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basic science csv Flashcards

1
Q

LATERAL PIVOT SHIFT FOR THE ELBOW– SEX with VAL gets better when flexed!!!

A

supination and extension then apply a valgus force when flexing and the RH reduces at 40 degrees of flexion

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2
Q

PIVOT SHIFT MNEMONIC: VALIRE FLEuR De li

A

VALGUS force on IR and EXTended knee- FLEx REDUCES the knee at 30 degrees

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3
Q

SNAPPING HIP: if you can see it it’s _____ snapping hip. if you can hear it it’s _____ snapping hip.

A

if you can see it it’s EXTERNAL snapping hip. if you can hear it it’s INTERNAL snapping hip.

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4
Q

PI = PT + SS

A

to become a PI- you have to do a lot of PT and be hard as Stainless Steel!! Pelvic incidence = pelvic tilt + sacral slope

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5
Q

aging is dry

A

water content of cartIlage decreases with normal aging

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6
Q

OA is wet

A

water content of cartIlage increases with osteoarthritis

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7
Q

PSSR - PISSER WITH AGE- PISSER USE INCREASES!! (INCREASED COMPONENTS OF CARTILAGE WITH AGE)

A

Protein -Stiffness (passive glycation leads to increased Stiffness of collagen) -chondrocytes Size -Ratio of PG keratin sulfate to chondroitin sulfate

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8
Q

NEWSS - WITH AGE you have less NEWSS! (DECREASED COMPONENTS OF CARTILAGE WITH AGE)

A

Number of cells- Elasticity- Water (differentiates from OA where water content actually increases)- proteoglycan Size- Solubility

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9
Q

TorTicolliS (TTS)

A

TILTS TOWARDS SCM! head TITLTS TOWARDS the SCM side- and chin rotates away

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10
Q

what do the accessory and proper collateral ligaments restrict in thumb UCL injury?

A

VOWELS GO TOGETHER ETC…. FP EA… -PCL is primary restraint to radial deviation with FLEXED MCP -ACL restrains radial deviation with EXT MCP

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11
Q

what BMP for OPEN TIBIA fxs?

A

bmp twO = Open tibias

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12
Q

rhBMP-2 in GRADE 3 OPEN tibial shaft fxs?

A

accelerate early fracture healing decrease need for BONE GRAFTING decrease need for 2ND SURGERYS decrease INFECTION

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13
Q

malformations with entire bone (absence- duplication of entire bone) - MOLECULAR BIO?

A

nuclear proteins and transcriptions factors

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14
Q

Anterolateral bowing

A

NF1

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15
Q

anterior / anteromedial bowing

A

fibular hemimelia

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16
Q

posteromedial bowing

A

calcaneovalgus foot

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17
Q

what inserts at the sublime tubercle?

A

MCL insertion subliMe tuberCLe

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18
Q

what inserts at the supinator crest of ulna?

A

LUCL insertion

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19
Q

screw home mechanism?

A

-tibia EXternally rotates on femur as the knee EXtends. -cuz LTP under LFC translates posterior as MFC and MTP don’t translate.

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20
Q

LFC and contact area moves posterior on the tibia during what knee ROM?

A

knee flexion from 0 to 120 degrees.

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21
Q

MFC and contact area remain relatively stationary during what knee ROM?

A

flexion from 0 to 120 degrees.

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22
Q

In what ROM do both condyles exhibit femoral rollback?

A

Beyond 120 degrees of flexion

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23
Q

what is the “comma sign””? “

A

arc formed by a portion of the SGHL/CHL complex -useful marker of the superolateral corner of torn subscapularis tendon.

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24
Q

Pott’s DISEASE

A

DESTRUCTION OF VERTEBRAE –> HORRIBLE KYPHOSIS SPARES DISC* Ziehl-Neelsen stain= mycobacterium “red snappers”” against blue background. AFB ON Lowenstein-Jensen medium is dxtc BUT 10 WKS TO GROW. DECOMPRESSION then Isoniazid- rifampin- pyrazinamide- and streptomycin”

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25
Q

Mazabraud syndrome

A

poly FD + iM Myxomas

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26
Q

HISTO DDX:

A

ABC- GCT- TELANGIECTATIC OSTEOSARC

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27
Q

Benign tumors USUALLY CURETTAGE & BG

A

COC FAG CHONDROBLASTOMA- OSTEOBLASTOMA- CHONDROMYXOID FIBROMA- ABC- GCT

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28
Q

Benign tumors OCCASSIONALLY CURETTAGE & BG

A

i knew that! (i NEU that)! NOF- UBC- ENCHONDROMA

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29
Q

which has higher risks for astxc DVT and SXTC PE: TKA vs THA?

A

TKA HIGHER risk of ASXTC DVT THA HIGHER risk of SXTC PE

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30
Q

1st physical sign of PE?

A

dyspnea or tachypnea

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31
Q

MC EKG signs associated with PE?

