B2 Clin Med Exam 1
Describe the nutrition therapy you would prescribe to a patient with GOUT during remission (between flares)
-consume 8-16 cups of fluid/day, at least half should be water -abstain from consuming alcohol -follow a well-balanced eating plan following US dietary guideliens -as tolerated, consume animal foods (continue to eat a moderate amount of protein) -maintain a desirable body weight (avoid fasting or heigh-protein diets for weight loss)
Describe the nutrition therapy you would prescribe to a patient with GOUT during an acute attack
-consume 8-16 cups of fluid/day, at least half should be water -abstain from consuming alcohol -limit animal foods -eat a moderate amount of protein -low-fat or non-fat dairy foods -tofu, eggs, nut butters -limit meat, fish, and poultry to 4-6 oz/day
What are the universal guidelines to prevent osteopenia/osteoporosis?
-consume adequate calcium and vit D -lifelong muscle strengthening and weight-bearing exercise -avoid tobacco -moderate or no intake of alcohol -steps to avoid falls
What does the anti-inflammatory diet limit?
-saturated fats and trans fats -omega-6 fats such as vegetable oils and animal fat -refined carbs (pasta, white bread, white rice, pastries, cookies, cakes, energy bars, candy) -eggs, red meat, butter, other full-fat dairy -refined and processed foods
What are the most observed nutrient deficiencies in patients with rheumatoid arthritis?
-vitamins C, D, B6, B12, E, and B9 -Calcium, Magnesium, Zinc, and Selenium
What meyerding grade for spondylolisthesis indicates 0% slippage?
0
What risser grade indicates no ossification?
0
What risser grade indicates up to 25% ossification
1
How do you treat rickets?
1. 1000-6000 IU daily (based on age) for 3 months 2. MD of 400-600 IU daily (based on age) 3. oral calcium to replace what body has lost
How do you prevent rickets?
1. 400 IU/day for infants up to 1 year of age 2. RDA of 600 IU/day for children 1 to 18 years of age
What are some comorbidites associated with goat?
1. HTN 2. DM 3. obesity 4. renal insufficiency 5. hypertriglyceridemia 6. hypercholesterolemia 7. CAD 8. early menopause
What are three physical exam findings for rheumatoid arthritis (RA) that could help you differentiate between RA and osteoarthritis?
1. Heberden's nodes 2. Bouchard's nodes 3. DIP/PIP predominant
What are the shoulder dislocation complications?
1. Hills-Sachs--humeral head compression fracture 2. Bankart--glenoid rim fracture 3. rotator cuff tears (increases with age, 30-85% pts older than 40) 4. vascular injury (axillary a. and v., rare) 5. nerve injury (occurs up to 50%, axillary n. 86%) 6. recurrent instability
What are some non-surgical treatment options for spinal stenosis?
1. OMT 2. physical therapy 3. behavioral change that results in weight loss or posture change 4. epidural steroid injection (conflicting data) 5. pain medications (limited usefulness)
What are the possible anomalies that come with congenital scoliosis? Hint: VACTERL
1. Vertebral anomalies 2. Anal atresia 3. Cardiac defects 4. Tracheoesophageal fistula 5. Renal defects 6. Limb defects
What is the work up for a patient with spinal stenosis?
1. XRAY of appropriate level of spine 2. MRI of appropriate level of spine (rarely) 3. may require myelogram (MORE rarely) 4. may require EMG
What are some common causes of gout flares?
1. acute alcohol ingestion 2. acute overindulgences in foods high in purines 3. rapid weight loss 4. starvation 5. dehydration 6. trauma 7. surgery 8. emotional stress 9. hemorrhage
what are recommendations to patients (men and women) age 50 years and older to prevent osteoporosis?
1. advise on adequate amounts of calcium (at least 1200 mg per day) and vitamin D (800-1000 IU per day) including supplements if necessary 2. regular weight-bearing and muscle-strengthening exercise -avoid tobacco -avoid excessive alcohol intake
What are some non-modifiable risk factors for osteoporosis?
1. age 2. female/male sex 3. race 4. heredity 5. previous fracture 6. early menopause/hysterectomy 7. build (body habitus)
What is the treatment for SC joint injuries?
1. anterior dislocations can be reduced manually (rest, heal with time, may reoccur) 2. posterior dislocations are rare but are considered urgent & may require vascular surgery consultation
What are other blood differentials you may want to consider that may indicate other autoimmune diseases other than rheumatoid arthritis (RA)?
1. anti-dsDNA (lupus) 2. anti-smith (Lupus) 3. anti-SS-A(RO), Anti-SS-B(LA) (Sjogren's)
What are the first three tests you order when you suspect a differential diagnosis of rheumatoid arthritis (RA)? Note: AFTER!! a CBC and CMP, which you should order to rule out infection (:
1. anti-nuclear antibody (ANA) 2. rheumatoid factor (RF) 3. cyclic citrullinated peptide (CCP)
What are the 4 scoliosis etiologies?
1. congenital 2. neuromuscular 3. compensatory 4. idiopathic
What are some causes of kyphosis?
1. congenital vertebral anomalies 2. spinal growth disturbance (Scheuermann disease) 3. neuromuscular afflictions 4. metabolic diseases 5. skeletal dysplasia 6. postural
What are the universal recommendations for bone health?
1. counsel on the risk of fractures 2. eat a diet rich in fruits and vegetables (supplemented if necessary) to a total calcium intake of 100 mg/day for men between 50 and 70, 1200 mg/day for women 51 or older, and 1200 mg/day for men 71 or older 3. vitamin D intake should be 800-1000 IU per day, supplemented if necessary for ages 50 and older 4. regular weight-bearing and muscle-strengthening exercise 5. fall prevention evaluation and training
What are the 3 subtypes of idiopathic scoliosis, based on age at presentation?
1. early onset (infantile <3 y/o) 2. juvenile (4-10) 3. late onset (adolescent >10)
What is the best way to work with patients to prevent and treat osteoporosis?
1. educate 2. improve adherence to medications 3. establish baseline BMD measurement 4. measure BMD every 1-2 years
What are some modifiable risk factors for osteoporosis?
1. excess consumption alcohol 2. vitamin D deficiency 3. tobacco smoking 4. malnutrition 5. high dietary protein 6. underweight/inactive 7. endurance training 8. heavy metals 9. soft drinks
What are some of the pain generators for patients with spondylolisthesis?
1. facet joint 2. intervertebral disc 3. nerve root compression and tension 4. referred pain from stressed posterior ligaments 5. acute fracture 6. paraspinal muscle spasm
What are the three things that play a big role in our health? Hint: harped on by Dr. He Aldret (:
1. genetics 2. choices 3. environment
What are some other diseases that rheumatoid factor is associated with?
1. hepatitis C 2. multiple myeloma 3. interstitial liver disease 4. subacute bacterial endocarditis
What is school screening for scoliosis controversial?
1. high false positive rate 2. only 0.3-0.4% of adolescent idiopathic scoliosis require intervention
What are the 4 common complications of osteoporosis?
1. hip fractures 2. vertebral fractures 3. wrist fractures (FOOSH) 4. rib fractures
What are treatments for spondylolisthesis/spondylolysis?
1. initial management 2. activity restriction 3. analgesics 4. anti-inflammatories 5. bracing (especially if due to acute fracture, short-term) 6. physical therapy (back school) 7. oral steroid 8. epidural injections
What are some basic outcomes of crystal-induced arthropathies?
1. joint destruction 2. renal disease 3. CAD (more common with gout) 4. age-related macular degeneration (more common with gout)
What are some common adjuncts and patient might be taking that have uricosuric effects?
1. lorsartan 50 mg 2. micronized fenofibrate 3. vitamin C (500mg QD)
What are the 4 clinical signs that must be present for 6 weeks for a differential diagnosis of rheumatoid arthritis (RA)?
1. morning stiffness lasting an hour or more 2. soft tissue swelling of three or more joints 3. soft tissue swelling of hand joints (PIP, MCP, or wrist) 4. symmetrical soft tissue swelling
When should you order advanced imaging (CT/MRI) for spondylolisthesis cases?
1. obtain based on clinical situation 2. adolescents with acute onset with spondylolysis noted on radiographs or high index of suspicion with negative radiographs 3. greater than 25% subluxation 4. failure to respond to treatment 5. neurological pain or exam findings (not absolute indication) 6. major neurologic dysfunction on presentation
How do you treat osteogenesis imperfecta?
1. ortho referral 2. growth hormone 3. hearing assessments 4. pamidronate 5. hearing assessments 6. close dental follow up 7. genetic counseling
What populations are at higher risks for developing vitamin D deficiency?
1. people who are often shielded from the sun or live in areas with less sunlight 2. children 3. populations with darker skin 4. exclusively breast-fed infants, particularly when the mother is deficient 5. people with diminished absorption (e.g., CF, celiac) 6. people taking medications that increase vitamin D metabolism (e.g., phenobarbital, phenytoin, antiretrovirals) 7. people who are calcium deficient 8. people with hepatic or renal dysfunction 9. people with genetic disorders affecting hydroxylation enzymes 10. people with naturally increased metabolism of vitamin d 11. people with hereditary resistance to vitamin D
What can a gout attack be triggered by?
1. release of uncoated crystals 2. precipitation of crystals in a supersaturated microenvironment
What are some red flags on physical exam for scoliosis?
1. shoulder asymmetry 2. unilateral scapular prominence 3. waist asymmetry
What are some medications associated with osteoporosis?
1. steroids 2. excess thyroid hormones 3. GnRH agonists 4. cyclosporine 5. methotrexate 6. phenobarbital 7. phenytoin 8. phenothiazine 9. heparin
What are the 3 stages of gout treatment?
1. treat acute attack 2. prophylaxis to treat chronic gout and prevent additional flares 3. lowering excess stores of urate to prevent flares of gouty arthritis and to prevent tissue deposition of crystals
What are common treatments and prevention of osteoporosis?
1. weight being exercise!!!!! 2. calcium and vitamin D 3. estrogen replacement 4. bisphosphonates 5. selective estrogen receptor modulators 6. calcitonin 7. investigational agents 8. osteoporosis risk assessment instrument (ORAI) 9. osteoporosis self-assessment tool (OST) 10. simply calculated osteoporosis risk estimation score (SCORE)
In scoliosis treatment for skeletally immature (risser grade 3 or less), a cobb angle of less than or equal to _______ degrees does not indicate a need for repeat imaging UNLESS there is clinical progression of the curve or significant pain
10
greater than ___% loss in body weight of an infant in the first few days of life requires an evaluation in the adequacy of feeding
10%
In scoliosis treatment for skeletally immature (risser grade 3 or less), a cobb angle of _______ degrees requires observation with clinical follow up every 6-8 months
11-19
What is the recommended daily amount of calcium in men 65 and older & postmenopausal women?
1200 mg/day
What is healthy weight BMI?
18.5-24.9
Grade __ spondylolysis should avoid higher contact sports
2
What risser grade indicates 26-50% ossification?
2
how much do children gain in height each year?
2-3.5 inches (5-9 cm)
How long should activity be restricted for chronic lesions of pars interarticularis?
2-4 weeks of activity restriction with gradual return over 2 weeks
In untreated patients with idiopathic scoliosis, _____ of patients had curve progression after skeletal maturity but curves less than 30 degrees tended not to progress
2/3 (67%)
Cobb angle between ______ and ______ degrees in premenarchal girls or boys between 12-14 years is an indication for referral
20 and 29 degrees
No consensus on optimal levels of Vitamin D but deficiency is most often defined as a level of less than ___________
20 ng/mL
In scoliosis treatment for skeletally immature (risser grade 3 or less), a cobb angle of _______ degrees requires a referral to ortho, start bracing >30 degrees or if progressive >5 degrees over 3-6 month period, and continue follow up every 6 months
20-50
normal thoracic spine has kyphotic curve of about ______ to _____ degrees
25-50
What risser grade indicates 51-75% ossification?
3
how many months should you wait in between corticosteroid injections?
3-4
how much do children gain in weight each year?
3.5-7 lbs (1.6-3.3 kg)
What risser grade indicates >76% ossification?
4
How long should activity be restricted for acute lesions of pars interarticularis?
4-6 weeks with gradual return over 4 weeks and (+/-) bracing
Between what ages is fat decreased so much that it reaches its minimum?
4-6 years old
gout incidence has increased ___% in the past decade with increased obesity of the population
40%
What is the recommended daily amount of vitamin D?
