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basic science Flashcards

1
Q

receiver operator curve

A

true positive (1-Sp) on y-axis; false negative (1-Sp) on x-axis

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2
Q

confirmation bias

A

when surgeons recall studies that prove their treatment and forget contradictory evidence

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3
Q

pelvic incidence and lordosis

A

PI - LL should be LESS THAN 11

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4
Q

Lesch Nyhan syndrome

A

severe MR; SELF MUTILATING/AGGRESSIVE; severe progressive scoli; wheel chair bound; hib sublux/dislocation is very common

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5
Q

gene for Lesh Nyhan

A
  • x-link rec; males; hypoxanthing guanine phosphoribosyl transferase (HPRT) - needed for purine metabolism
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6
Q

deficiency in morquio syndrome

A

n-acetylgalactosamine 6- sulfate sulfatase

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7
Q

deficiency in hurler

A

alpha L iduronidase;

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8
Q

deficiency in gaucher

A

beta gluccocerebrosidase

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9
Q

degnen disc disease has what effect on chondrocytes

A

apoptosis

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10
Q

order of inflammatory cytokines

A

IL 1 B; TNF alpha; then Nitric oxide and MMP’s

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11
Q

what is min brace hrs/day for 90%success in AIS

A

12 hours - success defined as avoiding surgical threshold of 50 deg

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12
Q

what is inducible resistance in MRSA

A

a plasmid changes resistance via 50S ribosome ; seen in eryhtromycin resistant strains - causes resistance to Clinda - use a D-Zone test to rule this out

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13
Q

type 1 error is a

A

false positive - reject the null when you should accept the null

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14
Q

osteocalcin made by

A

osteoblasts; attracts osteoclastss and is abundant in matrix; regulates mineralization and bone denisity

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15
Q

fibrillin gene defect does what in marfans

A

alters binding of TGF b and leads to high levels in tissue - causes the aortic root dilitation

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16
Q

gymnasts wrist occurs at which part of physis

A

zone of prov calcification - generally repetitive loading stress occurs here as it interferes with metaphyseal perfusion - may see physeal widening from active hypertrophic zone

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17
Q

how do thiazolidinedione meds work

A

activate PPARy to differentiate mesenchymal cells towards fat cells - down regulate osteoblastic transcription factors leading to increased fracture risk

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18
Q

what is the pathophys of MHE

A

defect in heparin sulfate which leads to poor chondrocyte organization and dev of exostoses

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19
Q

drug elution time for vanc/tobra in cement

A

4 months

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20
Q

what is condition with ACVR1 gene defect

A

fibrodysplasia ossificans (stone man)

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21
Q

tx of infantile hipdysplasia without dislocation

A

pavlik if US shows low alpha angle

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22
Q

what does BMP 2 do

A

in inflammatory phase of bone healing it recruits mesenchymal stem cells

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23
Q

best approach for talar neck fractures

A

2 incision med/lateral with med mal osteotomy if needed

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24
Q

time dependent vs concentration dependent abx

A

vanc is time dependent -needs good trough dosing b/w doses; gent is concentration dependent

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25
Q

what is lubricin in joints

A

NOT part of cartilage matrix but MADE by c-cytes - glycoprotein to reduce friction

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26
Q

Anakinra blocks which cytokine

A

IL-1

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27
Q

what is fretting corosion

A

micromotion between two metals that are NOT loose

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28
Q

crevice corrosion is

A

affects oxygen tension due to micromotion disrupting the passivation layer

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29
Q

fisher test is for

A

categorical variable for SMALL numbers of data

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30
Q

Chi-Sq test is for

A

categorical variable for LARGE numbers of data

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31
Q

which two tests are for comparing categorical data

A

Fisher for small; chi-sq for large

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32
Q

Unpaired t test is for

A

continuous data

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33
Q

extrinsic vs intrinsic tendon healing

A

extrinsic is FASTER but MORE adhesions

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34
Q

how does primary bone healing occur at midpoint

A

osteoclasts and blasts invovled in remodeling of lamellar bone - OC use cutting cones; OB lay down new bone behind