A

sinus tachycardia right axis deviation right BBB

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32
Q

with MOM- smaller implant diameter is associated with higher or lower serum metal ions?

A

elevated serum metal ion levels.

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33
Q

with MOM- cup abduction angle >55 degrees is associated with higher or lower serum metal ions?

A

elevated serum metal ion levels. Cup abduction angles >55 degrees is more vertical and edge loading.

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34
Q

Compression stocking

A

Mechanical increases fibrinolytic system decreases venous stasis

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35
Q

ASA

A

Inhibits PG and thromboxane production

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36
Q

IV heparin

A

Enhances Antithrombin 3 ability to inhibit factors IIa (thrombin)- III- Xa

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37
Q

Unfractionated heparin (subcutaneous)

A

Enhances Antithrombin 3 ability to inhibit factors IIa (thrombin)- III- Xa

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38
Q

LMWH (Lovenox)

A

Enhances Antithrombin 3 ability to inhibit factors IIa (thrombin) and Xa

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39
Q

Fondaparinux

A

Xa

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40
Q

Coumadin

A

Affects LIVER Vit K metabolism LIMITS production of clotting factors 2- 7- 9- 10 (1972)

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41
Q

Dextran

A

Dilutional– fluid overload

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42
Q

Dorr noted that wound complications and hematomas seen only in warfarin or LMWH- and NOT in…

A

ASA clopidogrel compression devices

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43
Q

Sclerostin (from OSTEOCYTES) inhibits what pathway?

A

Wnt pathway INHIBITION DECREASES BONE MASS

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44
Q

Wnt pathway regalates what process?

A

important regulators of bone mass stimulates production of OSTEOBLASTS

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45
Q

increased Wnt signaling is seen with what 2 diseases?

A

high bone mass seen in sclerosteosis and Van Buchem disease

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46
Q

Up-regulation of Wnt signaling does what to osteoblasts & chondrocytes?

A

good for fracture healing: suppression of chondrocyte formation and enhanced ossification. Wnt and hedgehog pathways control differentiation of progenitor cells into osteoblasts or chondrocytes.

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47
Q

LOWER postop fcnl scores- WHAT diameter and WHAT cup inclination are associated with HIGH cobalt and chromium levels after MOM resurfacing?

A

SMALLER implant diameter LARGER cup inclination

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48
Q

osteoclasts cause resorption lacunae BY RELEASING WHAT?

A

release cathepsin K and acid

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49
Q

XRT is better to be done PREOP or POSTOP Iin spine MET decompression?

A

XRT POSTOP better! XRT preop = 3x wound complications

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50
Q

what drug increases risk of osteoporosis and fracture?

A

anticonvulsant use (phenobarbital- carbamazepine- phenytoin- and valproate)

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51
Q

3 risk factors for nonunion of TYPE 2 ODONTOID FX

A

Increased fracture displacement posterior displacement increased angulation

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52
Q

ACSM recs on appropriate loads during training? NOVICE TRAINING

A

loads corresponding to 8-12 repetition max (RM)

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53
Q

ACSM recs on appropriate loads during training? INTERMEDIATE/ADV TRAINING

A

wider loading range- 1-12 RM periodized fashion

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54
Q

ACSM recs on appropriate loads during training? LOCAL MUSCULAR ENDURANCE TRAINING

A

light to mod loads (40-60% of 1 RM) high repetitions (> 15) short rest periods (< 90 s)

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55
Q

EMG denervation seen with what nerve problem? (fasciculations and positive short waves)

A

radiculopathy

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56
Q

Amyotrophic lateral sclerosis is a motor neuron disease that affects what?

A

both UMN & LMN rapid progression of weakness- muscle atrophy- fasciculations- spasticity- dysarthria- dysphagia- and respiratory compromise.

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57
Q

Sclerostin and dickkopf-1 (Dkk-1) are direct inhibitors of what pathway related to bone and/or cartilage regulation?

A

Wnt/Beta-catenin (_Å-catenin) pathway Knocking out or inhibiting sclerostin or Dkk-1 –> increased bone mass cuz constitutive activation of Wnt/_Å-catenin pathway.

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58
Q

BMPs work through WHAT to cause osteoblastic differentiation?

A

SMADs

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59
Q

PTH at physiologic levels binds to osteoblasts- causing a series of events that lead to

A

osteoblast-mediated osteoclast activation thus increased bone resorption

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60
Q

MC mechanism of wear: well-functioning THA

A

Adhesive wear

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61
Q

MC mechanism of wear: TKA revision with several small cement particles in the articulation

A

Abrasive wear

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62
Q

MC mechanism of wear: TKA with poly sterilized with gamma radiation in air

A

Delamination

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63
Q

Adhesive wear

A

2 surfaces forced together under a load WITH motion. When adhesive forces exceed material strength- material is removed from the weaker material.