400-800 UI/day
Progression of a Cobb angle greater than (or equal to) ____ degrees in any patient is an indication for referral
5
What risser grade indicates full bony fusion of the apophysis?
5
What percentage of isthmic spondylolisthesis (fracture of pars interarticularis that causes slide forward) incidence is in the general population? Extra: what percent are asymptomatic?
5% (50%)
In scoliosis treatment for skeletally immature (risser grade 3 or less), a cobb angle of greater than _______ degrees requires surgery to stabilize regardless of how much its changing
50
What percent of congenital scoliosis requires treatment because bracing is not helpful, and, therefore, early surgery is key?
50%
as little as a 5 kg weight loss can reduce the incidence of osteoarthritis by __%
50%
conservative management as treatment is ___% successful for symptomatic spondylolisthesis children
50%
surgery is indicated in skeletally immature patients with a slip greater than ___%
50%
infant growth after the first few days proceeds rapidly, so much so that infants increase length ___% in the first year and ___________ it by 3-4 years old
50%, doubles
surgery is indicated in skeletally mature patients with a slip greater than ___%
75%
What test: -tangentially looks across the spine from cephalad to caudad, scanning for asymmetry -curvature of the spine can cause ribs to be asymmetrical in length and shape, leading to the visible rib hump deformities in T-spine seen on this test
Adams forward bend test
What grade does the USPSTF recommend for screening for osteoporosis in women 65 and older and postmenopausal women younger than 65 with increased risk of osteoporosis?
B
ascorbic acid (vitamin C) deficiency because of the corner sign
Based on this radioimage, what would you likely diagnose the child with?
What is the measure of relative weight for height?
Body mass index (BMI)
What are proximal interphalangeal joint swelling?
Bouchard's nodes
What is bone and joint destruction secondary to a neuropathy and loss of sensation? Hint: risk factor for OA
Charcot joint
positive p-ANCA and positive anti-myeloperoxidase are associated with vasculitis, specifically ______ ______
Churg Strauss
What is the USPSTF grade for screening for vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults in postmenopausal women?
D
What is a preferred method of measurement of bone density, can measure hip, anterior-posterior spine, lateral spine and wrist, and is covered by medicare and medicaid? Hint: dual-energy radiographic absorptiometry
DEXA scan
What disease: -onset of symptoms is 5-15 years -slow progression -early contractures @ elbows and ankles -slow progressive scapulohumeroperoneal muscle weakness/wasting that typically starts with the arms and then progresses to the legs -severe dilated cardiomyopathy leading to arrhythmias (ventricular fibrillation) --> often cause of death -NO facial weakness, NO pseudohypertrophy, NO myotonia, NO intellectual impairment -clinical diagnosis based on early contractures of elbow flexors, ankle plantar flexors and spine, childhood onset of humeroperoneal weakness and wasting, and cardiac disease with conduction defects, arrhythmias, and cardiomyopathies -CK value mildly to moderately elevated -non-specific myofiber necrosis and endomysial fibrosis on muscle biopsy -muscle biopsy shows lack of emerin -ECG shows varying degrees of AV block, small T waves, atrial arrhythmias (CARDIAC INVOLVEMENT) -EMG non-specific -rarer autosomal dominant and autosomal recessive at 1q21.2 --> defective LMNA -X-linked recessive (Xq28 and Xq26.3, encoding for FHL1) -associated with mutations in genes encoding nuclear membrane proteins (EMD for emerin, LMNA for lamin A and C, SYNE1 and SYNE2 genes for nesprin1 and nesprin2) -supportive care only -implanted defibrillator/pacemaker as soon as diagnosis is made -muscle weakness and atorphy are slowly progressive during first 3 decades of life but advance more rapidly after -risk of cardiac death from heart block and from progressive HF and ventricular fibrillation
Emery-Dreifuss muscular dystrophy
What is associated with high-purine foods and excessive alcohol, especially beer and if paired together can trigger a gout attack?
GOUT
What is the oldest known kind of arthritis, its connection with the diet is legendary, and its prevalence is increasing in the US due to western diet, alcohol intake, medications (thiazide, loop diuretics), and prevalence of obesity?
GOUT
________ cannot be cured, but by complying with the medication prescription and following a nutrition prescription that limits purine-rich foods and alcohol, the probability of maintaining control is maximized
GOUT
What are swelling of distal interphalangeal finger joints?
Heberden's nodes
Grade __ spondylolysis can return to activity
I
What is the USPSTF grade for screening for vitamin D deficiency in asymptomatic, community-dwelling, non-pregnant adults?
I
What is the USPSTF grade for screening for vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults in men and pre-menopausal women?
I
What meyerding grade for spondylolisthesis indicates 0-25% slippage?
I
What meyerding grade for spondylolisthesis indicates 25-50% slippage?
II
What meyerding grade for spondylolisthesis indicates 50-75% slippage?
III
What meyerding grade for spondylolisthesis indicates 75-100% slippage?
IV
Which special test(s) of the shoulder tests: -supraspinatous pathology
Jobe
What is the congenital fusion of variable number of cervical vertebrae (commonly C2-C6), may result in atlantoaxial instability, associated with other bony abnormalities and significant scoliosis in >50%, and a classic triad of limited neck motion, low hair line, and short neck? Note: other associations with deafness, genitourinary abnormalities, cardiovascular abnormalities, and a sprengel's deformity (congenital elevation of the scapula)
Klippel-Feil syndrome
Where does 85% of spondylolisthesis occur at? Hint: think of there mechanical force is the greatest
L5-S1
What type of MRI involves an MRI that is combined with contrast imaging within the joint to demonstrate leak of fluid, in full thickness of rotator cuff tear, or labral tear?
MR-arthrogram
What is the gold standard for bone malignancy work up?
MRI or MRA
What do you treat an osteoid osteoma with?
NSAIDs
Which special test(s) of the shoulder tests: -SLAP tear or subacromial impingement if no click or clunk
O'brien's
What does the OMT management of rotator cuff tear involve?
OMT for minor tears with decreased ROM & direct treatment at increasing glenohumeral ROM
What does the OMT management of subacromial impingement involve?
OMT should be directed at the shoulder complex, upper thoracic, and ribs to free up motion and loosen the fascia of the shoulder to expedite the healing process
What does the OMT management of adhesive capsulitis involve?
OMT spencer technique can optimize and perhaps improve motion
What is useful to improve hyperlordosis (psoas muscle group) and reducing functional demands placed on musculoligamentous structures that are ill-equipped (postural model) in patients with spondylolisthesis/spondylolysis?
OMT treatment
What does non-operative management for Superior Labral tear in Anterior-Posterior plane (SLAP tear) involve?
PT for rotator cuff and scapulothoracic strengthening and posture training, NSAIDs, ice, and OMT
What is most common cause of fixed kyphotic deformity, if of unknown etiology, usually presents at age 12-17 years old (affects approximately 5% of general population and is somewhat more common in boys), presents with history of poor posture, thoracic curvature, hyperlordosis of the lower spine, and (+/-) hamstring tightness, 20% of affected persons have pain in the kyphotic region, and may be associated with spondylosis?
Scheurmann's disease
Which special test(s) of the shoulder tests: -biceps tendonitis
Speed's and Yergason's
What type of glenohumeral joint injury occurs at the labrum, most common cause is instability-type injury (e.g., dislocation), labrum is separated from underlying glenoid, and may involve biceps tendon origin?
Superior Labral tear in Anterior-Posterior plane (SLAP tear)
What race is gout more common in due to increased incidence of hypertension and diabetes?
US blacks
What imaging can be used to diagnose biceps tendinitis?
US for evaluation and injection guidance
What meyerding grade for spondylolisthesis indicates >100% slippage (vertebral body completely displaced (spondyloptosis)?
V
What vitamin affects calcium metabolism and bone remodeling?
Vitamin D
chondrosarcoma
What is this XRAY image showing?
enchondroma
What is this XRAY image showing?
hereditary multiple osteochdromatosis
What is this XRAY image showing?
non-ossifying fibroma
What is this XRAY image showing?
osteosarcoma
What is this XRAY image showing?
paget disease of bone
What is this XRAY image showing?
chondroblastoma
What is this XRAy image showing?
bankart lesion
What shoulder complication occurred during this shoulder dislocation, as shown by the CT image?
hill-sachs
What shoulder complication occurred during this shoulder dislocation, as shown by the CT image?
What do you expect to find on XRAYs for patients with adhesive capsulitis?
XRAY will not show capsulitis, but can rule out other causes of motion restriction like OA, surgical hardware, or posterior glenohumeral dislocation
After diagnosing a father's 3 year old daughter with rickets, he asks you the probability of a good outcome from the treatment you have prescribed. What is the best response to his question? a. most children have an excellent response and recover completely with supplementation b. it varies from child to child, most often, though, they will be rendered wheelchair bound by 12 c. rickets is a fatal disease d. rickets is a life-long complication and refer to orthopedics
a
After diagnosing a mother's child with ascorbic acid (vitamin C) deficiency, she asks you how long it will be until her child starts feeling better. What is the best answer? a. Constitutional symptoms (fatigue, irritability) will resolve within 24 hours of treatment, bleeding will improve in 2-3 days, gum disease improves within 2-3 weeks, and bone disease/ecchymosis will resolve over several weeks b. Constitutional symptoms (fatigue, irritability) will resolve within 72 hours of treatment, bleeding will improve in 2-3 days, gum disease improves within 2-3 weeks, and bone disease/ecchymosis will resolve over several weeks c. Constitutional symptoms (fatigue, irritability) will resolve within 24 hours of treatment, bleeding will improve in 2-3 weeks, gum disease improves within 2-3 months, and bone disease/ecchymosis will resolve over several years d. Constitutional symptoms (fatigue, irritability) will resolve within 48 hours of treatment, bleeding will improve in 3-4 days, gum disease improves within 3-4 weeks, and bone disease/ecchymosis will resolve over several weeks
a
What movement of the shoulder compresses the subacromial bursa?
abduction
subacromial bursitis pain is exacerbated by which movements?
abduction and internal rotation
What disease has radiograph findings that include: -short, thick tubular bones -irregular epiphyseal plates with cupping and delayed ossification -flat acetabular roofs with short round iliac bones -interpedicular narrowing of 1-5th lumbar vertebrae > risk of paraplegia
achondroplasia
What disease presents with: -shortening of limbs in the proximal portion (rhizomelic) -bowing of legs -trident configuration of fingers -narrowing of foramen magnum -narrowing of spinal canal -middle ear dysfunction > ear infections > hearing loss -macrocephaly -normal intelligence -short stature -delayed motor milestones -flat midface
achondroplasia
What is the most common, non-lethal chondrodysplasia caused by defect in cartilage-derived bone (either random mutation in FGFR3 OR AD inheritance)?
achondroplasia
What type of myopathies involve inflammatory myopathies, endocrine myopathies, systemic illness/infectious myopathies, and toxic/drug-induced myopathies?
acquired myopathies
What ligament provides horizontal stability (anterior and posterior) to the shoulder?
acromioclavicular ligament
What is also known as "frozen shoulder", progressive pain and restriction of both active and passive glenohumeral joint motion in all directions with pain often present at end ranges of motion, most common in patients age 40+, 15% of patients have bilateral shoulders affected, and is a result of inflammatory process causing fibroblastic proliferation of the joint capsule leading to capsular thickening, fibrosis, and adherence?
adhesive capsulitis
What is the treatment for scurvy?
administering 100 to 300 mg daily of Vitamin C in children and 500 to 1000 mg in adults for 1 months or until symptoms resolve
What is the most powerful risk factor for osteoarthritis
age
What populations have higher incidence of degenerative spondylolisthesis? Extra: what Wiltse Classification would this be?
age >40 & African Americans (type III)
What are some risk factors associated with rotator cuff tears?
age, smoking, hypercholesterolemia, family history
What are the basic, general principles of the anti-inflammatory diet?
aims for variety, plenty of fresh foods, limited processed foods and fast foods, and abundant fruits & veggies
what method of body composition assessment estimates body composition by having a person sit inside a chamber while computerized sensors determine the amount of air displaced by the person's body?
air displacement plethysmography
what drug is the 1st line for chronic GOUT treatment?
allopurinol
What does the OMT management of osteoarthritis involve?
anatomic barriers from osteophytes can limit motion, but Spencer and other soft tissue techniques can help optimize pt's available motion
What type of imaging is used to image vascular structures?
angiogram
What is the bony obliteration of a joint or disc space?
ankylosis
What views should you order for plain radiograph evaluation of bone malignancies?