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35
Q

what med helps spinal fusion in osteoporotic

A

teraperatide

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36
Q

best mdium for kingella growth

A

blood agar

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37
Q

kingella is gram

A

negative

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38
Q

time of sx before presentation kingella

A

9 days

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39
Q

what is granada agar used for

A

to isolate group B strep

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40
Q

what happens to disc during degeneration

A

increase Colllagen 1, and NON-enzyme x-links (this process increased adv glycation end products); Collagen 2 DECREASES;

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41
Q

increased cross linking in UHMWPE does what

A

decreases wear and decreased TOUGHness

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42
Q

how is primary bone healing accomplished

A

haversion remodeling

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43
Q

what enzyme is responsible for tumor invasion

A

MMPs - breakdown basement layer and interstitial stroma

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44
Q

what modality is BEST for detecting physeal bar

A

T1 MRI - bc wil show unossified bars too

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45
Q

Injury to what zone of physis causes growth arrest

A

resting zone - closes to epiphysis

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46
Q

what is order of zones of physis

A

epiphysis - resting > proliferation > hypertrophic (maturation, degen, provisional calicifcation) > metaphysis

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47
Q

where do most physeal fractures occur

A

in hypertrophic zone bw Provisional Ca and metaphysis

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48
Q

how to manage peds growh arrest from distal radius

A

simple bar - excise and fat; if small arrest in teenager epiphysiodesis of ulna is enough if asymptomatic) ; if large - corrective osteotomy

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49
Q

what is fatigue wear

A

progressive mechanical use and result of repetiive cyclic loads

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50
Q

post trauma ankle OA has similar impact on QoL as

A

ESRD and CHF_

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51
Q

pagets gene mutation

A

5q35-qter - ubiquitin binding protein sequestosome 1

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52
Q

what effect does motion have on tenon healing

A

collagen ORGANIZTION more than production

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53
Q

what condition shows tgf-beta excess

A

marfans

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54
Q

what is oncogenic osteomalacia

A

seen with osteoblastoma, fibrous dysplasia; and fibromas - FGF23 excess leads to poor phosphate resorption in kidneys and inhibits 1-alpha hydroxylase (low Phos and low 1,25 vit D)

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55
Q

what is pathogenisis of atlantoaxial sublux in rhA

A

Transverse lig becomes incompetent and Anterior ADI is wide

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56
Q

polylactic vs polyglycolic acids

A

used to make resorbable implants - PG has higher stiffness and resorbs FASTER 6-12 months vs 24 months for PL

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57
Q

what embroynic structure forms the disk

A

sclerotome

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58
Q

best stain for cartilage

A

safranin O and alcian blue

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59
Q

what is mode of failure for interference screw

A

graft tear, pull out or slippage

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60
Q

what is equation for number needed to treat

A

1/Absolute risk reduction

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61
Q

best mri for acute trauma

A

STIR - better than T2 bc STIR will supress fat and marrow edema

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62
Q

what is result of excess muscle-ski motion at ex-fix pin

A

increased inflammation and thus more pin site infections

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63
Q

how to double ex-fix pin stiffness without changing pin

A

bury the shank in proximal cortex

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64
Q

what is effect of HA coated ex-fix pin

A

improves pin/bone interface but INCREASED extraction torque

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65
Q

osteoclasts staining via

A

cathepksin K stain or TRAP

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66
Q

increased pin spread does what to a ex-fix

A

increased stability

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67
Q

in compression plating which screws get max stress

A

those FURTHEST from fracture - this is opposite of bridge plating

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68
Q

how to improve torsional strain in plate

A

4 screws on either side; no more improvement after 4

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69
Q

best rigidity construct for bridge plate

A

lowest working distance, and one more screw close to fracture, then one far away - like ex-fix

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70
Q

what is definition of frailty

A

decreased physio reserve and inability to respond to stressors

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71
Q

if you see peroneal tendon with third tendon

A

excise- p. quartus

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72
Q

growth factor timeline in masquelet

A

peak at 4 weeks; baseline at 6 months

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73
Q

where does artery of adamkiewc originate

A

T8-L1

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74
Q

what perecent of patients have lasting sx from plexus injury after lateral spine surgery