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64
Q

2 MODES of Abrasive wear?

A

2-body and 3-body abrasive wear.

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65
Q

2-body abrasive wear?

A

asperites or projections from one surface remove material from the opposing articulating surface. roughened surface (scratched ball)

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66
Q

3-body abrasive wear

A

third body particle interposed between bearing surfaces results in removal of material from 1 or both articular surfaces.

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67
Q

Fatigue wear

A

surface / subsurface cyclic shear stresses or strains in softer material of an articulation exceed fatigue limit for that material.

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68
Q

Delamination

A

surface damage seen with oxidized poly knees with crossing wear patterns and high-contact stresses.

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69
Q

Most “metal allergy”” is classified as hypersensitivity type ____? “

A

4 or delayed-type hypersensitivity response (cell-mediated response)

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70
Q

Type I hypersensitivity

A

anaphylaxis

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71
Q

Type II hypersensitivity

A

antibody mediated- such as seen in Grave’s disease or hemolytic anemia.

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72
Q

Type III hypersensitivity

A

immune complex diseases such as serum sickness or systemic lupus erythematosus.

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73
Q

study design: series of cases presented with outcomes (WO a control population or comparison group)

A

case series

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74
Q

what study design? patients receive a particular treatment and outcomes are then examined

A

case series

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75
Q

what study design? groups followed over time on the basis of receiving or NOT receiving an exposure (not randomized)

A

cohort

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76
Q

what study design? both groups receive both interventions over defined time period. ex. Groups A and B both receive the drug as well as placebo.

A

crossover design clinical trial allows within-participant comparisons

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77
Q

what study design? participants randomized to 2 or more groups- each of which receives a different tx or intervention. ex. Group A receives drug and Group B receives placebo.

A

parallel design trial allows comparison btwn groups

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78
Q

Serum creatine phosphokinase is elevated in what disease?

A

DMD

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79
Q

Increased granulation tissue production occurs with prolonged immobilization following contusion injury. This condition may lead to what?

A

myositis ossificans

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80
Q

CT of abdomen and pelvis are necessary OR unnecessary for WU of bone sarcomas?

A

UNNECESSARY BONE sarcomas (chondrosarcs) rarely metastasize to visceral organs. primary site of metastasis: LUNGS NEED CT chest and MRI of extremity

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81
Q

Implants composed of polylactic acid are excreted by what body system after absorbed?

A

RESPIRATORY Polylactic acid suture and suture anchors are bioabsorbable hydrolysis of ester background in vivo. Resulting lactic acid enters Krebs cycle and excreted as CO2 by the lungs.

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82
Q

2-stage process of bacterial biofilm development?

A
  1. adhesion of individual bacteria to a substrate regulated by adhesions. After several bacteria have attached- 2. quorum sensing (cell-to-cell communication) allows BIOFILM MATURATION and GENE EXPRESSION that activate virulence factor and antibacterial resistance of the bacteria.
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83
Q

During endochondral ossification of growth plate- WHAT contributes most to longitudinal growth of long bones?

A

chondrocyte hypertrophy intracellular volume and increased chondrocyte height cause growth of long bones.

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84
Q

What is the strongest predictor of persistent infection in early postop deep wound infections if implants retained until fracture union?

A

use of an IMN in open fracture

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85
Q

Rhizomelia

A

disproportion of proximal limb length ex. shortened limbs of achondroplasia (hip or shoulder)

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86
Q

MOA of Premature arrest following growth plate injury?

A

Vascular invasion across the physis -SH III and IV fxs create disruption thru all physeal zones. -A conduit blood vessels not normally present between metaphysis and epiphysis creates influx of osteoblasts and formation of bony bar which prevents further longitudinal growth.

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87
Q

perichondral ring of LaCroix (fibrocartilagenous periosteal ring surrounding the physis) PROTECTS against what?

A

50% of resistance to shear stress

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88
Q

MOA: Tetracyclines

A

Inhibit protein synthesis thus bacterial growth

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89
Q

3 specific mechanisms of tetracycline resistance

A

increased tetracycline efflux ribosome protection tetracycline modification

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90
Q

MOA: resistance to rifampin

A

Alteration of RNA polymerase

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91
Q

MOA resistance to? -lactam antibiotics

A

Altered membrane-binding protein

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92
Q

What has the most positive effect on wear-resistance of UHMWPE?

A

Radiation

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93
Q

What directly increases cross-linking?

A

Radiation

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94
Q

What changes POLY from partial crystalline to amorphous state?

A

Remelting

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95
Q

UHMWPE is manufactured via what process?

A

ram bar extrusion and compression molding.

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96
Q

Radiation is used to do what to POLY?

A

sterilize and cross-link

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97
Q

what directly increases cross-linking? what does cross linking to do wear?

A

level of radiation cross linking increases wear resistance

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98
Q

what quenches Free radicals generated during radiation?

A

either remelting or annealing

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99
Q

what does remelting do to wear characteristics?