anterior-posteiror and orthogonal views
What is an important for the diagnosis of rheumatoid arthritis (RA) because antibodies for it is VERY specific for RA (sensitivity 70% and specificity 95%), suggesting aggressive destructive RA?
anti-citrullinated protein antibodies (ACPA)
What type of diet is good for osteoarthritis because it can regulate common inflammatory responses?
anti-inflammatory diet
What test is: -associated with vasculitis -positive disease is not diagnostic for disease -c-ANCA (anti-proteiinase-3 or PR-3) is 80% of granulomatous angiitis (Wegener's) -p-ANCA (anti-myeloperoxidase or MPO) found in autoimmune kidney disease, RA, inflammatory bowel disease, and microscopic polyangiitis -if positive, then a "titer" is performed to determine the amount of antibody present (higher titer = more antibody present in blood)
anti-neutrophil cytoplasmic Ab (ANCA)
What is a test that: -associated with mixed connective tissue disease -95-100% are positive -MCTD has overlapping clinical featuers with SLE, scleroderma, and myositis -when it is positive it does not necessarily means the patient has MCTD -positive in 38-44% SLE (lupus) patients -positive in 20-30% of patients with scleroderma -positive in 10% of patients with rheumatoid arthritis (RA)
anti-ribonucleoprotein (anti-RNP)
What is a test that: -targets normal nuclear proteins -positive tests means autoantibodies are present -NOT A diagnostic test for lupus -commonly seen in 80-95% of lupus patients -also seen in scleroderma, polymyositis, rheumatoid arthritis (RA), and others -up to 15% of normal people are positive -false positive incidence increases with age -can be caused by many drugs, 95% of procainamide treated patients are positive
antinuclear antibodies (ANA)
What test can help diagnose certain collagen vascular disorders (it by itself cannot, but when combined with others can help), including SLE (lupus), systemic sclerosis, sjogren's syndrome, polymyositis (PM)/dermatomyositis (DM), drug associated lupus, and mixed connective tissue disorder (SLE + PSS)?
antinuclear antibodies (ANA)
Studies with ________ have suggested positive effects for patients with rheumatoid arthritis
antioxidants
Which special test(s) of the shoulder tests: -subscapularis, tight glenohumeral capsule
apley scratch
What is the facet joint at the posterior articulations of the vertebrae?
apophyseal joint
Which special test(s) of the shoulder tests: -glenohumeral instability
apprehension > relocation > anterior release
what is mandatory for all patients with new onset of acute monoarthritis & is very strongly recommended for those with recurrent attacks whose diagnosis has never been proven?
arthrocentesis
what is surgical puncture to remove fluid from the joint space?
arthrocentesis
What would you expect MRIs to look like for rotator cuff tears?
arthrogram can show RC tears, bursitis
What does the surgical management of rotator cuff tear involve?
arthroscopic (or mini-open) rotator cuff repair if muscle is viable, debridement of degenerative tissue, subacromial decompression, or reverse total shoulder arthroplasty if massive cuff tear and glenohumeral arthritis is present but deltoid still intact
What does the surgical management of osteoarthritis involve?
arthroscopic debridement if very limited OA in younger patient, hemiarthroplasty (humeral only) or total shoulder arthroplasty, may advance to reverse total shoulder arthroplasty if there is a massive cuff tear or failed TSA
What does surgical management for Superior Labral tear in Anterior-Posterior plane (SLAP tear) involve?
arthroscopic labral reepair
What type of surgery for OA: -may reveal unsuspected focal abnormalities -results in tidal lavage, which often is of sustained symptomatic benefit -expensive, complications possible -not recommended/endorsed for OA alone
arthroscopy
What disease has bone changes that include: -osteopenia (most common) -a row of beadlike prominences at the junction of a rib and its cartilage (rachitic rosary) -a white dense line of provisional calcification at the metaphysis (frankel line) -central rarefaction on the epiphyseal centers surrounded by a thickened white line of calcification (Wimberger ring) -zone of rarefaction which represents broken down bone, just under the white line at metaphysis (Trummerfield zone) -less dense transverse bands adjacent to Frankel lines -lateral metaphyseal spurs, VERY pathognomic!! (corner sign)
ascorbic acid (vitamin C) deficiency
What disease presents with: -hemorrhagic skin lesions that present early in the course which can be ecchymotic, petechial, or purpuric -irritability, developmental delay, decreased appetite, fatigue, dystrophic hair, and follicular keratosis on the buttocks/legs -poor wound healing -bleeding due to poor collagen formation and damage to coagulation factors -bleeding in skin, mucous membranes, joints, muscle, or GI - initially swollen, red & shiny gums that bleed with minimal trauma & progresses into black or necrotic gums or, in advanced cases, the loss of teeth due to secondary collagen damage of periodontal ligaments (gingival disease) -anemia due to iron deficiency, folate deficiency, bleeding, and hemolysis -subperiosteal hemorrhages, hemarthrosis, and soft tissue/muscle bleeding that lead to muscle pain, pseudoparalysis, and/or holding legs in frog-leg position -Most specific symptoms are follicular hyperkeratosis and perifollicular hemorrhage with petechiae and coiled hairs
ascorbic acid (vitamin C) deficiency
What is scurvy?
ascorbic acid (vitamin C) deficiency
What occurs after 1-3 months of Vitamin C deprivation and usually presents between 6 months and 2 years of age due to dietary deficiency, overheating foods rich in Vitamin C, or alcoholism, diabetes, smoking, AIDS, short gut syndrome, and chronic diarrhea?
ascorbic acid (vitamin C) deficiency
A 14YOM presents to your office c/o low back pain. Patients states he has been a gymnast for 7 years and recently started very competitive routines. He notes that his pain worsens on activity, improves with rest, and is dull and achy in nature. He denies any known injury. Upon physical exam, you notice that he has a hyperlordotic spine, waddling gait, vertical sacrum, and pelvis, and tight hamstrings. You immediately order a lumbar XRAY. What disease are you suspecting? a. disc herniation b. spondylolisthesis c. spondylolysis d. spondylosis
b
A 22 month old child presents to the clinic with mother c/o growing concerns. Upon physical exam, you note that the child has wide wrists, prominent knobs of bone at the costochondral joints, frontal bossing with open fontanelles, and abnormal posture with a bow-legged appearance. What is the most likely diagnosis? a. ascorbic acid (vitamin C) deficiency b. Rickets c. osteomalacia d. osteogenesis imperfecta
b
Surgical repair to __________ (shoulder dislocation complication) reattaches the labrum to the glenoid, reduces the redislocation rate to less than 5%, and pts and return to play in 3-4 months
bankart lesion
What shoulder dislocation complication involves: -humeral head pinches and splits during the labrum against the glenoid rim during dislocation -includes a fracture of the edge of the anterior inferior glenoid rim and attached segment of labrum as the humeral head dislocates
bankart lesion
What disease: -less common -X-linked recessive abnormality of Xq21 -partially functional dystrophin gene -milder in severity but same symptoms as duchenne muscular dystrophy
becker muscular dystrophy
When assessing for a tumor, you should always ask about the duration of a complaint, ________ may be there for years
benign
When assessing for a tumor, you should always ask if there is any pain associated with the mass, ______ are usually painless
benign
a lesion is (benign/malignant) if: -the patient is frequently asymptomatic -well-defined geographic lesion on radiology -capsulated -slow growing -smooth shape/oval -no skin dimpling
benign
What type of tumor of musculoskeletal system have XRAY findings that appear as: -lesion that most often eccentrically placed to the long axis of the bone -center is most radiolucent with increasing density towards the periphery -well-defined defect in the metaphysis and epiphysis with the destruction of the medullary cavity and adjacent cortex -destruction may stop just short of the joint -intact borders and a sharp inner margin may be associated with a better prognosis -tumors often thin the cortex, and may expand into the soft tissues surrounding the bone, or may expand the bone extensively, remaining within an eggshell-thin rim of periosteal new bone -treatment is curettage and packing, excision rarely needed
benign giant cell tumor
What type of tumor of musculoskeletal system: -most commonly affect people in their 20s to 30s -occur in the epiphyses and may erode the rest of the bone and extend into the soft tissues -notorious for their tendency to recur -a giant cell tumor may metastasize, even though it remains histologically benign -appear lytic on XRAY -Sx include: pain at adjacent joint, visible mass, swelling, bone fracture, limited movement in adjacent joint, fluid accumulation in adjacent joint -functionally malignant but histologically benign
benign giant cell tumor
Which special test(s) of the shoulder tests: -SLAP tear
biceps load
What is defined by inflammation of tendon and sheath along the long head of biceps with pain over bicipital groove, aggravated by resisted flexion of forearm? Hint: usually due to overuse leading to adhesions that bind the tendon in the bicipital groove
biceps tendinitis
what method of body composition assessment measures body fat by using a low-intensity electrical current because electrolyte-containing fluids, which readily conduct an electrical current are found primarily in lean body tissues, the leaner the person the less resistance to the current & the measurement of the electrical resistance is then used in a mathematical equation to estimate the percentage of body fat?
bioelectrical impedance
What are the first pharmacologic agents in line for osteoporosis treatment?
bisphosphonates
What treatment/prevention of osteoporosis involves: -alendronate & -increases bone density of spine and hip -decreases vertebral fracture rate -5 mg/day, 10 mg/day, once-weekly (70 mg) dosing options -can consider combining with estrogen if monotherapy ineffective -GI side effects (abdominal pain, dyspepsia, esophagitis, nausea, vomiting, diarrhea) -musculoskeletal pain -NOTE: etidronate not approved for treatment of osteoporosis, only when others ineffective
bisphosphonates
infant growth after the first few days proceeds rapidly, so much so that infants ______ ____ increases rapidly during the first 9 month from the 10-15% they already have when born and then decelerates at 6-9 months
body fat
all part of the holistic approach to a lifestyle is to promote optimal ______ health
bone
what is performed by inhibiting osteoclasts and stimulating osteoblasts?
bone formation
What is a surgical procedure in which healthy bone is transplanted from another part of the patient's body into the affected area?
bone grafting
What is performed by osteoclasts, stimulated by RANKL in normal process and PTH in pathologic process (metastatic disease)?
bone resorption
(osteogenesis imperfecta/non-accidental trauma) involves: -fractures in various stages of healing -cause of fracture is benign or seems inconsistent
both
What facilitates motion of rotator cuff muscles under the acromion?
bursa
What is a fluid filled sac between joints that decreases friction?
bursa
What is an acute phase reactant (APR) that is a marker of inflammation, is produced by the liver, serum concentration increases during inflammation, has more acute changes than ESR (elevated post-op, SLE, infections, morbid obesity, DM, CAD, smoker, cancer), and is a result of inflammatory stimuli causing macrophage cytokine production (IL-6, TNF-alpha, IFN-alpha) which stimulates this marker?
c-reactive protein
What treatment of osteoporosis involves: -hormonal inhibitor of bone resorption -vertebral fractures and spine bone density maintained -no statistic in hip fractures -may be less effective than other anti-resorptive treatments -possible analgesic effects in women with painful vertebral compression and fractures -can be subq injection or nasal spray
calcitonin
What is the active metabolite of vitamin D?
calcitriol
What is the primary nutrient in the bone?
calcium
sodium and protein intake can influence _________ metabolism
calcium
What maintain or increase bone density in post-menopausal women and help prevent hip and non-vertebral fractures in all older adults?
calcium & vitamin D
if a thoracic curve is greater than 75-80 degrees, what complication can occur?
cardiopulmonary compromise
What is a hard but slippery coating on the end of each bone in an articular joint, breaks down and wears away in osteoarthritis, is made of 65-80% of water, and has either hyaline, elastic, or fibro subtypes?
cartilage
Surgery is indicated in patients with spondylolisthesis when _______ _______ is present
cauda equina
entrapment of the _____ ______ roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal, leading to incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias and weakness, and bowel or bladder disturbances in severe cases
cauda equina
what medical conditions are associated with a higher risk of developing osteopenia/osteoporosis?
