MSK Flashcards
in fx for kids, what is often affected
the physis aka growth plate
S A L T E R classification
S: straight across-->TYPE 1 A: above growth plate-->TYPE 2 L: lower than growth plate-->TYPE 3 T: through growth plate-->TYPE 4 E: Erasure of growth plate/crush injury-->TYPE 5 R: Reaction periosteal-->TYPE 6
MC salter fx
type 2— above growth plate
fracture healing
- requires?
- involves?
- typical time in adults
- bony fragments be in contact or in very close proximity
- involves: bridging structure–>CALLUS
**ADULTS: 6-8 weeks
what is a callus
- bridging structure made of fibrous tissue and cartilage
1. internal callus
2. external callus - fragile
- must be protected with immobilization of the limb
what happens if theres motion at the fracture site during healing
Bony bridges aka calluses will break— fx can take longer to heal or not heal at all
name the four stages of fracture healing
- hematoma formation
- fibrocartilaginous callus formation
- bony callus formation
- bone remodeling
fracture healing is also called
fracture consolidation
define ossification
bone formation via osteoblasts
define osteogenesis
bone formation via osteoblasts
define bone remodeling
replacement of old bone tissue with new bone tissue
Osteoblasts do?
osteroclasts do?
BLASTS– build aka form new tissue
CLASTS–cleave/absorb the old tissue
which vits (3), hormones (3) and minerals (3) are required for bone remodeling
Vitamins D, C, and A +
Ca, phosphorous, and magnesium
hormones: parathyroid, GH and calcitonin
up to ___ - ___ % of bone mass is recycled every week
5-7%
where is the largest ca store in body
bones
list the three hormones that regulate ca [ ]
PTH
calcitonin
Vit d
what raises ca levels
vit d and PTH
what lowers ca levels
calcitonin
how does PTH increase blood [ca]—3 ways
- stim osteoclasts to b/d bone
- increasing reabsorption of ca by kidneys
- increasing conversion of inactive vit D to active vit —–which then increases ca reabsorption from GI track
PTH causes elevated blood _____ and decreased ____
elev CA and decr Phosphate
Vit D _____ absorption of ____ and ____ from ____
increases abs calcium and phosphate from the gut
roles of vit d—3
- incrs abs of ca and phosphate in gut
- incrs bone resporption
- incrs phosphate reabs in kidneys
how does calcitonin decrease ca levels
using calcium to build bone–>decreasing renal reabsorption of ca.
scoliosis
- define
- assoc wit?
- MC in?
- MCC
*deviation of the spine from the vertical axis (cobb angle)
greater than 10 degrees aka cobb angle >10 degrees
*LATERAL curvature of the spine
*MC in females or ppl with fam hx
*MCC=idiopathic
*can be assoc with kyphosis (humpback) or lordosis (sway back)
screening for scoliosis
- when?
- whats test called
- instrument?
- abnormal findings
occurs during routine pediatric exam
- adams forward bend test*
- instrument=scoliometer
- abnormal finding= anything over 7 degree curve is considered abnormal
most sensitive test for scoliosis
adams forward bend test
most definitive diagnosis for scoliosis
-finding?
xray–over 10 degreees as measured on the AP and lateral xray
treatment of scoliosis depends on what 3 things
- how bad the angle is
- the progression of the curve
- skeletal maturity of patient
Lumbosacral sprain/strain aka?
lower back pain
MCC of lower back pain?
lumbrosacral sprain/ strain
define lumbosacral sprain/strain
-moa
acute strain or tear of paraspinal muscles—-esp after twisting or lifting injuries
s/s of lumbosacral sprain or strain
- back pain (lower)
- muscle spasms
- DOES NOT RADIATE to leg
- NO neuro s/s
Dx for lumbosacral sprain/srain
clinical dx
xrays are not needed unless s/s persistnet >1 MO or red flag s/s present
define auto immune dz
groups of diseases (that often include joint involvement) where body’s own immune system attacks healthy tissue, skin, organs, joints, etc
what drugs are usually tx for rheum dzs (2)
- systemic glucocoticoid steorids bc the s/s are from immune system rxn—- steroids tamper down immune system
- DMARDS–>disease modifying AntiRheumatoid Drugs–>attempt to slow down dz effects on body
what are the lab tests commonly used with autoimmune dz (6)
- Erythrocyte Sedimentation Rate (ESR)
- C-reactive protein (CRP)
- Complement tests (C3, C4)
- Antinuclear Antibody (ANA)
- Rheumatoid Factor (RF)
- Anti-citrullinated protein antibody (ACPA)
what is ESR
- is it specific?
