age? |
|
Definition
| uncoupling of osteoclasts and blasts |
|
|
Term
| estrogen's effect on bone |
|
Definition
| blocks osteoblasts response to PTH |
|
|
Term
| bone density peaks at what age? |
|
Definition
|
|
Term
| age that long bones stop growing in males and females |
|
Definition
|
|
Term
| which dietary minerals affect peak bone mass? |
|
Definition
| Ca, protein, phosph, vit D, vit K |
|
|
Term
| when do men begin to lose bone mass, how much? |
|
Definition
|
|
Term
| when do women have the most bone loss? |
|
Definition
|
|
Term
| age related osteoporosis affects what kind of bone? |
|
Definition
| both cortical and trabecular |
|
|
Term
| in senile osteoporosis, what kinds of fractures are most common? |
|
Definition
|
|
Term
| what are factors that go into FRAX assessment tool? |
|
Definition
| age, sex, race, weight, height, prior fracture history, parent fracture history, smoking, >3EtOH/day, corticoids, 2ndary osteoporosis, RA, femoral neck bone density |
|
|
Term
| what is ideal serum Ca concentration? |
|
Definition
|
|
Term
| if blood Ca is too low, what does that cause? |
|
Definition
| tetani (skel muscles contracting) |
|
|
Term
| if blood ca is too high, what does that cause? |
|
Definition
| deposit calcium in bone, calcium rigor (cardiac failure) |
|
|
Term
| where is calcium absorbed most rapidly? |
|
Definition
|
|
Term
| if calcium intake is low, what type of transport is used? |
|
Definition
|
|
Term
| when lots of Ca is ingested, how is it absorbed? |
|
Definition
| passive transport (non vit d dependent, not limited) |
|
|
Term
| what increases bioavailability/absorption of Ca? |
|
Definition
|
|
Term
| what decreases Ca absorption? |
|
Definition
| low vit d, low gastric acidity, high intake of fiber, oxalate, phytates |
|
|
Term
| after 50, what is the RDA of Ca for men and women? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are some good sources for Ca? |
|
Definition
| dairy products, yogurt, tofu, almonds, clams, white beens, turnip greens, orange, calc-fortified OJ |
|
|
Term
| what sort of individuals should you target for calc supplementation? |
|
Definition
| those consuming inadequate diets (dieters, vegans), those who avoid dairy products, osteoporotic |
|
|
Term
| what are the risks of vit D and calcium supplements for primary prevention of fracture? |
|
Definition
|
|
Term
| ratio of ca to Phosph in bone |
|
Definition
|
|
Term
|
Definition
| unrefined grains, vegetables (dark green), seeds, nuts, legumes, milk |
|
|
Term
|
Definition
| increased intake associated with increased bone density |
|
|
Term
|
Definition
|
|
Term
| where is Vit D become 25 hydroxy vit d? |
|
Definition
|
|
Term
| organ that converts 25 hydroxy vit D to 1,25 form |
|
Definition
|
|
Term
| how does vit d affect bones? |
|
Definition
increasing absorption of Ca and P from GI
increasing resorption of Ca and P from bone
increasing of Ca and P by kidneys |
|
|
Term
| disorders associated with vit d deficiency |
|
Definition
Rickets
osteomalacia
osteoporosis |
|
|
Term
bone pain, muscular tenderness, hypocalcemic tetany, soft pliable bones manifested as bowed legs, knock knees, beaded ribs, pigeon breast, and frontal bossing of the skull.