A

< 5% at 1 y; but start with up to 34% with LE weakness

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75
Q

what is ant retractor up against during post approach

A

psoas

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76
Q

what is distal limit of ant hip approach

A

femoral NERVE

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77
Q

risk of MRSA colonization

A

higher in blacks; lower in adv age and females

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78
Q

main risk of haringe approach to hip

A

Sup gluteal NERVE (not artery)

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79
Q

how do osteoblasts affect immute system and Hematopoitic cells

A

jagged1 - notch pathway

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80
Q

HYPERcoagulopathies

A

MTHFFR gene has highest risk; Factor V leiden; Proten C and S deficiency, Protein C resistance, elevated factor VIII (opposite of hemophilia)

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81
Q

conditions that increas risk of DVT

A

pregancny, cancer, OCP, hormone tx

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82
Q

what counterintuitive hypercoag state occurs after starting warfarin

A

rapid rise in INR after unopposed warfarin in post-arthroplasty - has to do with rapid consumption of protein C

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83
Q

other names for thromboplastin

A

TF, Platelet TF, CD 142

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84
Q

which shoulder arthroplasty patients get LMWH

A

if higher risk and not mobilized; ASA and antiplatelet alone is NOT enough

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85
Q

what E source after 4 min of aerobic

A

glycogen and FA

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86
Q

when is ATP used

A

first 10 seconds of anaerobic

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87
Q

avulsion 5th MT jones frx tx

A

SURGERY

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88
Q

osteophyte formatio pathway

A

IHH stimulates chondrocyte differentiation - leading to endochondral ossification

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89
Q

abatacept MoA

A

blcoks T-cell activiation via MHC

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90
Q

how does L5 root get injured in L5-S1 fusion

A

lateral exit of Sacral screw heading towards ALA

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91
Q

case series is what L of evidence

A

4; also includes poor quality cohort studies or case control

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92
Q

sarcomere units

A

A band is myosin section; I band is actin filament; H band is area with NO acitin myosin overlap; z band bisects I band

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93
Q

what is osteonectin

A

glycoprotein that is secereted by osteoBLASTS and binds to calcium - therby regulating mineralization

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94
Q

annulus fibrosis is derived from

A

mesoderm

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95
Q

osteoblast pathway for immune regulation

A

via PTH to jagged (osteoblast) notch (h-poeitic cells)

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96
Q

what is role of BMP 2

A

chondrocyte differentiation pathway for mesenchymal cells

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97
Q

which BMP is osteoinductive

A

5,6,7,

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98
Q

what is BMP 1

A

MMP for propreptidase 1,2, 3 collagen

99
Q

refractory osgood schlater treated with

A

resection of TT OSSICLE ONLY - does not involve patellar tendon

100
Q

deficiency in heparin sulfatase

A

san fillipo syndrome

101
Q

beta galactosidase deficiency leads to

A

morquio

102
Q

morquio defect

A

beta galactosidase deficiency

103
Q

systematic review of RCT and level 2 studies is overall

A

level 2

104
Q

tibial tubercle ossification and fusion

A

11 and 14 ossify (F, M); and 14 and 18 fusion

105
Q

cathepskin K inhibtor works to decrease which cells activitiy

A

osteoclasts

106
Q

what is start of common pathway for coag

A

X to Xa conversion which leads to conversion of prothrombin to thrombin

107
Q

what does aspirin block

A

Thromboxane A2

108
Q

the Xa inhibitors

A

Fondaparinaux(indirect); Apixaban and Rivaroxiban (direct)

109
Q

which zone of cartilage has least proteoglycan

A

superfiical

110
Q

what fixation method is at risk for pull out

A

staple

111
Q

what fixation method is at risk for breakage

A

transfixtion pin

112
Q

what fixation method is at risk for cortical bone pull through

A

cortical button

113
Q

golgi organs purpose

A

relay muscle tension and length, proprioception

114
Q

pacinian corpuscles relay

A

deep pressure and vibration

115
Q

ruffini ends conve

A

sustained presure sensation

116
Q

merkel cells convey

A

sustained touch and pressure sensation

117
Q

decorin protein role

A

regulates collagen fiber size (decorates with diff collagen sizes)

118
Q

osteocalcin requires

A

vitamin K and is a gamma carboxylation of glutamic acid

119
Q

gene assay tests

A

PCR -DNA; northernblot and RT PCR - RNA level; and Western blot is for protein

120
Q

freeze dried vs frozen allografts

A

freeze dried have same compression and tensile strength; but less torsional and bending

