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Step 1 Decks > Musculoskeletal, Skin, and Connective Tissue > Flashcards

Musculoskeletal, Skin, and Connective Tissue Flashcards

1
Q

Which bones are formed by endochondral ossification and which are formed by membranous ossification?

A

Endochondral Ossification:
- Bones of axial skeleton, appendicular skeleton, and base of skull

Membranous Ossification:
- Bones of calvarium, facial bones, and clavicle

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2
Q

In endochondral ossification, ——— model of bone is first made by ———; ——— later replace with ——— and then remodel to ———

A

- cartilaginous

- chondrocytes

- osteoclasts and osteoblasts

- woven bone

- lamellar bone

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3
Q

In normal adults, woven bone occurs:

A

after fractures

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4
Q

In adults, woven bone can occurs with what disease?

A

Paget disease

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5
Q

Endochondral ossification is defective with which disease?

A

achondroplasia

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6
Q

In membranous ossification, ———formed directly without ———; Later remodeled to ———

A

- woven bone

- cartilage

- lamellar bone

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7
Q

Osteoblasts function to ——— by secreting ——— and catalyzing ——— in ——— environment via ———

A

- build bone

- collagen

- mineralization

- alkaline

- ALP (alkaline phosphatase)

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8
Q

Osteoblasts differentiate from ———in ———

A

- mesenchymal stem cells

- periosteum

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9
Q

Osteoblastic activity is measured by which 3 factors:

A

- bone ALP (alkaline phosphatase)

- osteocalcin

- propeptides of type I procollagen

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10
Q

Osteoclasts function to ——— by secreting ——— and ———

A

- dissolves (“crushes”) bone

- H+

- collagenases

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11
Q

Osteoclasts differentiate from:

A

a fusion of monocyte/macrophage lineage precursors

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12
Q

——— receptors on osteoclasts are stimulated by ——— (expressed on ———)

A

- RANK

- RANKL (RANK ligand)

- osteoblasts

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13
Q

Osteoclast activity is decreased by ——— (which is a ———) binds ——— to prevent ———

A

- OPG (osteoprotegerin)

- RANKL decoy receptor

- RANKL

- RANK-RANKL interaction Ž 

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14
Q

At low, intermittent levels, PTH exerts ——— effects (results in ———) on osteoblasts and osteoclasts (—direct or indirect effect?—)

A

- anabolic

- building bone

- indirect

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15
Q

Chronically elevated PTH levels (name disease state ———) cause ——— effects on bone (name associated condition ———)

A

- 1° hyperparathyroidism

- catabolic

- osteitis fibrosa cystica

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16
Q

Estrogen inhibits apoptosis in ———and induces apoptosis in ———

A

- bone-forming osteoblasts

- bone-resorbing osteoclasts

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17
Q

Estrogen causes what bone related action during puberty?

A

closure of epiphyseal plate

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18
Q

Estrogen deficiency (surgical or postmenopausal) Žhas what effect on bone and is associated with what condition?

A

- causes cycles of remodeling and bone resorption Ž

- increases the risk of osteoporosis

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19
Q

Greenstick fracture are ——— fracture extending —— following ——— stress; bone fails on ——— side; ——— side intact

A

- incomplete

- partway through width of bone

- bending

- tension

- compression

(Bone is bent like a green twig)

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20
Q

Torus (buckle) fracture is caused by a ——— force applied to ——— bone resulting in ——— on ——— side and fractures; ——— side remains solid (intact)

A

- axial

- immature

- cortex buckling

- compression (concave)

- tension (convex)

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21
Q

Achondroplasia is a failure of ———, resulting in Ž phenotype of ———

A

- longitudinal bone growth (endochondral ossification)

- short limbs

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22
Q

In Achondroplasia, ——— is not affected, resulting in phenotype of ———

A

- membranous ossification

- large head relative to limbs

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23
Q

In Achondroplasia, constitutive activation of ——— results in inhibition of ———

A

- fibroblast growth factor receptor (FGFR3)

- chondrocyte proliferation

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24
Q

The mode of inheritance for Achondroplasia is ——— with ——— penetrance (homozygosity is ———) (> 85% of mutations occur ———)

A

- autosomal dominant

- full

- lethal

- sporadically

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25
Q

Achondroplasia is associated with  what relative to parents?