celiac disease (+ other malabsorptive disorders), COPD, CKD, DM, hemiplegia, hyperparathyroid disease, hyperthyroidism, subtotal gastrectomy
What type of tumor of musculoskeletal system appears on XRAY as: -lesion is lytic with well defined margins and can be from 1-6 cm in size -scalloping or expansion of cortical bone may be present -fine calcifications, either punctate or in rings may be visible -cysts are present in about 20% of cases and both MRI and CT can define the fluid levels (CT also useful for defining the relationship of the tumor to the joint, integrity of the cortex, and intralesional calcifications)
chondroblastoma
What type of tumor of musculoskeletal system: -sometimes called a Codman's tumor -most often affects the ends of the long bones in the arms and legs at the hip, shoulder, and knee -rare, occurring most commonly in people aged 10-20 -arising in the epiphysis, tumor may continue to grow and destroy bone -on XRAY, appears as a cyst containing spots of calcification -MUST be surgically excised -rare type of benign bone tumor that originates from cartilage
chondroblastoma
What type of tumor of musculoskeletal system: -symptoms may vary depending on the location of the tumor -pain in the knee, hip, and shoulder joint -withered or shrunken appearance of the muscle near the affected bone -impaired mobility of the adjacent joint -fluid accumulation in the joint adjacent to the affected bone -treated via surgery, bone grafting, physical therapy -can recur after removal
chondroblastoma
What type of tumor of musculoskeletal system: -lesions occur predominantly in men who are in their 2nd to 4th decades -they are usually located within the bone marrow cavity -these tumors are usually asymptomatic but may enlarge and become painful -they are often found when XRAYs are taken fro another reason -tumors may appear lytic on XRAY with appears of stippled calcification -usually visible on bone scan and may raise concern of a malignancy
chondroma
What type of tumor of musculoskeletal system: -uncommon benign tumor which characteristically forms mature cartilage -found mostly in the small bones of the hand and/or feet, although it can also occur in long, tubular bones, primarily in the humerus, femur, and ribs -focal areas of myxoid degeneration may result in mistaken diagnosis of chondrosarcoma -classified according to their location (enchondroma within the bone/medullary cavity, periosteal on the surface of the bone, and soft tissue) -XRAY findings can be diagnostic, if not should perform biopsy -asymptomatic does not need excision or other treatment, but follow up XRAYs (6 months to 1 year later) are indicated to rule out disease progression
chondroma
What type of tumor of musculoskeletal system: -slight male to female predominance -children fare worse than adults -peripheral lesions lower grade than central -5 year survival is ~50% -4% develop in <20 years old -50% occur >40 years old -76% of primary are centrally located, it is the most common malignancy of shoulder/sternum -10% develop from benign lesions (Secondary), like enchondromas or osteochondromas -presents with pain related to location of mass lesion, typically in the shoulder -suspect if tumor involves the shoulder/sternum/pelvis or areas in the body with lots of cartilage
chondrosarcoma
What are some sources of vitamin c?
citrus fruits, tomatoes, potatoes, brussel sprouts, cauliflower, broccoli, strawberries, cabbage, spinach, and breastmilk
What congenital muscular dystrophy is merosin (a glycoprotein found in basement membrane of muscles) positive or negative?
classic congenital muscular dystrophy
What is: -confirmed on XRAY -can be displaced or non-displaced -Type 1 involves the middle third (80%) -Type 2 involves the distal third (12-15%) -Type 3 involves the proximal third (5-6%) -simply, closed fractures may be treated non-operatively -significantly displaced, comminution, or shortening may need surgery because restoring this structure's length is important in overall shoulder function --> refer to orthopedic referral for surgery -pain with ROM above 90 degrees
clavicle fracture
A fracture of the pars interarticularis on oblique radiograph would appear as a "______ __ ___ ______" on "scotty dog"
collar on the neck
What occurs due tot he body's compensatory mechanisms (ex: leg length discrepancy), and treatment includes shoe lifts?
compensatory scoliosis
Treatment for ________ __________ involves: -initial management is pain control (NSAIDs if tolerable or acetaminophen), continue physical activity --> do NOT lay around until it gets better -Persisting pain may require opioids (start low and then increase) --> hospitalization if fracture is bad enough -surgical treatment (kyphoplasty, vertebroplasty) --> research says these do not necessarily correlate with pain relief (overtime not much improvement in pain)
compression fractures
What imaging has high radiation exposure, is better for bone detail (e.g., fracture lines), has software packages that can allow for 3D reconstruction of images, can use contrast that is iodine based, and has imaging in 3 planes (axial, coronal, and sagittal)?
computerized tomography
What imaging should you use to confirm that bone has been fractured because it has 3D reconstruction capabilities and good bone detail?
computerized tomography
What type of imaging shows sharper imaging of bone and tissue?
computerized tomography
What are several distinct diseases that have a common characteristic of severe involvement at birth, often follow a more benign clinical course, are ALL autosomal recessive, and have high association with brain malformations?
congenital muscular dystrophies
What diseases: -severe involvement at birth (hypotonia and weakness noted at birth && joint contractures of variable severity) -arthrogryposis (multiple joint contractures at birth) -deep tendon reflexes hypoactive or absent -cognitive impairment is a frequent manifestation (brain involvement) -cardiac involvement ranges from absent or mild to severe -of suspected, can get cranial MRI, eye exam, and DNA testing -muscle biopsy is negative -CK moderately elevated -EMG non-specific -muscle biopsy shows proliferation of endomysial collagen envelops individual muscle fibers at birth, extensive fibrosis and degeneration and regeneration of muscle fibers, and proliferation of fatty and connective tissue --> if negative, get a genetic test -cardiac evaluation (EKG and echo) -supportive care and monitoring only -CNS involvement has progressive deterioration, but purely congenital is relatively static and is non-progressive
congenital muscular dystrophies
What are abnormalities of vertebral formation during the first trimester, implies failure of segmentation or malformation of some vertebral elements, may be associated with fused ribs and spinal cord anomalies, is associated with many developmental and genetic syndromes, high incidence of genitourinary anomalies, and may be associated with plagiocephaly in infants?
congenital scoliosis
What ligament is vertical, in the shape of an inverted pyramid, and attaches to the scapula/conoid tubercle and to the clavicle?
conoid ligament
What ligament units the coracoid process and clavicle and mediates synchronous scapulohumeral motion by attaching the clavicle to the scapula?
coracoclavicular ligament
What are the ligaments in the sternoclavicular joint that provide support and strength to the joint?
costoclavicular ligament, sternoclavicular ligament, and infraclavicular ligament
Which special test(s) of the shoulder tests: -AC joint
cross arm and chuck norris
What is the formation of crystals within the joint space and deposition of crystals in soft tissue?
crystal-induced arthropathy
After diagnosing a mother's child (23 months old)with severe ascorbic acid (vitamin C) deficiency that involves gingival disease but no tooth loss, the mother is distraught and questions what symptoms/permanent damage will remain in her baby. What do you tell her? a. no permanent damage will occur b. gingival disease will stay for the rest of the child's life and refer to pediatric dentist c. fatigue and irritability will remain for the rest of the child's life due to the vitamin C deficiency d. the only permanent damage that occurs after scurvy is treated is tooth loss
d
What type of spondylolisthesis is an epidural steroid injection useful for?
degenerative
conservative management as treatment is 90% successful for ________ spondylolisthesis patients
degenerative
What can occur 6-8 weeks after starting allopurinol, thought to be a cell-mediated immunity to allopurinol and its metabolites?
delayed-hypersensitivity
food and exercise play and important, but supportive, role in patients with osteopenia/osteoporosis because it may slow overall bone loss but it is unlikely to increase bone ________ alone
density
what is the most common type of curve in the thoracic spine with the apex to the right of the midline?
dextroscoliosis
What do you expect XRAY images to show for a patient with OA?
diagnostic, shows the 4 radiographic signs of OA: 1. joint space narrowing 2. osteophytes 3. subchondral sclerosis 4. subchondral cysts
infant growth after the first few days proceeds rapidly, so much so that infant weight ________ birth weight by 4-6 months and __________ birth weight by 1 year
doubles, triples
Which special test(s) of the shoulder tests: -supraspinatous tear
drop arm
what method of body composition assessment uses 2 low-dose XRAYs that differentiate among fat-free soft tissue (LBM), fat tissue, and bone tissue, providing an precise measurement of total fat and its distribution in all but extremely obese subjects?
dual energy X-ray absorptiometry (DEXA)
what method to assess body composition is the gold standard?
dual energy X-ray absorptiometry (DEXA)
What disease(s) treatment: -involves supportive care mostly (increasing quality of life) through physical therapy, bracing, wheelchairs, prevention of scoliosis, multi-disciplinary approach -glucocorticoids to try to delay progression (decreases apoptosis of myotubules, can keep patients ambulatory for longer than expected) -digoxin for cardiac decompensation -rapid treatment of pulmonary infections
duchenne & Becker muscular dystrophies
What disease(s): -Elevated CK levels -Elevated AST/ALT -muscle biopsy shows muscle fiber degeneration and regeneration accompanied by increased intrafasciular endomysial connective tissue (connective tissue where there shouldn't be) -muscle biopsy absent staining for dystrophin or decreased staining -EMG non-specific -can be tested prenatally -PCR for dystrophin gene diagnoses 2/3 of cases, if negative but suspicion is high can get a muscle biopsy
duchenne & Becker muscular dystrophies
What disease presents with: -progressive weakness -intellectual impairment -pseudohypertrophy of the calves -proliferation of connective tissue in muscle -mostly asymptomatic during early infancy with normal motor milestones -weakness of hip girdle muscles at 2 years -gowers sign can present by 3 and be fully expressed by 5-6 years old -tredelenburg gait and difficulty climbing stairs at 4 years of age --> most common presentation -toe walking due to tightness of achilles tendon -lordotic posture -unable to jump -falls frequent -pharyngeal weakness and weak cough -pseudohypertrophy of the calves -loss of deep tendon reflex of knee (distal reflexes preserved more than proximal)
duchenne muscular dystrophy
What disease: -X-linked recessive, abnormal Xq21 (high rate of spontaneous mutations, making up 33% of all new cases) -most common hereditary neuromuscular disease -most common type of muscular dystrophy to present in childhood -absent or non-functional gene responsible for the production of cytoskeletal protein, dystrophin
duchenne muscular dystrophy
What disease: -cardiomyopathy present in 50-80% of cases due to fibrosis of the posterobasal left ventricular wall -wheel chair dependent by 10-12 years -scoliosis -equinovarus deformities of the feet -contractures of ankles, hips, knees, and elbows -death usually by 18-20 years of age due to respiratory failure, heart failure, pneumonia, and aspiration and airway obstruction -wasting of thigh muscles -tongue hypertrophy -forearm hypertrophy -firm or rubbery consistency of muscles on palpation
duchenne muscular dystrophy
What is the most common hereditary neuromuscular disease?
duchenne muscular dystrophy
What is the most common type of muscular dystrophy to present in childhood?
duchenne muscular dystrophy
What does the non-operative management of adhesive capsulitis involve?
early initiation of PT for at least 3-6 months, treatment of underlying medical comorbidities that may be involved, NSAIDS and/or intra-articular corticosteroid injections, and heat or cold therapy
What measures the electrical activity of muscles at rest and during contraction (Muscle v. Nerve v. NM junction) and is an evaluation of weakness?
electromyogram (EMG)
What measures muscle response or electrical activity in response to a nerve's stimulation of the muscle, it is used to help detect neuromuscular abnormalities? During the test, one or more small needles (electrodes) are inserted through the skin into the muscle
electromyography (EMG)
What is a nuclear envelop protein that is mutated in EMD, resulting in complete loss of emerin expression in muscle?
emerin
What type of tumor of musculoskeletal system: -benign cartilage tumors that are commonly found in the tubular bones of the hand and foot -tend to be diaphyseal or metaphyseal lesions -probably arise from residual nests of cartilage cells left behind by growing physis -chondrocytes of them grow slowly, expanding the cortical bone and thinning the cortex -may cause an unsightly swelling or pathologic fracture of bone -typically asymptomatic -hand pain may occur if tumor is very large -may cause fracture in hand if affected bone has weakened -enlargement of affected finger can occur -radio-opaque -treated with surgery or bone grafting
enchondroma
What can be indicated after failure of oral medications for patients with spondylolisthesis?
epidural steroid injection
What is a less common subtype of osteoarthritis that is: -more sever and destructive -combination of cartilage and inflammatory synovial changes -manifests in women around time of menopause -hands are most often involved (sudden onset of palpable pain, swelling, deformity of the DIP and PIP joints, phalangeal deformities appearing as wavy or subluxed, Heberden's and Bouchard's nodes can be seen clinically) -tends to "burn out" swelling ceases to progress and pain subsides and deformity persists -laboratory tests for systemic inflammation are usually normal -evidence of inflammatory process on XRAYs and in synovial specimens (central joint erosions, gull-wing deformities, prominent osteophytes) -can be treated with RA treatments or OA treatments
erosive osteoarthritis
What is an acute phase reactant (APR) that is a general marker of inflammation and is measured by blood being drawn into a long thin tube and allowed to settle under gravity for 1 hour? Note: its rate depends on concentration of serum proteins (IgGs and fibrinogen), anemia, CHF, age, gender, viscosity, lipids, thyroid, OC/pregnancy, etc. && is often >100 in cancer, vasculitis, sepsis
erythrocyte sedimentation rate
What type of tumor of musculoskeletal system tend to occur in the central axis such as the pelvis and spine?