121
Q

does frozen graft have osteoinductive potential

A

yes limited; and has osteoconductive; lasts 1-5 years

122
Q

quad weakness leads to what during swing phase

A

knee hyperextension; hip flexors rapidly contract to flex femur and then gluts rapidly contract to slow femur - as a result tibia swings forward and hyperextends

123
Q

what is needed to maintain articular cartilage phenotype

A

PTH-RP

124
Q

role of aggreca

A

exerts swelling pressure against restraint of collagen

125
Q

what does type 6(VI) collagen do

A

mechanical signaling to chondrocytes

126
Q

how does clonazepam increase osteoporosis

A

does NOT interfere with vitamin D BUT can increase sclerositin levels and therby decrease osteoblast

127
Q

max length for nerve conduit

A

3cm

128
Q

order of nerve function return

A

sympathetic, pain, temp, touch, proprioception, motor

129
Q

where do obturatator arter and sup gluteal arise

A

INTERNAL iliac

130
Q

general muscle fiber type

A

slow oxidative (type I), fast oxidative-glycolytic (type IIA), and fast glycolytic (type IIB)

131
Q

Type I fibers

A

type 1 smaller and contract more slowly and less forcefully but are fatigue resistant. Type IIA is intermediate, type IIB is fastest most powerful but most fatigue-prone myofibril type.

132
Q

definition of specificity

A

probability that negative person will test negative - TN / FP + TN

133
Q

lab values in type 1 Vit D Rickets

A

low ca, low phos, low 1,25, high ALP, PTH

134
Q

lab values in type 2 Vit D Rickets

A

low Ca, low phos, HIGH 1,25, HIGH ALP and PTH

135
Q

x linked hypophosphatasia

A

low PO4; NORMAL CA; ALP high, NORMAL PTH, LOW VIT D 1,25 - bc kidneys can resorb phosphate

136
Q

where does scfe happen

A

maturation zone of hypertrophic zone

137
Q

where does scurvy and corner fractures occur

A

zone of provisional calification

138
Q

what conditions affect the reserve zone of physis

A

Gauchers and Diastrophic Dysplasia

139
Q

rifampin affects

A

RNA polymerase

140
Q

CaSo4 vs CaP04

A

phosphate is stronger; BOTH are wear to shear and torsion

141
Q

non nitrogen containing bisphos have

A

ATP analog that causes apoptosis of osteoclasts etidronate, and clonodrate

142
Q

power equation

A

1- type 2 error (beta)

143
Q

what makes a RCT level 2

A

follow up less than 70%

144
Q

what is Rh factor

A

IgM against the IgG

145
Q

ranking of tensile strength in implants

A

cobalt, titanium, stainless steel and cortical bone

146
Q

effect of bisphos in Osteogenesis imperfecta

A

improves bone density, reduces fracture and reduces bone pain

147
Q

COMP mutation leads to

A

pseudoachondroplasia and MED

148
Q

COL2A1 mutation

A

SED - same as MED but with spine involvement

149
Q

what is nitrogen containing bisphos

A

alendronate - works via farnesyl trasnfersase

150
Q

Xlinked hypophosphatemic rickets vs hypophosphatasia

A

X-linked hypophos is a LOW phos and normal Ca due to bad kidney receptor - vit D resistent rickets; hypophosphatasia is s due to bad ALP; ca and phos are HIGH

151
Q

what molecules are for compressive strength vs tensile

A

compressive - Ca-HA and proteoglycans and tensile is type 1 collagen

152
Q

what gene contols axial skeleton development

A

HOX

153
Q

level of evidence prospective cohort

A

level 2

154
Q

what does lovenox do

A

enhances binding of AT3 to thrombin

155
Q

what stimulates osteoblasts to differenitate

A

PTH and TGF b - for mesenchymal cells

156
Q

definition of sensitivity

A

probability that positive Is a true positive IN THOSE WITH disease

157
Q

which BMP invovled in FOP

A

BMP 4

158
Q

what bmp is NOT osteoinductive

A

BMP 3

159
Q

what nerves are obturator

A

L234

160
Q

deep peroneal nn supplies which foot muscles

A

EHL, EDB

161
Q

structure of osteons aka Haversions systems

A

osteons are defined by cement lines; inside are vascular canals that care artery, vein, neve; volkman are transverse connections; haversian CANALS are along the long axis