A

Associated with increased paternal age

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26
Q

What is the most common cause of short-limbed dwarfism?

A

Achondroplasia

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27
Q

With Osteoporosis, ——— lose mass despite normal ——— and ——— (I.e., ———)

A

- trabecular (spongy) and cortical bone

- bone mineralization and lab values

- serum Ca2+ and PO4 3−

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28
Q

Osteoporosis is most commonly due to ——— (due to ———) related to . ———, ———, and ———

A

- bone resorption

- increased osteoclast number and activity

- decreased estrogen levels, old age, and cigarette smoking

29
Q

Give 5 examples of drugs and 5 examples of other conditions that Osteoporosis can be 2° to:

A

- drugs (eg, steroids, alcohol, anticonvulsants, anticoagulants, thyroid replacement therapy)

- other conditions (eg, hyperparathyroidism, hyperthyroidism, multiple myeloma, malabsorption syndromes, anorexia)

30
Q

Osteoporosis is diagnosed by measurement of ——— by ——— test looking at the ———, with a T-score of ≤ ——— or by a ——— (eg, ———) at ———

A

- bone mineral density

- DEXA (dual-energy x-ray absorptiometry)

- lumbar spine, total hip, and femoral neck

- −2.5

- fragility fracture

- fall from standing height, minimal trauma

- hip or vertebra

31
Q

One-time Osteoporosis screening recommended in ———

A

females ≥ 65 years old

32
Q

List 2 approaches to prophylaxis against Osteoporosis:

A

- regular weight-bearing exercise

- adequate Ca2+ and vitamin D intake throughout adulthood

33
Q

List 4 treatments for Osteoporosis:

A

- bisphosphonates

- teriparatide

- SERMs (selective estrogen receptor modulators)

-denosumab (monoclonal antibody against RANKL)

34
Q

List 5 key symptoms of Osteoporosis:

A

- vertebral compression fractures

- acute back pain

- loss of height

- kyphosis

- fractures of femoral neck or distal radius (Colles fracture)

35
Q

Osteopetrosis is a failure of ——— due to ———, resulting in ——— bones that are prone to ———

A

- normal bone resorption

- defective osteoclasts Ž

- thickened, dense

- fracture

36
Q

In Osteopetrosis, mutations (eg, ———) impair ———

A

- carbonic anhydrase II

- ability of osteoclast to generate acidic environment necessary for bone resorption

37
Q

In Osteopetrosis, overgrowth of ——— fills ——— leading to Ž———

A

- cortical bone

- marrow space

- pancytopenia, extramedullary hematopoiesis

38
Q

Osteopetrosis can result in ——— and ——— due to narrowed foramina

A

cranial nerve impingement and palsies

39
Q

Osteopetrosis on x-rays shows:

A

diffuse symmetric sclerosis (bone-in-bone, “stone bone”)

40
Q

For Osteopetrosis, ——— is potentially curative as ———

A

- bone marrow transplant

-osteoclasts are derived from monocytes

41
Q

Osteomalacia occurs due to defective ——— and rickets occurs due to defective ——— (occurs only in ———)

A

- mineralization of osteoid (unmineralized bone tissue)

- mineralization of cartilaginous growth plates

- children

42
Q

Osteomalacia and rickets are most commonly due to:

A

vitamin D deficiency

43
Q

In osteomalacia, X-rays in show what two findings:

A

osteopenia and pseudofractures (insufficiency fractures; also called Looser zones, cortical infractions, or Milkman line)

44
Q

In rickets, X-rays in show what two findings:

A

epiphyseal widening and metaphyseal cupping/fraying

45
Q

List 3 key findings in children with rickets:

A

- pathologic bow legs (genu varum)

- beadlike costochondral junctions (rachitic rosary)

craniotabes (soft skull)

46
Q

Relative to osteomalacia/rickets, decreased vitamin D Ž—> ———serum Ca2+ Ž  —> ——— PTH secretion —> ——— Ž  serum PO4 3−

A

- decreased

- increased

- decreased

47
Q

Relative to osteomalacia/rickets, hyperactivity of osteoblasts Ž —> ———  ALP

A

Increased

48
Q

Osteitis deformans (also called ———) is a common, localized disorder of ——— caused by  ——— activity followed by ——— activity that forms ——— bone

A

- Paget disease of bone

- bone remodeling

- increased osteoclastic activity

- increased osteoblastic activity

- poor-quality

49
Q

In osteitis deformans, how are serum Ca2+, phosphorus, PTH, and ALP levels?