A

reduces wear characteristics

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100
Q

describe the process of annealing

A

UHMWPE heated BELOW melting point avoids the reduction in crystallinity MORE free radicals REMAIN

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101
Q

describe the process of remelting

A

UHMWPE heating ABOVE melting point changing it from partial crystalline to amorphous state removing ALL free radicals

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102
Q

Friedrich ataxia

A

spinocerebellar disorder: ataxic gait- areflexia- weakness- loss of propioception- scoliosis foot deformity (cavus- varus- clawtoes)

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103
Q

DOes Charcot-Marie-Tooth

A

Hip dysplasia

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104
Q

Malignant hyperthermia

A

myelomeningocele

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105
Q

What protein promotes tumor cell attachment to bone during metastasis?

A

Integrin

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106
Q

Osteocalcin secreted by what? what role does it play?

A

secreted by osteoblasts role in mineralization and calcium homeostasis

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107
Q

inhibition of cell-wall synthesis via inhibition of peptidoglycan synthesis

A

Cephalosporins and penicillin are bactericidal

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108
Q

irreversibly bind 30S ribosomal proteins- inhibiting translation

A

aMINoglycosides

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109
Q

inhibit cell-wall synthesis by disrupting addition of cell-wall subunits

A

Glycopeptides (vancomycin)

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110
Q

inhibit DNA-dependent RNA polymerase excellent biofilm penetration

A

Rifamycins Bacteria develop rapid resistance to Rifampin when used as monotherapy

111
Q

bind 50S ribosomal subunits

A

MACROlides (erythromycin)

112
Q

Heuter-Volkmann principle

A

bone placed in longitudinal tension will stimulate longitudinal growth compressive longitudinal forces inhibit longitudinal growth

113
Q

Healing after a tendon repair or rupture undergoes what stages?

A

1 inflammatory 2 cellular proliferation 3 remodeling

114
Q

During the inflammatory phase

A

neutrophils and macrophages migrate into the injury site and release chemotactic factors that recruit fibroblasts. A tendon is thought to be weakest 5 to 21 days after repair- which coincides with the inflammatory phase

115
Q

During the proliferative phase-

A

inflammatory cells secrete cytokines and growth factors (PDGF- IGF- (BMP) -12 and BMP 13- and TGF-beta) that promote differentiation of fibroblasts

116
Q

remodeling stage.

A

Fibrosis and decreased cellularity

117
Q

Conditions related to PTH

A

hypoparathyrodism- pseudohypoparathyroidism- renal osteodystrophy

118
Q

Conditions related to Vitamin D

A

Rickets

119
Q

Hypophosphatasia

A

AR– inborn error in production of alkaline phosphatase (tissue-nonspecific isoenzyme of alkaline phosphatase: TNSALP)- leading to low alkaline phosphatase– Increased urinary phosphoethanolamine

120
Q

main problem with renal osteodystrophy?

A

uremia related phosphate retention

121
Q

MCComp of ROD?

A

pathological fracture

122
Q

with ROD- amyloid stains pink on

A

Congo red stain

123
Q

labs characteristic of renal osteodystrophy (high turnover)

A

Decreased calcium- increased serum phosphate- increased alkaline phosphate- and increased parathyroid hormone

124
Q

labs of nutritional rickets due to vitamin D deficiency.

A

Decreased calcium- decreased serum phosphate- increased alkaline phosphate- increased parathyroid hormone

125
Q

labs of low-turnover renal osteodystrophy

A

Increased calcium- normal serum phosphate- increased alkaline phosphate- normal parathyroid hormone

126
Q

low-turnover renal osteodystrophy is classically caused by

A

excess deposition of aluminum into bone impairs PTH release from parathyroid gland disrupts mineralization

127
Q

labs of hypoparathroidism

A

LOW calcium- HIGH serum phosphate- NL alkaline phosphate- LOW PTH

128
Q

labs of primary hyperPTH

A

HIGH calcium- NL serum phosphate- NL or HIGH alkaline phosphate- HIGH PTH

129
Q

defect in mineralization of osteoid matrix caused by inadequate calcium and phosphate prior to closure of physis?

A

rickets

130
Q

defect in mineralization of osteoid matrix caused by inadequate calcium and phosphate after physeal closure?

A

osteomalacia

131
Q

what physeal zone with rickets?