|
|
Definition
|
|
Term
|
Definition
|
|
Term
| what can cause decreased synthesis of vit d from sunlight? |
|
Definition
| dark skin, SPF, smog and clouds |
|
|
Term
|
Definition
| egg yolk, fatty fish, liver, fortified products |
|
|
Term
| AAP recommendation of vit d supplements in infants |
|
Definition
| 400/day; breast milk is poor source of vit d |
|
|
Term
| in older adults, what's the recommended vit d supplementation? |
|
Definition
|
|
Term
| effect of protein on bone |
|
Definition
| achieve peak bone mass in youth, avoid resorption in pts with neg nitro balance. imp in preventing falls |
|
|
Term
|
Definition
| forming matrix proteins like osteoclacin |
|
|
Term
|
Definition
| dark green leafy vegetables, vegetable oil |
|
|
Term
| how does obesity affect bones? |
|
Definition
increased lean and fat mass increases bone density,
but increased visceral fat decreases bone density |
|
|
Term
| how does excessive vit A affect bone? |
|
Definition
| increase risk for fracture |
|
|
Term
| four basic principles of medical ethics |
|
Definition
| beneficence, non-maleficence, autonomy, justice |
|
|
Term
| 4 things for evaluating capacity |
|
Definition
communicate
understand
reason
appreciate situation and consequences |
|
|
Term
| 4 quadrants approach to ethics consult |
|
Definition
medical indications
pt preferences
QoL
contextual features |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| if pt has metal impants, where do you do DEXA scan? |
|
Definition
|
|
Term
|
Definition
| pt's BMD compared to mean and std in young control population, used for therapy guidance in post men women |
|
|
Term
|
Definition
| pt's BMD compared to mean and std in AGE MATCHED controls |
|
|
Term
| which imaging technique do you use for bone marrow density? |
|
Definition
|
|
Term
| a bone scan is what kind of imaging, how does it work? |
|
Definition
| nuclear imaging; bone-seeking radioactive compound (Tc99m methylene diphosphonate) injected into pt. images obtained 3hrs later |
|
|
Term
| on a bone scan, how does radio compound localize in body? |
|
Definition
| blood flow, osteogenic activity, interrupted sympathetic nerve supply |
|
|
Term
| what are indications for a bone scan? |
|
Definition
| evaluation for skeletal metastasis (osteoblastic), osteomyelitis, stress fracture |
|
|
Term
| how should you do a bone scan for osteomyelitis? |
|
Definition
| early flow images over 60s, then evaluate again 3hrs later |
|
|
Term
| how is sensitivity and specificity in a bone scan? |
|
Definition
| hi sensitivity, low specificity |
|
|
Term
|
Definition
|
|
Term
|
Definition
| overlyin skin is not intact |
|
|
Term
|
Definition
| bone has been weakened by disease |
|
|
Term
|
Definition
| bone broken into more than 2 pieces |
|
|
Term
| legg-calve-perthe syndrome |
|
Definition
| osteochondritis of the hip joint, leads to collapse of the hip joint, commonly found in young children (boys>girls), loss of blood supply to femoral head (ischemic necrosis); may have subcortical fracture, fracture of epiphysis, often leads to osteoarthritis |
|
|
Term
|
Definition
| partial fracture of a bone (common in children since their bones are more flexible) |
|
|
Term
|
Definition
common wrist fracture in older adults
fracture of distal radius with dorsal angulation distal fragment, usually from fall. may have dinner fork deformity |
|
|
Term
|
Definition
| fracture through posterior elements of C2 |
|
|
Term
|
Definition
unusual completely transverse fracture (no jagged edges or fragments)
in long bones, common in paget's
in vertebrae, common in ankylosing spondylitis |
|
|
Term
|
Definition
| orbital bones, blunt trauma, may entrap rectus muscle (diplopia), often wise to wait many days before deciding on tx |
|
|
Term
|
Definition
| fracture of medial and lateral malleoli; distal fibula and tibia may also be additionally fractured |
|
|
Term
|
Definition
soon begins with hemorrhage leading to hematoma contained by periosteum.
inflammatory cells (attracted by soluble mediators)
osteoclasts activated, remove necrotic bone
granulation tissue laid down
soft callus of woven bone
hard callus
remodelling over months (replace woven bone by lamellar bone) |
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