A

- Normal Serum Ca2+, phosphorus, and PTH levels

- Elevated ALP

50
Q

List the divisions of the brachial plexus:

A

Roots
Trunk
Divisions
Cords
Branches

(Remember To Drink Cold Beer)

51
Q

Relative to locations, ——— of brachial plexus and the ——— artery pass between ——— and ——— muscles (——— vein passes anteromedial to the ———)

A

- Trunks

- subclavian

- anterior scalene

- middle scalene

- subclavian

- scalene triangle

52
Q

The brachial plexus is composed of which nerve roots?

A

four cervical nerve roots (C5-C8) and
first thoracic nerve root (T1)

53
Q

Brachial plexus roots combine to form ——— trunks : ——— forms the upper trunk, ——— forms the middle trunk and ——— forms the lower trunk

A

- three

- C5-C6

- C7

- C8-T1

54
Q

What injury causes Erb palsy (“waiter’s tip”) ?

A

Traction or tear of upper trunk: C5-C6 roots

55
Q

In infants, what tends to cause Erb palsy (“waiter’s tip”)?

A

lateral traction on neck during delivery

56
Q

In adults, what tends to cause Erb palsy (“waiter’s tip”)?

A

trauma leading to neck traction (eg, falling on head and shoulder in motorcycle accident)

57
Q

List the involved muscles and associated deficits in Erb palsy (“waiter’s tip”):

A

Deltoid, supraspinatus - Abduction (arm hangs by side)

Infraspinatus, supraspinatus - Lateral rotation (arm medially rotated)

Biceps brachii - Flexion, supination (arm extended and pronated)

(ERB gets DIBS on TIPS )

58
Q

Define abduction vs adduction:

A

Abduction refers to moving a limb away from the midline of body

Adduction refers to moving a limb toward the midline of your body

59
Q

Define supination vs pronation of the forearm:

A

Supination is a movement that turns the palm to face anteriorly or palm facing up

Pronation is a movement that turns the palm to face posteriorly or palm facing down

60
Q

What injury causes Klumpke palsy?

A

Traction or tear of lower trunk: C8-T1 roots

61
Q

In infants, what tends to cause Klumpke palsy?

A

Upward force on arm during delivery

62
Q

In adults, what tends to cause Klumpke palsy?

A

trauma (eg, grabbing a tree branch to break a fall)

63
Q

List the involved muscles and associated deficits in Klumpke palsy:

A

Intrinsic hand muscles: lumbricals, interossei, thenar, hypothenar

Claw hand: lumbricals normally flex MCP joints and extend DIP and PIP joints

64
Q

What injury causes thoracic outlet syndrome?

A

Compression of lower trunk and subclavian vessels, most commonly within the scalene triangle

65
Q

What tends to cause thoracic outlet syndrome?

A

Cervical/anomalous first ribs (arrows), Pancoast tumor

66
Q

List the involved muscles and associated deficits in thoracic outlet syndrome:

A

Intrinsic hand muscles: lumbricals, interossei, thenar, hypothenar
(Same as Klumpke palsy)

Atrophy of intrinsic hand muscles; ischemia, pain, and edema due to vascular compression

67
Q

What injury causes winged scapula?

A

Lesion of long thoracic nerve, roots C5-C7 (“wings of heaven”)

68
Q

What are causes of a winged scapula?

A

Axillary node dissection after mastectomy, stab wounds

69
Q

List the involved muscles and associated deficits in a winged scapula:

A

Serratus anterior

Inability to anchor scapula to thoracic cage, thus cannot abduct arm above horizontal position

Step 1 Decks (8 decks)

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