A

zone of provisional calcification

132
Q

pseudofracture on compression side of bone

A

Looser’s zones

133
Q

MC form of rickets

A

XLD Vitamin D-Resistant Rickets (Familial Hypophosphatemic Rickets) inability of renal tubules to absorb phosphate

134
Q

Hypophosphatemic rickets

A

mutated PHEX gene caused by inability of kidney proximal tubules to reabsorb phosphate

135
Q

labs of Hypophosphatemic rickets

A

normal serum calcium and PTH low serum phosphorous elevated alkaline phosphatase

136
Q

key lab factor that differentiates nutritional from hypophosphatemic rickets

A

elevated PTH

137
Q

hereditary vitamin D dependant rickets type I

A

Loss of function mutations in 25 (OH) vitamin D hydroxylase gene decrease in 1-25(OH) 2 vitamin D

138
Q

Hereditary vitamin D dependant rickets type II

A

defect in intracellular receptor for 1-25-(OH) 2-vitamin D3 increase in 1-25(OH) 2 vitamin D

139
Q

Hyperphosphatemia

A

mutation in GALNT3 gene elevated serum phosphate decreased PTH/calcium

140
Q

Lyme arthritis tx?

A

oral amoxicillin- doxycycline- or cefuroxime for 4 weeks. IV ceftriaxone with neurologic involvement such as facial nerve palsy or meningitis

141
Q

What mechanism is responsible for the initiation of mechanical failure seen at the midstem modular junction of modular revision hip stems?

A

Fretting fatigue contacting components experience cyclic loads while small oscillatory motion occurs between them. increases tensile and shear stress- leading to small flaws that result in crack propagation.

142
Q

stress-strain curve demonstrates what of a material?

A

mechanical properties nonlinear curve seen with toe- linear- and failure regions– modulus of elasticity (slope of stress/strain)- tensile strength- ultimate strain- and strain energy density

143
Q

load-elongation curve demonstrates what of a material?

A

structural properties nonlinear curve shows a toe region- linear region (slope is stiffness)- and a failure region.

144
Q

stress-strain curve

A

mechanical properties

145
Q

load-elongation curve

A

structural properties

146
Q

external fixation heals fracture thru

A

endochondral mechanism. Bland-appearing cartilage callus fits with nonunion

147
Q

Tendons should have what ratio of matrix protein?

A

95% collagen type I <5% collagen type III

148
Q

In articular cartilage- Interleukin 1 (IL-1) increases

A

matrix metalloproteinase that directly degrade cartilage

149
Q

chondroprotective functions -increases both collagen and proteoglycan synthesis while inhibiting matrix degradation and cell proliferation

A

TGF beta

150
Q

accelerates arthritis

A

IGF1

151
Q

-anabolic effects on proteoglycan synthesis -prevents tissue catabolism by preventing an IL-1 beta-induced decrease in proteoglycan synthesis

A

Glucosamine

152
Q

tx for Parosteal osteosarcoma

A

Wide resection

153
Q

pathogenesis of posttraumatic osteoarthritis

A

Fracture-related chondrocyte death (apoptosis) concentrated along matrix cracks in superficial layer of cartilage Apoptosis is accentuated by a series of aspartate-specific cysteine proteases

154
Q

Ethylene oxide sterilization affects wear properties or not?

A

no effect on wear properties of poly and should not affect its potential to contribute to osteolysis

155
Q

Elastic modulus

A

mathematical description of the tendency of a material to be deformed elastically in response to an applied force.

156
Q

Viscoelastic materials such as bone

A

exhibit time-rate-dependent stress-strain behavior as a function of internal friction. modulus of viscoelastic materials increase as strain rate increases.

157
Q

Material properties

A

characterize mechanical functional limits of a material independent of the size or shape of that material.

158
Q

HA binds to lubricin- a glycoprotein- creating a cross-linked network. Boundary lubrication occurs when

A

fluid film has been depleted and contacting bearing surfaces are separated only by a boundary lubricant of molecular thickness- which prevents excessive bearing friction and wear. In articular cartilage- this monolayer of glycoprotein is adsorbed on each of the opposing articular surfaces.

159
Q

Aggrecan

A

interacts with HA and link proteins to create a proteoglycan aggregate this attracts water to cartilage and gives tissue its viscoelastic properties

160
Q

Reverse TSA improves kinematics in RC deficient joint by what directional change to the COR?

A

Medial

161
Q

What method of spinal fixation requires the largest force to disrupt the bone-implant interface?

A

Pedicle screws

162
Q

Amphotericin and nystatin exerts antifungal activity MOA

A

binding to sterols disrupting the cell membrane.

163
Q

Sulfonamides and trimethopim mimic the metabolite substrate

A

block synthesis of metabolites such as folic acid.

164
Q

Rifampin MOA

A

inhibits bacterial RNA polymerase- blocking synthesis of RNA

165
Q

Tetracycline chloramphenicol clindamycin bind to

A

ribosomes block bacterial growth by inhibiting protein synthesis.

166
Q

percentage of astxc pseudotumors in MOM?

A

5.00%

167
Q

What factor induces myofibrillar muscle protein synthesis (MPS)?

A

Resistance exercise above 60% 1-repetition maximum (RM) Resistance exercise induces myofibrillar MPS that drives muscle hypertrophy

168
Q

Aerobic-zone exercise does not result in hypertrophy of skeletal muscle- but it does

A

increase oxidative capacity.