ewing sarcoma
What type of tumor of musculoskeletal system: -presents similar to other malignancies -pain and constitutional symptoms that mimic osteomyelitis -metastatic disease in 25% at presentation (most commonly to lungs, bone, and bone marrow) -risk factors include; race because it is almost exclusively a disease of white children -on XRAY have onion skinning appearance or moth eaten appearance
ewing's sarcoma
85-90% of patients with primary gout develop excess urate stores due to an inability to __________ insufficient amounts of normally produced uric acid in the urine
excrete
What disease: -autosomal dominant deletions at 4q35 gene locus with abnormal expression of double homeobox protein 4 gene (DUX4) leading to toxic gain-of-function mechanism -has genetic anticipation -presents in late childhood or early adolescence -slowly progressive -weakness in facial and shoulder girdle muscles (scapulohumeral) with preservation of deltoid strength -decreased facial expression, mild ptosis, inability to close eyes tightly, inability to pucker lips/whistlee -prominent scapular winging -wasted biceps and triceps -difficulty elevating arms -ASYMMETRICAL in weakness -decreased deep tendon reflexes -foot drop -weakness of abdominal muscles -sensorineural hearing loss -NO pseudohypertrophy of calves, NO cardiac involvement, RARE intellectual involvement, RARE respiratory involvement, RARE contractures -retinal vasculopathy -coats syndrome (retinal telangiectasia and exudation that can progress to retinal detachment and visual loss) -weakness of face, shoulder girdle, and upper arm with relative sparing of deltoid muscles -upward displacement of umbilicus that occurs with flexion of the neck when patient is supine, reflecting the weakness of lower abdominal muscles and is present in 90% of patients (Beevor sign) -genetic testing principle diagnosis -CK can be normal or elevated -EMG non-specific -muscle biopsy non-specific -supportive care only -scapulothoracic fusion (improvement in abduction and flexion of the upper arm, relieves shoulder pain and fatigue, improves appearance of neck and shoulder) -cosmetic surgery to improve facial muscle expression
facioscapulohumeral muscular dystrophy
What is the mechanism of injury for a clavicle fracture?
fall directly on shoulder
What is the most common cause of AC joint injury?
fall onto shoulder or blunt trauma
T/F: BMI is a measure of body composition
false
T/F: one XRAY is good enough
false
T/F: you can brace someone who is skeletally mature
false
T/F: you can view the pars interarticularis on AP and lateral radiographs
false
What drug is the 2nd line for chronic GOUT treatment
febuxostat
What type of tumor of musculoskeletal system appears on XRAY as: -expansion of the metaphysis and diaphysis -endosteal scalloping -ground glass appearance of the matrix
fibrous dysplasia
What type of tumor of musculoskeletal system has surgical indications that include the following: -severe or progressive disease -non-union -persistant pain -fracture of a weight bearing bone -curettage is affective but may not be permanent -deformity of long bones may require corrective osteotomy and internal fixation
fibrous dysplasia
What type of tumor of musculoskeletal system involves treatment: -usually conservative and primarily to prevent deformity -treat any underlying endocrine disturbance -in upper extremity lesions, more than 80% respond to nonsurgical management -no specific medical treatment exists for the bone disease, although early evidence suggests that vit D and bisphosphonates (after physeal closure) may be helpful in ameliorating pain and possibly in reconstituting lesions with normal bone -concomitant calcium and vitamin D2 must be given to avoid secondary hyperparathyroidism
fibrous dysplasia
What type of tumor of musculoskeletal system: -has monostotic form that affects only one bone, most commonly ribs, proximal femur, and craniofascial bones && is 7-10x more common than polyostotic && can be associated with systemic conditions polyostotic form that affects many bones, up to 75% of the skeleton -craniofacial form -cherubism form
fibrous dysplasia
What type of tumor of musculoskeletal system: -skeletal developmental problem -medullary bone is replaced by fibrous tissue, which appears radiolucent on radiographs (ground glass) -trabeculae of woven bone contain fluid-filled cysts that are embedded largely in collagenous fibrous matrix, which contributes to the generalized hazy appearance of bone
fibrous dysplasia
in order to evaluate the adequacy of an infant's nutrient intake you need to understand the typical changes in body composition during the ________ year of life
first
When does spondylolisthesis most commonly occur?
first and second decades of life (0-19 years old)
growth slows after the ______ _____ in child development and stays steady
first year
_________ and vitamins A & K influence bode remodeling
fluoride
What phase of adhesive capsulitis involves pain with motion or at rest, night pain, and gradual motion loss?
freezing
What phase of adhesive capsulitis involves pain decreases, but symmetrical loss of both active and passive ROM interfere with daily activities?
frozen
What congenital muscular dystrophies have central nervous system (CNS) abnormalities?
fukuyama CMD, muscle-eye-brain CMD, and walker-Warburg syndrome
What is MRI contrast typically made of?
gadolinium-based
How do you treat a shoulder dislocation?
goal is to restore normal function and to return to same level of activity by: -optimizing muscle strength and kinetic chain -PT -conservative tx in pt >40 -immobilize for 2-3 weeks -candidates for surgery: young athletes with first dislocation or pts with recurrent instability despite conservative tx
What would you expect ultrasounds to look like for rotator cuff tears?
good for dynamic evaluation of a tear, quick and reliable, user dependent (can actually see tear)
(gout/pseudogout) has monosdium urate crystals
gout
(gout/pseudogout) has negatively birefringent urate crystals seen on polarizing synovial fluid examination in 85% of specimens
gout
Characteristic radiographic findings of _____________ include: -Corticated erosions (sharply defined margins) of the joint with overhanging osteosclerotic edges -Sclerotic borders, sometimes called cookie-cutter or punched-out borders -Asymmetrical distribution among the joints -Strong predilection for distal joints, especially the lower extremities -Soft tissue masses may represent tophi, rarely diagnostic -Intra-osseous tophi may create "holes in the ends of long bones"
gout
What is a metabolic disorder that allows uric acid/monosodium urate to precipitate as needle-like crystals and accumulate in blood and tissues?
gout
What is definitively diagnosed based on the demonstration of urate crystals in aspirated synovial fluid in the face of characteristic signs and symptoms?
gout
What is the inflammation caused by monosodium urate monohydrate crystals, resulting in intra-articular inflammation, tophi (soft-tissue crystal deposits) can occur in bone, and nephrolithiasis?
gout
long-term management of ______ focuses on lowering uric acid levels and reducing total body burden of urate
gout
A scoliometer reading of _________ ____ ______ _________ in patients with a BMI >85th percentile is an indication for referral
greater than (or equal to) five degrees
A scoliometer reading of _________ ____ ______ _________ in patients with a BMI <85th percentile is an indication for referral
greater than (or equal to) seven degrees
Cobb angle_______ ___ ______ ______ in ANY patient is an indication for referral
greater than thirty degrees
On overhead activity, the supraspinatus and/or subacromial bursa can be become pinched between the ____________ of the humerus and the acromion, which can lead to edema and hemorrhage, causing the bursa to become inflamed (bursitis) which furthers the cycle of impingement and pain
greater tubercle
Patients should be made aware that all reports of eating plans or treatments that come from non-scientific sources (such as those based on testimonials or marketing products) should first be discussed with their _________ ______ _________ or __________
health care professional or dietician
What disease: -autosomal dominant condition that can lead to both sessile and pedunculated lesions -lesions may occur on different bones or on the same bone, and symptoms present in the first decade of life -risk of malignant transformation to chondrosarcoma is unknown but may be 25-30% compared to approximately 1% for a solitary osteochondroma -risk of malignant degeneration increases as the number and size of the osteochondromas increases -in general, a sessile lesion is more likely to degenerate into sarcoma than an exostosis
hereditary multiple osteochondromatosis
What type of myopathies involve muscular dystrophies, congenital myopathies, metabolic/mitochondrial myopathies, and channelopathies?
hereditary myopathies
For ___-grade slips, the fusion is often extended to additional level to provide stability
higher-grade
What shoulder dislocation complication involves: -posterolateral humeral head compresses (fractures) as it impacts the anterior inferior glenoid rim
hill-sachs
What treatment of osteoporosis involves: -increasing bone density more (about twice as much) than anti-resorptive therapies
human recombinant PTH
What is an intra-articular injection commonly used to treat OA that is synthetic or derived from rooster comb?
hyaluronic acid
what method of body composition assessment measures body density by weighing the person first on land and then again while submerged in water, and the difference between the person's actual weight and underweight weight provides a measure of the body's volume & a mathematical equation using the 2 measurements (volume and actual weight) determines body density, from which the percentage of body fat can be estimated?
hydrodensitometry
What type of scoliosis involves curvature without an identifiable cause in an otherwise normal child, is the most common type of scoliosis, is more common in females than males (AND progress and require treatment in females), is rarely associated with back pain, and 20% of patients have a positive family history?
idiopathic scoliosis
patients with ________ ________ have higher incidences of suicidal ideation, decreased perception of health status (even after treatment, and those treated surgically are less affected than those treated with bracing
idiopathic scoliosis
What does the surgical management of subacromial impingement involve?
if no improvement after 4-6 months non-operative treatment, subacromial decompression or acromioplasty is recommended
bone resorption (increases/decreases) more than bone formation, resulting in net bone loss
increases
What estimates energy needs via metabolic cart or respiratory chamber to analyze the rates of O2 consumption and CO2 production and these gas exchange results are converted to REE via calculation (weir)?
indirect calorimetry
________ nutrient needs reflect growth, energy expended in activity, basal metabolic needs, and interaction of nutrient consumed while physiological development is an indicator of nutrition status & weight, length, head circumference, and weight-for-length used which is gender specific
infant
Are these symptoms inflammatory or non-inflammatory? -morning stiffness -systemic symptoms -better when active -warmth and/or erythema -soft tissue swelling/tenderness -elevated CRP -synovial WBC >2000
inflammatory
What are a group of diseases that involve chronic muscle inflammation, accompanied by muscle weakness?
inflammatory myopathies
What disease: -has anti-Jo1 antibodies (anti-nuclear antibody that targets histidine-tRNA ligase) -more abrupt onset -fever -crack hands (Mechanic's hands) -Raynaud's phenomenon present -associated with Interstitial lung disease -can have arthritic involvement -often poor response to therapy -associated with increased ESR, CK (creatinine kinase), and aldolase -anti-Mi2, anti-SRP, anti-DM/PM are other antibodies in myositis
inflammatory myopathy
Which muscle(s) of the rotator cuff muscles facilitates external rotation and extension of humerus and humeral head stabilization?
infraspinatous and teres minor
naked urate crystals interact with intracellular and surface receptors of local dendritic cells and macrophages, activating the ________ ________ _________
innate immune system
_____________ is a molecule that stimulates bone resorption and stimulates osteoclast differentiation and bone resorption
interleukin 1 (IL-1)
What type of chondrosarcoma comes from enchondroma?
intramedullary chondrosarcome
What is a tough fibrous membrane sac that holds all the bones and other joint parts together?
joint capsule
What structures occupy the subacromial space of the shoulder?
joint capsule, rotator cuff muscles, and bursa
What type of curvature of the spine occurs in the sagittal plane?
kyphosis
Typical _____ ______ involves: -surgical treatment is rarely indicated, and only when spinal cord compression has occurred -bracing has been part of this disease for many years and can be avoided in all but very severe cases -an exercise programs, and education of the patients can help reduce the complications
kyphosis treatment
What is the surgical procedure typically done to treat spinal stenosis?
laminectomy
What subtype of idiopathic scoliosis, based on age of presentation, is the most common and makes up 80-85% of cases?
late onset (adolescent >10 y/o)
What type of XRAY view helps evaluate the presence of spondylolisthesis?
lateral
What type of spine radiograph is used to assess sagittal alignment?
lateral spine radiograph
What is the lesser common type of curve in the thoracic spine with the apex to the left of the midline, leading to a higher probability of spinal cord tumor or syrinx?