162
Q

bone maturity woven vs lamellar

A

woven is immature; lammelar is more stiff and more organized

163
Q

what makes mature osteoblasts

A

BMP; beta cantenin, PDGF, IDGF, TGF B;

164
Q

how to bisphos prevent osteosclasts

A

inhibits ability to make microtubules at ruffled border leading to apoptosis

165
Q

what cancer can you use bisphos to prevent skeletal events

A

multiple myeloma

166
Q

collagen 1 composiition

A

1 alpha-2 chain; 2 alpha-1 chains - triple helxi

167
Q

most abundant non collagen protein in bone

A

osteocalcin

168
Q

ostenectin secreted by

A

platelets and osteoBlasts

169
Q

bone vascularity high vs low pressure

A

nutrient artery is 2/3 of bone supply and is HIGH pressure; low pressure is periosteal supplies outer 1/3 via Volkman

170
Q

how does estrogen help bone growth

A

inhibits adenylyl cyclase and decreases RANKL

171
Q

which IL stimulate bone RESORPTION

A

IL 1 and 10 stimulate osteoclasts; IL 6 in myeloma

172
Q

vitamin D requirements 1500

A

if pregnant, fracture healing; or post-menopause

173
Q

vit D requirement 2000

A

lactating

174
Q

vitamin D requirement 750

A

adults;

175
Q

vitamin D requirement 1000-1350

A

yound adults and teens

176
Q

vitamin D for kids

A

600-800

177
Q

protrusio vs coxa prufunda

A

profunda is acetabulum is medial to iliosichial line; protrusio is femoral head is medial to ilioishcial line

178
Q

gene transmission of duchenne

A

X-linked recessive

179
Q

scleraxis does what

A

transcription factor for tendon/ligament

180
Q

dexa scoring is Z or T

A

T score

181
Q

indepdence lost at 1 year after hip fracture

A

50% at 1 year

182
Q

what factor stimulates cartilage regeneration

A

TGF B

183
Q

what happens to FGFR in achondroplasia

A

abnormally turned ON

184
Q

what is pathologic cell in pagets and osteopetrosis

A

osteoclasts - but in pagets its INCREASED resorption; and in osteopetrosis its decreases osteoclasts

185
Q

role of fibronectin

A

cell adhesion; growth, migration and development

186
Q

fibrillin is associated with

A

elasin DEPOSITION

187
Q

which metal has highest bacteria adherence

A

Ti-Alloy > Steel> pure titanium; tantalum Is relatively resistent

188
Q

denosumab blocks and binds to

A

RANKL (LIGAND)

189
Q

cells of nucleus pulposes as disc degenerates

A

decrease in size and cell

190
Q

huntingtons repeat

A

CGG

191
Q

inheritance of hemophilia

A

xlinked RECESSIVE

192
Q

what factors BLOCK the osteolytic cascade

A

IL1 receptor antagonis; OPG, IFN gamma, IL 4 and IL 10

193
Q

what factors mediate osteolysis

A

TNFa; IL6; IL 1; PG2; RANKL

194
Q

what gait mechanic are a/w with KNEE oa progression

A

ADDUctor moment at tibia

195
Q

what leads to cartilage brittleness with age

A

increaseing advanced end glyoclation products over time

196
Q

heparin works by binding

A

Antithrombin 3

197
Q

tensile strength of nerves comes from

A

collagen 1

198
Q

what does transient osteoporosis of hip look like on MRI

A

BRIGHT on T2 bc more bone marrow edema; T1 is hypointense

199
Q

tx of transient osteoP of hip

A

protected WB ; can last 6-8months -no surgery needed self limiting

200
Q

ZPA zone of polarizing activity affect

A

hand polarization

201
Q

order of nerve structure

A

ENDO; Perineural, fascile; EPI

202
Q

sural nn runs with which vein

A

LESSER saphenous vein

203
Q

what is purpose of funnel plot

A

to show publication bias in meta analysis - would want even funnel shape

204
Q

what is best test to compare frequency or proportions

A

Chi-Squared test

205
Q

sheathed tendons get their blood supply from

A

VINCULA - NOT paratenon

206
Q

what restrains the swelling pressure from aggrecan

A

Collagen (2)