169
Q

Etanercept modifies natural history of inflammatory arthropathies thru what MOA?

A

Inhibitory binding to TNF alpha– decreases activation of mesenchymal cells- reducing pannus formation- cartilage destruction- and osteoclastic bone resorption

170
Q

IL-1 production in response to inflammatory stimulus contributes to the

A

rapid loss of proteoglycans- leading to cartilage destruction and osteoclastic bone resorption.

171
Q

anakinra

A

competitive inh of IL-1 type I receptor.

172
Q

Abatacept

A

selective costimulation modulator inhibits T lymphocyte activation implicated in juvenile idiopathic arthritis.

173
Q

pseudotumors occur in MOM hip resurfacing arthroplasty (MOMHRA) cuz increased wear attributable to what?

A

edge loading associated loss of fluid-film lubrication

174
Q

Edge loading is from what?

A

abnormal contact stresses in setting of a malpositioned cup orientation

175
Q

Alveolar rhabdomyosarcoma (ARMS)

A

PAX3-FKHR fusion gene

176
Q

Alveolar rhabdomyosarcoma (ARMS)

A

t(1– 13) t(2– 13)

177
Q

MOA of monoclonal Ab used to tx osteoporosis (denosumab)

A

inh of RANK ligand (RANKL)

178
Q

Level 1 evidence includes randomized controlled trial with

A

statistically significant difference or no statistically significant difference but narrow confidence interval

179
Q

level 2 therapeutic study would include a….

A

lesser-quality randomized controlled trial (eg- <80% follow-up- no blinding- or improper randomization)

180
Q

non-randomized prospective cohort study that compares results of tx or systematic reviews of level II studies or level I studies with heterogenous results

A

level 2

181
Q

normal joint fluid values volume WBC PMN total protein glucose

A

volume < 3.5 mL WBC < 200 cells/™Êl PMN < 25% total protein 1 g to 2 g/d glucose nearly equal to blood

182
Q

how a RCT gets a level 2 rating?

A

-poor randomization technique- such as randomization by days of the week or hospital record number (from which investigators can easily determine the randomization assignment) -less than 80% follow-up -evaluators unblinded to treatment assignment.

183
Q

Osteoclastic bone resorption is stimulated by what molecular interaction?

A

(RANK) -(RANKL)

184
Q

OPG

A

receptor competitively binds RANK blocking interaction with RANKL and inhibiting osteoclastogenesis

185
Q

PTH increases serum calcium indirectly by what 3 processes?

A

1 binding to osteoblasts 2 increasing expression of RANKL 3 decreasing expression of OPG

186
Q

pannus of RA and monosodium urate crystals of gouty tophi trigger the release of what?

A

inflammatory cytokines such as IL-6- IL-8 and TNF alpha.

187
Q

Loss of function of OPG gene results in what disease?

A

osteoporosis

188
Q

metalloproteinase MMPs are matrix-degrading enzymes that increase permeability of the basement membrane. what can this allow in regards to cancer?

A

cancer cell invasion metastasis to occur

189
Q

Platelet-derived growth factor has been shown to have what effect on tumors?

A

promote tumor migration and prevent cell death.

190
Q

How are free radicals removed from highly cross-linked polyethylene?

A

Thermal processing: heat treatment of cross-linked polyethylene to remove free radicals

191
Q

which thermal processing method is better?

A

annealing prefered because better mechanical properties of poly.

192
Q

Trabecular bone is remodeled through osteoclast activation that creates a resorption pit

A

known as a Howship lacuna. After pit is formed- osteoclasts are replaced by osteoblasts that form new bone matrix. cement line separates new bone formation from resorption.

193
Q

Cutting cones are created in

A

cortical bone remodeling.

194
Q

Haversian canals vs Volkmann canals?

A

Haversian canals carry nerves and blood vessels longitudinally in bone. Volkmann canals connect different Haversian canals.

195
Q

Trabecular bone is remodeled through the formation of what?

A

Howship lacunae.

196
Q

most common soft-tissue sarcoma of the foot

A

Synovial sarcoma

197
Q

Ring chromosomes

A

parosteal osteosarcoma

198
Q

Creep

A

increased displacement over time attributable to same force- such as during initial period of poly compression of THA and methylmethacrylate in taper-designed cemented femoral stems

199
Q

What molecules have been shown to promote fibrosis during muscle injury?

A

TGF-_Å1

200
Q

severity of biologic response to particulate poly wear debris is directly proportional to what

A

particle number- response is dose-dependent. particles sized between 0.2 ™Êm and 7-8 ™Êm are most stimulatory- but a direct proportional correlation does not exist with sizes outside of this range.

201
Q

What dominant intracellular proteins become directly phosphorylated as a result of BMP binding to its receptors?

A

SMADs

202
Q

> 65 yos at increased risk for adverse GI effects when placed on NSAIDs- and should be placed on what at the same time?

A

PPI prophylaxis

203
Q

What technique results in largest reduction of free radicals?