levoscoliosis
What are tough, cord-like tissues that connect bone to bone?
ligaments
What are tissues that stabilize bones and allow joint movement?
ligaments, tendons, and muscles
What disease: -progressive hereditary myopathies affecting hip and shoudler girdle -autosomal recessive (most common) and autosomal dominant -pt may present with cramps with exercise -abnormal gait with lordotic posture -progressive weakness and muscle atrophy mainly involving the shoulder girdle (scapulohumeral type), the pelvic girdle (pelvifemoral type) or both -progresses slowly over years (adulthood- most patients wheelchair bound) -decreases deep tendon reflexes -NORMAL intellectual function -rare cardiac involvement -genetics can confirm test -CK elevated (can be mild or profound) -EMG non-specific -muscle biopsy shows deficiency of alpha-sarcoglycan -supportive care treatment only (to prevent contractures and light exercise) -variable prognosis
limb-girdle dystrophy
What is a malignant tumor of fat?
liposarcoma
For ___-grade slips, single-level fusions are adequate for stabilization
low-grade
What stage of paget disease of bone is being described: -normal bone is resorbed by osteoclasts that are more numerous, larger, and have many more nuclei than normal osteoclasts -bone turnover rates increase to as much as 20 times normal
lytic
What are spots of bone damage that result from cancerous plasma cells building up in your bone marrow?
lytic lesions
What imaging cannot be used with pacemakers or if patient has metal in their body, is very good for soft tissue detail, and can diagnose rotator cuff tears?
magnetic resonance imaging
What type of imaging has no radiation, involves imaging via magnetism for fluid containing structures, has batteries and metal contraindications, good for evaluation of soft tissues and neural tissues, contrast may be used, imaged in 3 planes (axial, coronal, sagittal), and strength of the magnet will determine detail of imaging and slices?
magnetic resonance imaging
What type of imaging shows soft tissue, bone edema, and tumors in great detail?
magnetic resonance imaging
When assessing for a tumor, you should always ask about the duration of a complaint, ________ may be there for week/smonths
malignant
When assessing for a tumor, you should always ask if there is any pain associated with the mass, ______ are usually painful
malignant
a lesion is (benign/malignant) if: -the lesion is painful (only at advanced stage) -lytic lesion with poor defined margins -non-capsulated -fast growing (usually) irregular shape/not smooth -skin dimpling
malignant
What does the surgical management of adhesive capsulitis involve?
manipulation under anesthesia (MUA), arthroscopic capsular release if extensive PT has not helped
What would you expect XRAYs to look like for rotator cuff tears?
may show decreased subacromial space, osteophytes, AC joint arthropathy
Once diagnosed with osteopenia/osteoporosis, what is the first line of treatment?
medication
What can gout be treated successfully with?
medication and nutrition therapy
What diet is rich in fish, fruit and vegetables, low in saturated fat, reduces CVD risk, improves disease activity, reported significant benefit in intervention subjects compared with controls in patients with rheumatoid arthritis, and is great for pain, early morning stiffness, and functional status of patients with rheumatoid arthritis?
mediterranean diet
(men/women) are affected with spinal stenosis slightly higher frequency than women
men
When can the bone remodeling cycle become unbalanced?
menopause with aging women or in aging men
What is a general term for skeletal disorders characterized by low bone mass?
metabolic bone disease
When do most bone sarcomas peak in incidence, especially osteosarcomas and ewing's sarcomas?
mid-teenage years
What population does lumbar spinal stenosis most commonly affect?
middle-aged and elderly
What stage of paget disease of bone is being described: -rapid increases in bone formation from numerous osteoblasts -osteoblasts remain morphologically normal thought increased in number -newly made bone is abnormal with collagen fibers deposited in a haphazard fashion rather than linerally, as with normal bone formation -high degree of bone turnover occurs as the osteoclastic and osteoblastic activities of bone destruction and formation repeat
mixed
OMT is directed at optimizing ________ in patients with scoliosis by improving the strength of the musculature (Psoas and abdominal muscles) through stretching of tight tissues or correcting somatic dysfunctions (muscle energy, myofascial release, HVLA if FUNCTIONAL scoliosis but NOT structural)
mobility
What is the scoliosis treatment for risser 4 and 5?
monitor every 6-12 months until 1 year after skeletal maturity and surgery may be indicated for curve greater than 50 degrees
What treatment of osteoporosis involves: -prolia (denosumab) -treats osteoporosis in postmenopausal women at high risk of bone fracture -treatment of bone loss with prostate or breast cancer undergoing hormone ablation therapy -used to increase bone mass in men with osteoporosis
monoclonal antibodies
bone malignancies are ___________, involving surgeons, radiation oncologists, medical oncologists, and physical therapy or occupational therapy
multidisciplinary
What are bunds of specialized cells that contract when stimulated by nerves?
muscle
What myopathy is distinguished from all other neuromuscular diseases based on: -primary myopathy--disease occurring primarily in muscle -genetic basis -progressive course (gets worse) -degeneration and death of muscle fibers occur at some stage in the disease
muscular dystrophy
when there is concern for radicular pain from nerves in the spine, one can order a ____________
myelogram
_____________ are primary diseases of the muscle that can be hereditary or acquired and tend to follow a proximal distribution (in contrast to neuropathies which tend to be distal)
myopathies
What disease: -2nd most common muscular dystrophy in NA, Europe, and Australia -autosomal dominant mutations either CTG repeats in DMPK protein (DM1) or CCTG repeats (DM2) -has genetic anticipation -facial wasting (inverted V-shaped upper lip, thin cheeks, scalloped and concave temporalis muscles, narrow head and high arched palate, tongue thing and atrophic) -mild progressive weakness (wasting of intrinsic muscles of hands & sternocleidomastoid muscles, scapular winging, gowers sign and difficulty climbing stairs) -typically do not lose the ability to walk --> not wheelchair bound -preserved deep tendon reflexes -MYOTONIA (difficulty relaxing after contraction -speech slurred (difficulty speaking, secondary to involvement of face tongue and pharynx) -slow gastric emptying, poor peristalsis, and constipation -heart block and arrhythmias (CARDIAC INVOLVEMENT) -hypothyroidism, adrenocortical insufficiency, diabetes, precocious or delayed puberty, testicular atrophy and testosteerone deficiency -immune deficiencies common (decreased IgG) -cataracts common -intellectual impairment (50% cases) -DNA analysis of blood to demonstrate abnormal expansion of CTG or CCTG repeat gold standard -CK normal, monitor immunoglobulins, adrenal cortical function, and thyroid function -ECG conduction defects (get EKG regularly), arrhythmia -muscle biopsy shows central nuclei and selective atrophy of histochemical type I fibers, no fibrosis of muscle -symptomatic and supportive treatment -myotonia can improve with exercise -myotonia may improve with drugs that raise depolarization threshold (mexiletine, phenytoin, carbamazepine, procainamide, and quinidine sulfate) -cardiac, endocrine, GI, and ocular complications can be treated (EKG annually, endocrine assessment, US abdomen for diaphragm motion, ophthalmology evaluation, pacemaker placement)
myotonic muscular dystrophy
Which special test(s) of the shoulder tests: -subscapularis pathology
napolean and lift off
Which special test(s) of the shoulder tests: -subacromial impingement
neer's & hawkin's
What type of association with GOUT does dairy foods, particularly low-fat dairy?
negative
alcohol and caffeine can have __________ effects on bone health (but only when calcium intake is poor)
negative
What measures how well and how fast the nerves can send electrical signals, has differential diagnoses (myopathy v. neuropathy), and can identify generalized v. focal involvement?
nerve conduction test (NCT)
What is the characteristic syndrome associated with lumbar stenosis?
neurogenic pseudo-claudication
2% of cases of spondylolisthesis have ______ _______ (numbness, tingling, or weakness in the legs) and this only occurs if the slippage is REALLY bad, hence why it is rare
neurologic symptoms
What occurs in children who have cerebral palsy, muscular dystrophy, SMA, congenital myopathies, spina bifida, spinal cord injuries, and other congenital or trauma neuromuscular conditions, has a more rapid progression of curvature than idiopathic, and non-ambulatory patients are at increased risk?
neuromuscular scoliosis
What type of association with GOUT does animal or vegetable protein, purine-rich vegetables?
no association
What type of association with GOUT does wine have?
no association
(osteogenesis imperfecta/non-accidental trauma) involves: -retinal hemorrhages -subdural hemorrhages -lack or delay in seeking medical care -characteristic patterns of bruising
non-accidental trauma
Are these symptoms inflammatory or non-inflammatory? -no morning stiffness -night pain -pain worsens with activity -bony swelling, not warm/red -NO systemic features or gelling -Normal CRP/ESR -synovial WBC <2000
non-inflammatory
What type of tumor of musculoskeletal system: -lesions normally regress spontaneously -only definite indication to treat is a pathologic fracture -natural history is that they either spontaneously resolve or move to the diaphysis of the bone
non-ossifying fibroma
What type of tumor of musculoskeletal system: -asymptomatic and usually discovered as an incidental finding on XRAY -occasionally, larger lesion presents as a pathologic fracture -very typical appearance on XRAY -eccentric, multi-loculated sub-cortical lesions with a central lucency and a scalloped sclerotic margin -sometimes cortical thinning but no periosteal reaction -serial XRAYs will show lesion migrating away from the epiphyseal plate with time
non-ossifying fibroma (NOF)
What diagnosis are for patients with DEXA scan that is up to -1?
normal
nutrient recommendations for rheumatoid arthritis patients should be individualized to the patient based on what?
nutrition status and any extant comorbidities
What are some foods moderate in purines?
oatmeal, wheat bran, wheat germ, meat and poultry, crab, lobster, oysters, shrimp, dried beans, peas, and lentils, asparagus, cauliflower, spinach, mushrooms, and green peas
The most significant recognized link between osteoarthritis and food is _________
obesity
What has the highest correlation with knee osteoarthritis because every extra pound you gain adds 3 pounds of pressure to your knees and six pounds of pressure to your hips?
obesity
What type of XRAY view evaluates spondylolysis lesions?
oblique
the anti-inflammatory diet is high in _________ ____________ _____ _______ like olive oil, flax, walnuts, pumpkin seeds, fatty cold-water fish
omega-3 polyunsaturated fatty acids
What does the surgical management of biceps tendinitis involve?
open or arthroscopic tenodesis
What disease has these characteristic symptoms and signs: -pain related to use of joints -pain worse during the day, less in evening -minimal morning stiffness (<20 minutes) and after inactivity (gelling) -ROM decreased -joint instability -bony enlargement -restricted movement -crepitus -variable swelling and/or instability
osteoarthritis
What is a chronic, degenerative disorder characterized by a loss of cartilage?
osteoarthritis
every 2 unit increase in BMI increases risk of ___________ by more than 1/3 (33%)
osteoarthritis
what is the slow progressive degeneration of articular cartilage, is the most common joint disease, caused by persistent and abnormally high stress loads on the joint surfaces (initially result in the loss of proteoglycans and chondrocytes from the articulating surface of the cartilage), cartilage may crack (fibrillate), erode, and expose underlying bone in this disease, and can be due to enzymatic damage (by metalloproteases--elastase, collagenase, or cathepsins)?
osteoarthritis
What type of tumor of musculoskeletal system treatment involves: -surgical resection by curettage, intralesional excision or en-bloc excision depending on site -cytosurgery, radiation, and chemotherapy may have a role in aggressive and surgically unresectable lesions of the spine
osteoblastoma
What type of tumor of musculoskeletal system: -solitary, benign and self-limited tumor that produced osteoid and bone -tumor occurs in the dorsal aspect of vertebrae, the metaphysis or diaphysis of long bones, and rarely in the pelvis -in the spine, the tumor is usually located in the posterior processes while the vertebral bodies are spared -on XRAY, osteoblastomas appear as a radio-lucent defect with a central density due to ossification -lesion is well circumscribed and may have a surrounding sclerosis on XRAY -tumor demonstrates increased isotope uptake on bone scan -biopsy is usually performed to confirm the diagnosis
osteoblastoma
During bone remodeling, (osteoblasts/osteoclasts) are involved in bone formation
osteoblasts
What are outgrowths of normal bone and cartilage (cartilage cap) in abnormal locations?
osteochondroma
What is the most common benign bone tumor?