207
Q

what is pathology of factor V leiden

A

leads to hypercoag due to increase thrombin activation

208
Q

muscle fibers 1 vs 2

A

1 is slow; lower strength and speed; uses aerobic and oxidative energy; atrophies first; 2 is fast; fatigues quickly and is glycolytic

209
Q

ach and muscle contraction

A

ACH binding leads to ca release - ca then binds tropoin - changes tropomyosin and leads to exposure of actin for myosin binding

210
Q

what is tx for familial vit D resistent rickets

A

phosphate replacement and Vit D (calcitriol)

211
Q

what are the vitamin D versions

A

D3; then 25D3 then 1,25 D3(Calcitriol)

212
Q

tib ant activation during heel strike

A

eccentric followed by conccentric

213
Q

microfracture stimulates what cells

A

mesenchymal cells from the marrow tomake fibrocartilage

214
Q

what happens in factor v leidein

A

prevents inibition by activated factor C’

215
Q

duchenne inheritance

A

xlinked RECESSIVE

216
Q

how much force in medial knee if neutral

A

65% in neutral leg

217
Q

what is epigenetics

A

gene alterations that do NOT involve DNA mutations

218
Q

what is most common sx with PE

A

dyspnea - NOT tachycardia

219
Q

renal osteodystrophy labs

A

hypoCa bc phosphate retained binds to Ca and damaged kidney cant make 1,25 Calcitriol; hyper PTH results

220
Q

what other conditions are seen with renal osteodys

A

osteomalaciA, AVN, tendinitis and rupture; CTS due to amyloid; and brown tumors from hyperPTH

221
Q

what is LOW turnover renal osteodystrophy

A

normal PTH; deposits of Alumininum in bone; impaired PTH release; disrupts mineralization

222
Q

labs in vit D dependent type 1

A

low vit D 1,25 and low Ca,lowphos, high PTH and ALP

223
Q

labs in vit D dependent type 2

A

HIGH vit D 1,25 and low Ca,lowphos, high PTH and ALP

224
Q

labs in x linked vit D resistnet

A

LOW phos, normal Ca; low vit D 1,25 HIGH PTH and ALP

225
Q

labs in hypophosphatasia

A

LOW ALP; high Ca, and hi phos; normal Vit D

226
Q

Labs in renal osteodys

A

low Ca; high phos; high PTH; high ALP; low vit D

227
Q

what happesn to proteoglycans in disk with aging

A

decreased - they get broken down

228
Q

follow up time frame for lateral condyle growth arrest

A

3 years

229
Q

LMWH is associated with increased

A

thrombocytopenia

230
Q

muscle tension determinted by

A

cross section volume

231
Q

what is effect of SCD

A

increased cardiac output; stroke volume; EF and MAP; pre load; reduce afterload

232
Q

what cells fix muscle injuries

A

satellite cells

233
Q

poland syndrome features

A

syndactyly with unaffected thumb; ipsilateral chest wall issues - absent pec; or assymetric nipples

234
Q

max dose of abx in PMMA

A

up to 10gm of vanc and up to 12.5gm tobra for 40 gram PMMA

235
Q

diff types of drug recall

A

class 1 is for serious harm or death; class 2 is temporary or reversible adverse events, class 3 is no adverse issues

236
Q

which part of tendon covering provides neuro signal

A

ENDOtenon - closed layer to tendon; paratenon is most superficial

237
Q

Strategies to minimize confounding

A

randomization, restricted enrollment, matching, and post hoc analyses.

238
Q

force and excursion of muscle related to

A

muscle architecture - number and orientation of fibers

239
Q

terres major innerveated by

A

lower subscap

240
Q

how much can you lenghten leg before injuring sciatic

A

10% of femur or 4cm

241
Q

transfemoral amputaiton increases how much E

A

60% increase

242
Q

what Growth factor is for Chondrogenesis

A

TGF

243
Q

forteo uses in osteoporosis fracture

A

can help if bisphos resistent

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