- what does high ESR mean
measures how quickly RBCs settle at bottom of test tube
- –settle faster=inflammation
- **it is non-specific and is elevated in many diff conditions
what is CRP
- used for?
- sensitive, specific?
- used to detect or monitor significant inflammation in acute conditions—infections
- used in monitoring chronic inflamm conditions to detect flare ups and det if tx is effective–EX: RA, Lupus, vasculitis)
- sensitive but not specific
What is Complement tests
-when does it go up? go down?
C3 and C4
- immune system proteins that normally rise dramatically just after an infection and injury
- BUT in LUPUS—– where the immune system is constantly activated, the levels go down bc they stop responding as dramatically since there is chronic dz state
what is antinuclear antibody (ANA)
(+) test means?
they attack healthy body tissues— specifically targeting each cell’s nucleus
(+) ANA means immune syst has launched misdirected atttack on healthy tissue
Rheumatoid factor (RF) what is it
- diagnose wht?
- sensitive? specific?
- autoantibody that attacks healthy body cells
- often used to diagnose RA
- not sensitive
- not specific
Anti-citrullinated protein antibody (ACPA)
- what is it
- diagnoses wht?
*autoantibodies that are directed against peptides + proteins that are citrullinated–>test allows for EARLY diagnosis of RA
patho for RA
-rf
hyperplastic synovial tissue (pannus) leads to destruction of joints
inflammation of the synovium=destruction of joint
**t-cell mediated—type IV **
RF
- women
- smoking
- 20-40yo
- HLA-DRA 1 and 4
RF for RA (4)
- women
- 20-40 YO
- smoking
- HLA-DRA 1 & 4
organsims assoc with reactive arthritis
GI: salmonella, shigella, campy, yersinia,
GU: chlamydia
organsims assoc with reactive arthritis
GI: salmonella, shigella, campy, yersinia,
GU: chlamydia
Polyarteritis Nodosa– what causes it
- MC in who
- incr assoc with what dz
type 3 hypersensitivity rxn–> leads to ischemia and microanurysms of affected vessels (CNS, GI and/or renal MC)
MC in men 40-60YO
incr assoc with Chronic HBV and HCV
Polymyositis
- cause
- patho
- RF
Unknown cause, but thought to be a genetically susceptible individual plus an environmental trigger leads to immune activation, which results in chronic inflammation.
*inflammatory myopathy due to CD8+ lumphocyte infiltration of endomysium
CD8+ lymphocyte infiltration of endomysium
RF
- wonen
- 30-50 YO
SLE
patho
rf (8)
autoantibody production–deposition of immune complexes, complement activation and accompany tissue destruction/vasculitis
- **multi-organ autoimmune disorder of CT
- type III hypersen (Ag-Ab immune complexes)
RF
- young females— onset=20-40s
- AA
- hispanic
- native american
- genetic + environmental
- sun exposure
- infections
- estrogen—OCPs
Congenital Hip Dislocation/Dysplasia
- define
- rf (4)
abnormality in shape and/or stability of femoral head and acetabulum
RF
- breech presentation
- first born child
- females
- fam hx
Congenital Hip Dislocation/Dysplasia
- define
- when is this diagnosed
- RF
- PE
- Dx
- tx: <6mo, 6m-2yo
- abnormality of the shape/stability of the femoral head + acetabulum
- hip is examined at birth + every well-check visit up until 9 MO and/or child is walking independently
RF
- Breech presentation
- first born child
- females
- +fam hx
PE–looking for hip asymmetry, instability and limited abduction
1. BARLOW MANEUVER–>gentle adduction w.o downward pressure to feel for dislocatability—typically will hear a CLICK or CLUNK
- ORTOLANI MANEUVER–>abduction and elevation to feel for reducibility— resulting in a CLICK or CLUNK
OTHER FINDINGS: asymmetry, restricted hip abduction,
DX
*clinical with confirmation imaging (MC is US for kids <4MO)
TX
<6MO: Pavlik harness
6m-2y: closed reduction in OR
*monitoring with routine hip xrays until skeletal maturity
RF for SCFE
- children 8-16YO
- obese
- AA
- males during growth spurt
- if seen in kids b4 puberty–suspect hormonal or systemic disorders –hypothyroidism or hypopituitarism
RF for Legg-Calve-Perthes disease (4)
-whats a decr RF?