osteochondroma
What type of tumor of musculoskeletal system appears on XRAY: -XRAY demonstrates a bony outgrowth from the cortex -trabecular pattern and density of the outgrowth are the same as in the normal bone -there is no reactive bone at the base -lesion may be stalked or flat -XRAY opacity is smaller than mass feels clinically
osteochondroma
What type of tumor of musculoskeletal system: -most often in people aged 10 to 20 -can be single or multiple -multiple tend to run in families -secondary malignant chondrosarcoma develops in about 10% of patients with multiple and <1% of those with single lesions -most common benign bone tumor -outgrowths of normal bone and cartilage in abnormal locations
osteochondroma
____________ are activated by calcitriol because it stimulates RANKL expression, prostaglandin E2 because it activates adenylyl cyclase and stimulates resorption, IL-6, and MIP-1A
osteoclast
During bone remodeling, (osteoblasts/osteoclasts) are involved in bone resorption
osteoclasts
Osteoprotegerin (OPG) inhibits (osteoblasts/osteoclasts)
osteoclasts
______________ are inhibited by osteoprotegrin (OPG) because it is a decoy receptor produced by osteoblasts and stromal cells that binds to and sequesters RANKL, thus inhibiting osteoclast differentiation, fusion, and activation && calcitonin, which interacts directly with the osteoclast via cell surface receptors Hint: their inhibition decreases bone resorption
osteoclasts
(osteogenesis imperfecta/non-accidental trauma) involves: -family history (scoliosis or short stature) -blue sclera -wormian bones
osteogenesis imperfecta
What disease (general) presents with: -excess or atypical fractures due to brittle bones -short stature -scoliosis -basilar skull deformities -blue sclerae -hearing loss -opalescent teeth that wear quickly (dentinogenesis imperfecta) -increased laxity of the ligaments and skin -wormian bones (small, irregular extra bone pieces in cranial sutures) -easy bruising
osteogenesis imperfecta
What disease has biochemical parameters of bone and mineral metabolism that are usually normal with a few exceptions, being: -normal to elevated alkaline phosphatase in neonatal period -notably elevated alkaline phosphatase in school aged children -hypercalciuria
osteogenesis imperfecta
What disease: -caused by a mutation in type 1 collagen (COL1A1 or COL1A2) -most common genetic cause of osteoporosis -triad of fragile bones, blue sclera, and early deafness -4 main classifications (AD)
osteogenesis imperfecta
What type of tumor of musculoskeletal system treatment involves: -successful surgery requires the tumor to be completely removed -sometimes surgeries are quite extensive, require resection of large area of bone and implantation of bone grafts -have higher risk of complications and a longer recovery period -operation usually entails a longer hospital stay of at least several days -frequently located in weight-bearing bones and during the recovery period, a longer period of limited weight bearing is required -method of choice in many cases is radio frequency ablation (tumor heated up for a period of approximately 6 minutes and thus ablated)
osteoid osteoma
What type of tumor of musculoskeletal system treatment involves: -treating the pain b/c the most significant symptom is pain, which can be treated with aspirin, ibuprofen, or other OTC anti-inflammatory drugs -some patients have relief with a given medication for a while, but then it stops working -a change to another anti-inflammatory medication may then be required
osteoid osteoma
What type of tumor of musculoskeletal system: -most common benign osteoid-forming tumor, accounting for 10% of all benign bone tumors -males >>> females -second decades of life --> 10-19 years old -proximal femur is the most common site -dull aching pain is the most frequent symptom -symptoms are relieved with non-steroidal anti-inflammatory secondary to a high concentration of prostaglandins in the nidus -may have a unique pathogenic nerve supply as well, a unique finding among bone tumors --> PAINFUL!!! -XRAYs show new bone formation and sometimes a small lucent spot (smaller than 1.5 cm) which is defined as the nidus
osteoid osteoma
What type of tumor of musculoskeletal system: -tends to affect young adults -can occur in any bone but is most common in long bones -can cause pain (usually worse at night) that is typically relieved by mild analgesics, particularly aspirin (prefer ibuprofen because of Reye's Syndrome) -physical examination may reveal atrophy of regional muscles -characteristic appearance on XRAY is a small radiolucent zone surrounded by a larger sclerotic zone (if tumor is suspected, a technetium-99m bone scan should be performed; an osteoid osteoma appears as an area of increased uptake) -permanent relief is obtained if the small radiolucent zone is removed surgically or with percutaneous radiofrequency ablation
osteoid osteoma
What diagnosis are for patients with DEXA scan that is -1 to -2.49?
osteopenia
What is a complex, multifactorial disease of which food and dietary supplement plays an important role?
osteopenia/osteoporosis
What is a calcification at the disc/joint margin that protrudes at an angle of greater than 45 degrees?
osteophyte
Nutrition changes, although important, are not the first line of treatment for ______________: -Once the bone density has decreased to the "disease" range, medications are necessary -However, food intake changes & DS aid in the efficacy of medications & assist in treatment
osteoporosis
Pathogenesis of __________________ includes: -estrogen deficiency -calcium deficiency & secondary hyperparathyroidism -androgen deficiency -changes in bone formation -secondary causes and medications
osteoporosis
What diagnosis are for patients with DEXA scan that is -2.5 and above?
osteoporosis
What is a disorder of compromised bone strength predisposing to fractures and loss of bone integrity?
osteoporosis
What type of tumor of musculoskeletal system have a predilection for long bones of the lower limb, especially the tibia and distal femur?
osteosarcoma
What type of tumor of musculoskeletal system: -60-70% five-year survival currently -limb-sparing in 80%+ currently -long-term morbidity from chemotherapy (heart disease, second cancer, early menopause and infertility) -risk factors include; prior treatment for childhood cancer with radiation therapy/chemotherapy, hereditary retinoblastoma, Li-Fraumeni syndrome, Rothmund-Thomson syndrome, and radium exposure, previous Paget disease of bone
osteosarcoma
What type of tumor of musculoskeletal system: -causes painful swelling around the knee and sometimes humerus -rare joint effusion or ROM problems -night pain and limping -firm/soft mass fixed to underlying bone -serum alkaline phosphatase (bone fraction) elevated -secondary are usually in individuals >40 -secondary usually occur in area of previous Paget disease of bone or radiotherapy
osteosarcoma
What type of tumor of musculoskeletal system: -malignant bone tumor -XRAY shows large ill-defined lytic lesion (sunburst pattern) -codman's triangles
osteosarcoma
What type of surgery for OA: -may delay need for TKR for 2-3 years
osteotomy
What disease: -asymptomatic in 70-90% of cases -bone pain most common symptom -secondary osteoarthritis when it occurs around a joint -bony deformity (most commonly bowing of an extremity) -excessive warmth due to hypervascularity -neurologic complications caused by compression of neural tissues
paget disease of bone
What is the excess of bone destruction and unorganized bone formation and repair, the second most common bone disorder int he US, has unknown etiology, usually affects the axial skeleton, vertebrae, skull, pelvis, tibia, and femur, and most persons are asymptomatic & diagnosis is incidental?
paget disease of bone
What is the second most common bone disorder in elderly persons after osteoporosis? Hint: involves remodeling osteoclastic activity followed by osteoblastic activity
paget disease of bone
Which special test(s) of the shoulder tests: -subacromial impingement or acromioclavicular joint
painful arc
What is a bisphosphonate used to treat osteogenesis imperfecta that inhibits bone resorption via actions on osteoclast activity, leading to an indirect increase in bone density?
pamidronate
failure of proper spinal stenosis work up may results in permanent __________ of your patient!
paralysis
What hormone stimulates the conversion of 25-OH-D to 1,25-(OH)2-D (calcitriol)?
parathyroid hormone
When chronically elevated ______________ is a potent stimulator of bone resorption
parathyroid hormone
_____________ is a molecule that stimulates bone resorption and activation of its receptor stimulates adenylyl cyclase, binds to cell-surface receptors on osteoblasts to stimulate production of RANKL and M-CSF, and is secreted by many cancer cells
parathyroid hormone
What treatment of osteoporosis involves: -bisphosphonates (first in line), least expensive option -selective estrogen receptor modulators (SERMs) -monoclonal antibodies -human recombinant PTH -estrogen hormonal therapy -calcitonin
pharmacologic
What does the non-operative management of rotator cuff tear involve?
physical therapy similar to subacromial impingement plan, avoid overhead activities
What occur when a baby develops a flat spot on one side of the head or the whole back of the head?
plagiocephaly
What are the typical radiographical modalities for all bone sarcoma work ups?
plain radiographs, CT, and angiogram, MRI, MRA, and bone scan
What type of imaging delinates bones and soft tissue swelling?
plain radiography
What type of imaging is the first study for deformities, limited range of motion, swelling/masses, infections, good for trauma (not sensitive for early stress fractures), can pick up tumors, and is used as a baseline?
plain radiography
What type of imaging provides a 2D picture, uses low dose radiation, requires multiple views (AT LEAST 3!!!!! AP, lateral, and oblique), and is the FIRST STEP for imaging evaluation?
plain radiography
What is the initial joint manifestation in 50% of gout cases?
podagra
What type of association with GOUT does alcohol (beer and liquor) have?
positive
What type of association with GOUT does high consumption of meat and seafood have?
positive
What type of spine radiograph is used to assess coronal curvature?
posterior-anterior spine radiograph
exercise to prevent osteopenia/osteoporosis should focus on what?
posture, balance, gait, coordination, hip & trunk stabilization
when is there an adiposity rebound in preparation for puberty (often seen earlier in women than men)?
pre-puberty
What type of gout is related to under-excretion or over-production of uric acid & has genetic predisposition?
primary gout
What type of osteoarthritis involves variable number of joints in characteristic locations?
primary osteoarthritis
What type of osteoarthritis is more commonly diagnosed, is the wear and tear osteoarthritis, and is degenerative joint disease?
primary osteoarthritis
What does conservative treatment for AC joint injuries involve?
protect, rest, ice, compress, elevate (PRICE), sling 1-2 weeks, early ROM and strength, OMM to resolve somatic dysfunction, education that deformity will remain
What is associated with aging, trauma, and metabolic abnormalities (thyroid disease, hyperparathyroidism, hypomagnesemia, hypophosphatemia, and hemochromatosis)?
pseudogot
(gout/pseudogout) has calcium pyrophosphate crystals
pseudogout
(gout/pseudogout) has positively birefringent crystals on polarizing synovial fluid, apearing blue when aligned parallel with slow axis of red compensator and perpendicular to yellow compensator
pseudogout
A crystal-induced arthritis in the glenohumeral joint is more likely to be due to _________
pseudogout
Characteristic radiographic findings of _____________ include: -Joint destruction -Hook-like Osteophyte -Chondrocalcinosis -"String-of-pearls" subchondral cysts
pseudogout
What is inflammation caused by calcium pyrophosphate dihydrate crystals and is also called calcium pyrophosphate disease?
pseudogout
What drugs can be used to treat myotonic muscular dystrophy? Hint: Queen Patricia Cant Pick Me
quinidine sulfate procainamide carbamazepine phenytoin mexiletine
What is pain in the distribution of the nerve root located at the level of the lesion, more commonly seen in degenerative spondylolisthesis & most common in the distribution of the L5 and S1 nerve roots?
radicular pain
_____________ is a molecule that stimulates bone resorption and is secreted by osteoblasts to bind to RANK on osteoclasts
rank ligand
How does medication work to treat gout?
reduce uric acid in the blood
What does the non-operative management of osteoarthritis involve?
regular exercise, heat for comfort, may benefit from PT, NSAIDs, and/or corticosteroid injection
During bone _________, bone tissue is removed by osteoclasts and then new bone tissue is formed by osteoblasts. Both processes utilize TGF-Beta and IGF (insulin-like growth factor) signaling
remodeling
bone repairs itself by actively _______
remodeling
if a thoracic curve is greater than 70 degrees, what complication can occur?
respiratory function compromised
What does the non-operative management of biceps tendinitis involve?
rest, PT, NSAIDs, corticosteroid injection into biceps tendon sheath at the bicipital groove
What does the non-operative management of subacromial impingement involve?