A

Thermal stabilization thru remelting

204
Q

myasthenia gravis

A

progressive weakness loss of acetylcholine receptors 2/2 to AI antibodies at NMJ Rest periods allow uptake of Ach and initial strength- but easy fatigability. tx aimed at immunomodulation acetyl cholinesterase inhibitors coupled with thymectomy can control symptoms

205
Q

what test is used when data are nonparametric- meaning either not normally distributed or variances are not equal among groups?

A

Mann-Whitney U test

206
Q

what test is used with parametric- normally distributed data?

A

Student t test ANOVA

207
Q

what is used to assess the relationship between a dependent variable and multiple independent variables?

A

regression analysis

208
Q

Argatroban

A

Direct thrombin inhibition -prevents conversion of fibrinogen to fibrin

209
Q

Aspirin

A

-Binding of COX-1 and COX-2 -suppressing thromboxane A2 -effectively preventing platelet aggregation

210
Q

Fondaparinux

A

Inhibition of factor Xa thru antithromin binding -conformational change in antithrombin enhances ability to inhibit Factor Xa.

211
Q

Enoxaparin

A

Inhibition of factor Xa thru antithromin binding -conformational change in antithrombin enhances ability to inhibit Factor Xa.

212
Q

Warfarin

A

-Inh of vit K-dep carboxylation -interfering with cyclic interconversion of vitamin K and its 2- 3 epoxide -hepatic synthesis of factors II- VII- IX- and X with reduced activity

213
Q

biggest RF for nonunion in post spine fusion?

A

smoking

214
Q

Compared to autograft- ALLOGRAFT demonstrates… ______ inflammatory response _____ rate of biological incorporation and remodeling _____ proportion of large-diameter collagen fibrils

A

PROLONGER inflammatory response -SLOWER rate of biological incorporation and remodeling -HIGHER proportion of large-diameter collagen fibrils.

215
Q

Hemophilia A

A

XLR deficiency of factor 8 recurrent spontaneous hemarthroses- synovitis and joint destructioN

216
Q

von Willebrand disease

A

lack of von Willebrand factor decreased platelet aggregation mucosal bleeding NOT hemarthroses

217
Q

Protein C and S deficiencies

A

AD lead to thrombosis- NOT bleeding- as protein C and S shut off thrombin formation.

218
Q

Redosing of abx should occur

A

3 to 4 hours after initial dose for procedures that extend beyond 3 to 4 hours.

219
Q

current recs for abx prophylaxis for major ortho procedures is to administer IV abx ……

A

within 1 hour of surgical incision.

220
Q

3 basic mechanisms of antibiotic resistance

A

1 avoidance 2 decreased susceptibility 3 inactivation

221
Q

Biofilm formation is a classic example of what mechanism of abx resistance?

A

avoidance biofilm creates a physical barrier to the antibiotic

222
Q

high-shear environments ______ biofilm production

A

stimulate

223
Q

MOA of calcitonin?

A

Interferes with osteoclast maturation inhibits phosphate reabsorption decreases calcium reabsorption in kidneys.

224
Q

1st stage of osteoarthritis is marked by

A

increase in water 2/2 to disruption of matrix

225
Q

One hallmark of osteoarthritic cartilage is a reduced repair mechanism attributable to what cell response?

A

decreased chondrocyte response to growth factor stimulation (TGF-alpha and ILGF-1).

226
Q

Microscopic evidence and process of cartilage degeneration with decreased water content in terminal phases of osteoarthritis

A

1 fibrillation of superficial and transition zones 2 disruption of tidemark by subchondral blood vessels 3 subchondral bone remodeling

227
Q

Wnt-induced signal protein 1 increases what cell and what process?

A

chondrocyte protease expression. Failure to restore tissue balance ultimately leads to continued destruction and osteoarthritis.

228
Q

diffusely positive S-100 and pleomorphic large elongated spindle-shaped blue cells

A

malignant peripheral nerve sheath tumor (MPNST) NF1 inherited AD

229
Q

toughness

A

amount of energy per volume a material can absorb before failure (fracture)

230
Q

HOW TO CALCULATE TOUGHNESS?

A

area under stress/strain curve (joules per meter cubed- J/m3)

231
Q

creep

A

increased load deformation with time under constant load

232
Q

load relaxation

A

decrease in applied stress under conditions of constant strain

233
Q

hysteresis (energy dissipation)

A

characteristic of viseoelastic materials loading curve does NOT follow unloading curve difference between curves is energy that is dissipated

234
Q

Elastic zone

A

zone where a material will return to original shape for a given amount of stress

235
Q

toe region

A

straightening of crimped ligament fibrils applies to a ligaments stress/strain curve

236
Q

Yield point

A

transition point between elastic and plastic deformation

237
Q

Yield strength

A

amount of stress necessary to produce a specific amount of permanent deformation

238
Q

Plastic zone

A

zone where a material will NOT return to its orginal shape for a given amount of stress

239
Q

Breaking point

A

object fails and breaks

240
Q

Ultimate (Tensile) strength

A

load to failure

241
Q

Hooke’s law

A

when a material is loaded in the elastic zone- stress is proportional to the strain

242
Q

Young’s modulus of elasticity

A

measure of stiffness (ability to resist deformation) of a material in elastic zone slope of the stress/strain curve in elastic zone

243
Q

HIGER modulus of elasticity indicates what type of material?