- age 4-10
- males—4x more likely
- obesity
- coagulation abnormalities (face V leiden)
DECR RF: low incidence in AAs
strongest bone in body?
femur
what is the femur surrounded by
hamstrings and quads
RF for Patellofemoral syndrome (chondromalacia)
- cyclists
- runners
- women
Rf for achilles tendon rupture
75% from sport related injury/weekend warriors
- incr risk with fluoroquinolone use, corticosteroid injections
- 30-50YO
three ankle bones
tibia
fibula
talus
ankle mortise
separation b/w end of tibia and talus bone
RF for plantar fasciitis (5)
- flat feet
- high arches
- heel spurs
- females 40-60 YO
- obese
Neuropathic (charcot) arthropathy
Decrs sensation, autonomic dysfunction and repeptitve microtrauma leads to bone resoprtion and weakening
*seen with DM and tables dorsalis (tertiary syphilis)
disruption of the articulation of the medial cuneiform and base of the 2nd metatarsal leading to ligamentous injury and/or fracture
Lisfranc injury
Lisfranc injury
disruption of the articulation of the medial cuneiform and base of the 2nd metatarsal leading to ligamentous injury and/or fracture
AC ligament provides ____ stability
horizontal
muscles of rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
what nerve runs behind the humerus
radial nerve
Osteomalacia
- define
- MCC
- CM
- labs
- imaging findings
*disorder of decr mineralization of new bone growth
“softening of bones”
MCC=severe vit D deficiency–vit D absorbs CA–we need CA to mineralize or harden new bone
*can also be genetic cause—genetic disorder causes hypophosphatemia and chronic kidney dz
CM
- bone pain + muscle weakness
- bone tenderness
- fractures
- diff walking and waddling gait
LAB findings
- elev alk phosph
- elev PTH
- low serum Ca and VIt d
Radiographic findings
Vertebral body trabeculae have a distinct appearance due to inadequate mineralization
Osteogenesis Imperfecta
- define
- cm
- pe
- dx
- tx
- rare genetic CT dz
- autosomal dominant dz
- defects in gene that encodes for type 1 collagen
- assoc with fetal perinatal death in severe form
CM
Severe, premature osteoporosis - multiple recurrent spontaneous fractures with minimal or no trauma in childhood, leading to limb deformities & shortening.
Deafness can also occur
PE
- Blue tinted sclerae is a hallmark
- Thin skin
- Hyperextensibility of the ligaments
- Otosclerosis with significant hearing loss
- Brown teeth (hypoplastic and deformed as well). ***Not to be confused with *TETRACYCLINE TEETH.
- Intelligence NOT affected
Dx: Clinical & x-rays; Confirmed with genetic/DNA testing
Management:
Bisphosphonates, physical therapy and surgical interventions. Most people are wheelchair bound.
Scoliosis
- define
- assoc with?
- list the four main categories and mc?
- mc in who
- CM
Scoliosis is characterized by lateral curvature of the spine
*Associated with rotation of the involved vertebrae and classified by its anatomic
location, in either the thoracic or lumbar spine.
*** four main categories of scoliosis:
idiopathic,
congenital,
neuromuscular (associated with a neurological or muscular disease), and syndromic (associated with a known syndrome).
*Idiopathic scoliosis accounts for around 80% of cases
It is more common in girls and typically develops around 10–12 years of age, but can occur earlier.
CM
*Scoliosis in adolescents does not typically cause significant pain.
If a patient has significant pain, she/he should be evaluated to rule out the possibility of some other disorder such as infection or tumor.
*Deformity of the rib cage and asymmetry of the waistline are clinically evident for curvatures of 30 degrees or more.