A

stiffer material

244
Q

SIR- COST COULD PUSH POLLY TO CANCEL HER TELEPHONE CARRIER

A

CERAMIC- COCR- SS- TITANIUM- CORTICAL BONE- PMMA- PE- CANCELLOUS- TENDON- LIGAMENT- CARTILAGE

245
Q

Brittle material

A

material that exhibits linear stress stain relationship until point of failure ONLY ELASTIC DEFORMATION PMMA ceramics

246
Q

Ductile Material

A

large amount of plastic deformation before failure METAL

247
Q

Viscoelastic material

A

material that exhibits a stress-strain relationship dependent on load and rate by which load is applied exhibit a time-dependent mechanical behavior function of internal friction of a material LIGAMENTS AND BONE

248
Q

Fatigue failure

A

failure at a point below the ultimate tensile strength secondary to repetitive loading depends on magnitude of stress and number of cycles

249
Q

Endurance limit

A

maximal stress under which an object is immune to fatigue failure regardless of the number of cycles

250
Q

Creep

A

progressive deformation of metal in response to constant force over an extended period of time

251
Q

Corrosion

A

chemical dissolving of metal

252
Q

galvanic corrosion

A

dissimilar metals leads to electrochemical destruction

253
Q

mixing metals 316L stainless steel and Co-Cr has highest risk of what type of corrosion?

A

galvanic corrosion can be reduced by using similar metal

254
Q

crevice corrosion? what metal is most prone?

A

in fatigue cracks due to differences in oxygen tension 316L stainless steel most prone

255
Q

fretting corrosion

A

at contact sites between two materials with micromotion against each other leading to mechanical wear and material transfer at the surface. -head-neck junction in THA

256
Q

ability of a material to absorb energy and plastically deform without fracturing

A

toughness

257
Q

rupture of a material under repeated cyclic stresses- at a point below the normal static breaking strength

A

fatigue failure

258
Q

Free radical oxidation- or oxidative corrosion- is a

A

chemical reaction involving a change in the oxidation state of polyethylene or metal.

259
Q

what metal forms adherent oxide coating through self passivation and is corrosion resistant?

A

TITANIUM

260
Q

STAINLESS STEEL components

A

primarily iron-carbon alloy with lesser elements of chromium molybdenum MANGANESE

261
Q

Cobalt alloy components

A

COBALT CHROMIUM MOLYBDENUM

262
Q

ranking of ultimate strength- from highest to lowest is:

A

1) cobalt chrome 2) titanium 3) stainless steel 4) cortical bone

263
Q

Endurance limit VS FATIGUE STRENGTH?

A

BOTH ARE THE SAME– maximum cyclic load (10 million cycles) that a standard sized metal can absorb before fracture

264
Q

Ductility

A

how much strain a material can take before rupturing

265
Q

PMMA

A

reaches ultimate strength at 24 hours– strongest in compression– Young’s modulus between cortical and cancellous bone

266
Q

CERAMIC

A

typically brittle- low fracture toughness- LOW TENSILE STRENGTH- high compressive strength

267
Q

TORSION/ SIPRAL FX

A

longer the bone- greater the stresses on the outer cortex under torsion

268
Q

ultimate strength

A

Load at which a material fractures

269
Q

Tantalum is often used in implants where bony ingrowth is desired.

A

very resistant to corrosion

270
Q

mnemonic for primary hypercoagulopathies (inherited)

A

FAC DR SD! (fac doctor SD) Factor V leiden mutation (Factor) Antithrombin III deficiency (At3) protein C Deficiency (C Def) activated protein C Resistance (C Res) protein S Deficiency (S Def)

271
Q

What is the function of the homeobox gene products (HOX genes)?

A

Regulate somatization of the axial skeleton direct the formation of limbs and organs along the A-P axis (imaginary line that runs from head to tail in animals)

272
Q

WHAT ARE inheritable genetic alterations that do not involve DNA mutation?

A

Epigenetic changes (DNA methylation- histone modification- nucleosome location- or noncoding RNA)

273
Q

WHAT ARE genes that are artificially introduced into a single-celled embryo and are present in all cells of that organism?

A

TRANSGENES

274
Q

HOW MUCH CALCIUM TO TAKE PER DAY IF POSITIVE HX of osteoporosis- confirmed by a T-score <-2.5?

A

1000-1500mg of calcium per day at baseline

test (3 decks)

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