*Lesser curves may be detected through a forward bending test, which is designed to detect early abnormalities of rotation that may not be apparent when the patient is standing erect. Rotation of the spine may be measured with a scoliometer.
*Rotation is associated with a marked rib hump as the lateral curvature increases in severity.
normal curve in lumbar region
anterior convexity—-lumbar lordosis
normal curve in thoracic region
posterior convexiy—-kyphosis
excesive kyphosis=?
PATHOLOGIC
Hyperkyphosis
kyphosis often accompanied by?
scoliosis
RF (4) for acute osteomyelitis
-mc pathogen
sickle cell dz
dm
immunocomp
preexisting joint dz
MC pathogen=staph aureus
RF for OA
MODIFIABLE: obestiy, trauma, heavy labor
NON-MOD: incr age, female, fam hx
gout
- what is it
- wht happens
- what causes it
- RF
- inflammatory monoarticular arthritis
- caused by crystalization of monosodium urate in joint
- hyperuricemia is hallmark of dz but does NOT itself indicate gout
- MC=men >30 YO
- ETIOLOGY=incr production of uric acid OR decreased excretion of uric acid (90%)
- inflamm in joint occurs when uric acid crystals collect in synovial fluid as extracellular fluid becomes saturated with uric acid
Pseudogout aka Calcium Pyrophosphate Dihydrate Deposition dz
- RF
- define
RF
- hemochromatosis
- hyperparathyroidism
- hypomagnesia
*calcium pyrophosphate dihydrate deposition in joints + soft tissue–leads to inflammation and bone destruction
define tumor
abnormal growth
resulting from uncontrolled proliferation
serves no physiologic function
***Not all tumors are cancerous (malignant)
tumor=neoplasm
define cancer
= refers to a malignant tumor and is not used to refer to benign growths, such as lipomas or hypertrophy of an organ
can benign neoplasm be life threatening?
YES–>if they are enlarged in critical locations
EX: benign meningioma at the base of skull–compression of brain tissue
Benign tumor
-structure
- encapsulated
- well differentiated
- retain some normal tissue structure
- DO NOT invade the capsules surrounding them
- DO NOT spread to regional lymph nodes or distant locations
*generally named by tissue they arrise from + suffic -oma
what is a benign tumor of smooth muscle of uterus called
leiomyoma
benign tumor of fat cells
lipoma
malignant tumor
- growth rate
- hallmark microscopic finding?
grow more rapidly vs benign
*loss of differentiation and absence of normal tissue organization=microscopically
*hallmark finding under microscope=ANAPLASIA–>the loss of cellular differentiation, irregularities of size/shape of nucleus and loss of normal tissue strcture
carcinoma arises from
epithelial tissue
adenocarcinomas arise from
ductal or glandular structure
Mammary adenocarcinoma
malig tumor arising from breast glandular tissue
-sarcoma
ca arrising from CT tissue
rhabdomyoscarcoma
malig CA of skel muscle
lymphomas
CAA of lympahtic tissue
Leukemias
CA of blood forming cells
two CAs that were not named after cell type from they originate
Hodgink dz
Ewing sarcoma
transformation
process by which a normal cell becomes a CA cell
autonomy
cancer cell’s independence from normal cellular controls— part of transformational process
what do tranformed cells lack
normal “social controls” seen in nontransformed cells
can CA cells die
no they are usually immortal—- unlimited life spand and will cont to divide for years
are CA cells anchorage dependent or independent
independent— can proliferate suspended without attaching to a surface (unlike normal cells)
Benign tumors VS Malignant
- growth rate
- capsule definition
- degree of invasiveness
- diffferentiated
- miotix index
- ability to metastisize
BENIGN
- grow slowly
- well-defined capsule
- not invasive
- well differentiated–look like the tissue from which they arouse
- low mitotic index– dividing cells are rare
- do not met
MALIG
- grow rapidly
- not encapsulated
- invade local strucutures and tissues
- poorly differentiated–may not be able to determine tissue of origin
- high mitotic index–many dividing cells
- can spread distantly–often thru BVs or lymphatics
Osteoid osteoma
benign bone tumor characterized by small, radiolucent nidus—- produces high levels of prostaglandins