rest, ice, NSAIDs for the acute stages, PT for cuff strength and scapulothoracic function, and subacromial corticosteroid injection
What type of tumor of musculoskeletal system: -50% of all sarcomas in children less than 15 years of age -alveolar type makes up ~20% of cases and is termed so because growth appears similar to pulmonary alveoli in 50% or more cases -translocation of the PAX3-FOXO1 (60%)/PAX7-FOXO1 (20%) genes -embryonal type is 60-70% of cases that involves immature skeletal muscle, younger age, and has favorable prognosis
rhabdomyosarcoma
Due to increased risk for CVD and osteoporosis, patients with _________ __________ should have a diet that is nutrient dense and low in saturated and trans fats
rheumatoid arthritis
The main dietary recommendations for patients with _________ ________ are: -eat a wide variety of foods -eat a large proportion of the meal plan from grains (whole), vegetables, fruits, nuts, and seeds -emphasize intake of low-fat, calcium-rich foods -moderate fat intake (esp. if limiting foods in sat'd and tans fat, as well as cholesterol) -moderate simple sugar intake from processed foods and sweets -moderate alcohol intake if they choose to drink although not scientifically advocated, these too: -adequate consumption of calcium-containing foods -regular consumption of fish containing omega-3s -insure adequate intake of vitamins C, E, and zinc
rheumatoid arthritis
What is a debilitating systemic autoimmune disease characterized by chronic polyarthritis that involves the linings of the joints and is often symmetrical in nature?
rheumatoid arthritis
fish oils and omega-3 fatty acids (such as borage & evening primrose oils) confer modest anti-inflammatory effects in __________ _________ patients
rheumatoid arthritis
patients with ________ _______ are also at an increased risk for CVD, infection, lymphoproliferative malignancies, GI disease, and osteoporosis
rheumatoid arthritis
patients with ____________ ___________ are at risk for malnutrition resulting from factors such as: -disability -feeding issues (low energy intake and energy-adjusted intakes of fat, low vitamin A and beta-carotene) -medication interactions -increased nutrient needs or reduced utilization
rheumatoid arthritis
What disease would you expect from this XRAY finding: -soft tissue swelling around joints -early erosion of proximal phalangeal joint (decreased joint space) -changes in joint leads to decrease/loss of function and ROM -characteristic deformities
rheumatoid arthritis (RA)
What disease would you expect with these physical exam findings: -swan-neck deformity of fingers -ulnar deviation of hand/fingers -nodulosis -heberden's nodes -bouchard's nodes -DIP/PIP predominant
rheumatoid arthritis (RA)
What disease has: -low bone density -deformities of the shaft of lone bones (bowing) -loss of demarcation between metaphyses and growth plate and loss of the provisional zone of calcification -widening of growth plate (from proliferation of uncalcified cartilage and osteoid) -metaphyseal widening, splaying, cupping, and fraying
rickets
What disease has: -normal/low serum calcium -phosphorous low -alkaline phosphatase elevated (bones trying to reabsorb) -increased PTH -low vitamin D (calcitriol)
rickets
What disease presents with: -failure to thrive -listlessness -protruding abdomen -muscle weakness -fractures -craniotabes -frontal bossing -delayed fontanel closure -rachitic rosary -harrison's groove -respiratory infection -scoliosis -increased kyphosis/lordosis -enlargement of wrists and ankles -fraying at distal metaphysis -valgus or varus deformities -anterior bowing of tibia and fibula -leg pain -tetany, seizure, or stridor due to laryngeal spasm (hypocalcemic symptoms)
rickets
What disease: -occurs in growing children & adults (but termed osteomalacia in adults) -due to the failure of bones to mineralize, especially at epiphyseal cartilage matrix (growth plate) -in adults, it occurs due to bones weakened by demineralization (calcium loss) -may be asymptomatic or manifest a isolated or generalized muscle and bone pain
rickets
What is the failure of growing bones to mineralize, especially at the epiphyseal cartilage matrix (growth plate) due to vitamin D deficiency?
rickets
What risser grade indicates substantial growth remaining?
risser grade 0-2
What risser grade indicates little growth remaining?
risser grade 3
What risser grade indicates skeletal maturity?
risser grade 4 (females) and risser grade 5 (males)
what is used to grade skeletal maturity based on level of ossification and fusion of iliac crest apophyses; can tell you whether or not scoliosis will advance?
risser sign
What type of joint is the sternoclaviulcar joint, despite functioning like a ball-and-socket joint?
saddle synovial joint
Standing lateral radiographs are diagnostic for _______ _______, requires anterior wedging of greater or equal than 5 degrees in at least three adjacent vertebral bodies
scheuermann kyphosis
What disease: -wedge-shaped vertebral bodies -narrow disk spaces -irregular disk surfaces -kyphosis greater than 40 degrees -poorly formed vertebral plates -Schmorl's nodes (protrusion of disk material into vertebral body)
scheuermann kyphosis
What disease: -overall, 60% of patients have (+) antibody tests, meaning lack of these antibodies does not rule out the disease -presents with cutaneous calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST syndrome) -anti-centromere (ACA) is positive in 57% of patients -anti-SCL 70 is positive in 40% of patients
scleroderma
What stage of paget disease of bone is being described: -bone formation dominates and the bone that is formed has disorganize pattern (woven bone) that is weaker than normal adult bone -woven bone pattern allows the bone marrow to be infiltrated by excessive fibrous connective tissue and blood vessels, leading to hypervascular bone state
sclerotic
What is a curvature of the spine in the coronal plane of greater than 10 degrees?
scoliosis
What type of gout is related to: -myeloproliferative diseases or their treatment -therapeutic regimens producing hyperuricemia (diabetes, obesity, any acidosis, low-dose aspirin, thiazide diuretics, cyclosporine A, alcohol) -renal failure or renal tubular disorders -lead poisoning, hyperproliferative skin disorders -enzymatic defects
secondary gout
What type of osteoarthritis is caused due to injury or metabolic and occurs at an earlier age (45-50 years old)?
secondary osteoarthritis
What type of osteoarthritis: -caused by trauma (repetitive micro-trauma caused by neuropathic arthritis) -caused by joint infection -can be inflammatory (RA, psoriatic arthritis, gout, pseudogout) -genetic forms associated with type 2 collagen defects, nail-patella syndrome, joint hypermobility, and more severe Ehlers-Danlos and Larsen syndromes (these 2 can cause precocious OA) -caused by metabolic errors (deposition diseases)
secondary osteoarthritis
What treatment of osteoporosis involves: -acting as an estrogen agonist and bone and heart -acting as estrogen antagonists in breast and uterine tissues -potential for preventing osteoporosis without the increased risk of breast or uterine cancer -approved for osteoporosis prevention & treatment in postmenopausal women -reduces vertebral fractures by 60% -relative risk of breast cancer of 0.24 -decreased bone turnover and maintained hip & total body bone density -total cholesterol and LDL levels decreased -side effects included: flu-like symptoms, hot flashes, leg cramps, and peripheral edema
selective estrogen receptor modulators (SERMs)
What occurs when a patient falls onto the shoulder while arm is in abduction and external rotation, often present with limited ROM and guarding, and the anterior direction is the most common (90%)?
shoulder dislocation
What do you expect to find on MRIs for patients with adhesive capsulitis?
show capsular thickening and inflammation, but is unncessary for diagnosis
What test is used for spondylolisthesis and spondylolysis in which the subject stands on one foot on the symptomatic side and extends his/her back and is repeated on the opposite side, positive if lumbar pain is induced, and has poor sensitivity and specificity?
single leg hyperextension test (stork test)
what method of body composition assessment estimates body fat by using a caliper to gauge the thickness of a fold of skin on the back of the arm (over the triceps), below the shoulder blade (subscapular), and in other places (including lower body sites), and then compares these measurements with standards?
skinfold measures
What type of association with GOUT does coffee intake have? Note: not related to caffeine
slight negative
What type of tumor of musculoskeletal system: -less than 1% of malignancies b/c arise from mesenchymal tissue -over 50 histopathologic subtypes -75% involve the limbs -can originate from muscular, vascular, adipocytic (Fat), or other connective tissue elements
soft tissue sarcoma
What does the OMT management of biceps tendinitis involve?
spencer technique for mobilization of GHJ, myofascial release, fascial unwrapping, UE lymphatic drainage
There is a strong association with _____ ______ to develop into isthmic spondylolisthesis (1/3 cases, 33%) because if you have a developmental problem in your spine, it is likely to slip
spina bifida
_____________ osteoarthritis can involve apophyseal (facet) joints, intervertebral discs, or paraspinous ligaments?
spinal
Typical symptoms of _____ _______ include radiating pain, numbness, and muscle weakness of the arms (cervical spine) or legs (lumbar spine)
spinal stenosis
What disease presents with: -appear or worsen with the onset of ambulation or on standing and are promptly relieved by sitting or lying down -stiffness of the thighs and legs -back pain -visceral disturbances such as urinary incontinence that may be a result of impingement of sacral roots -back pain -dull to severe pain in the buttocks into one or both legs -numbness, weakness, or paresthesias in lower extremities -simian stance (ape-like) -worse walking downhill in contrast to up hill
spinal stenosis
What is the narrowing of the spinal canal that surrounds and compresses the spinal cord in the neck and nerve roots in the back?
spinal stenosis
symptoms of lumbar _______ _______ appear or worsen with the onset of ambulation or on standing and are promptly relieved by sitting or lying down? Hint: shopping cart syndrome
spinal stenosis
What refer to inflammation of one or more of the vertebral bodies (TB infection or inflammatory disease like RA or AS)?
spondylitis
What disease matches this physical examination: -TART at lumboscral junction -tight hamstrings (knees and hips partially flexed) -gait can be abnormal with shortened stride and stiff legged -Phalen-Dickson sign (indicates lots of slippage, sacrum up and down with pelvis, waddling gait, hyperlordotic spine, tight hamstrings) -increased intersegmental motion at lumbosacral junction -anterior spinous process "drop off sign" --> one may be way deeper than another -paraspinal muscle spasm -tenderness at iliolumbar ligament
spondylolisthesis
What occurs when the vertebral body "slips" or has anterior translation in relation to the body below? Hint: it is the structural outcome of several different processes
spondylolisthesis
What disease presents with low back pain that: -increases with activity -better with rest -sharp to dull in nature -unilateral or bilateral -mild to moderate in severity -can radiate to the buttocks and thigh -movements involving rotation and extension exacerbate -change in gait or posture
spondylolisthesis/spondylolysis
What is a defect in the pars interarticularis?
spondylolysis
What is often used very generally to refer to any degenerative back problem?
spondylosis
what refers to degenerative disc disease?
spondylosis
Which special test(s) of the shoulder tests: -cervical nerve root compression
spurling's
compression fractures that are (stable/unstable) involve the anterior/posterior column still intact, no neurologic deficits
stable
What injury: -due to trauma (fall on lateral shoulder) -present with focal pain medially -point tenderness at SC joint -dislocations are possible (may be anterior or posterior) -airway (trachea) and vasculature (jugular vein and carotid artery) must always be assessed -epiphysis fuses last (age 23-25)
sternoclavicular (SC) joint
What test is used for spondylolisthesis and spondylolysis in which the subject is supine, the knee is fully extended and the leg is passively flexed at the hip, is positive if radicular pain is induced, sensitivity 91% and specific 26% for disc herniation, and will not be positive for spondylolisthesis and spondylolysis most of the time?
straight leg raise
What is the principal bursa of the shoulder positioned between the acromion and head of the humerus and overlying supraspinatus tendon?
subacromial bursa
What is the principal bursa of the shoulder positioned between the acromion and head of the humerus and overlying the supraspinatous tendon, compressed during glenohumeral ABduction?
subacromial bursa
What is the likely diagnosis when: -no muscle atrophy is present -glenohumeral joint is stable -pain arc (+) sign in the range of 60-120 degrees of ABduction -positive Hawkin's and/or Neer's -Jobe (+), indicative of supraspinatus damage -O'Brien's may be generally painful, but there is no localization of pain t osuperior labrum or painful pop
subacromial impingement
What is the most common cause of shoulder pain?
subacromial impingement
What occurs due to a combination of compression of rotator cuff between humeral head and anterior acromion (especially when excessively curved)/coracoacromial ligaments/AC joint?
subacromial impingement
What is a small volume located deep to the acromion process, occupied by supraspinatous muscle and distal tendon and potential bursa?
subacromial space
Which muscle of the rotator cuff muscles facilitates internal rotation and ADduction of humerus?
subscapularis
Which special test(s) of the shoulder tests: -glenohumeral capsule and/or acromioclavicular joint ligament laxity
sulcus sign
What muscle of the rotator cuff muscles facilitates humeral ABduction and humeral head stabilization?
supraspinatous
What type of chondrosarcoma comes from osteochondroma?
surface chondrosarcoma
What is the treatment of choice for degenerative spondylolisthesis, especially when degenerative changes and translation narrow the spinal canal and compress nerve roots?
surgery
__________ is indicated for patients with persistent pain, progressive spondylolisthesis, or neurological symptoms who fail non-operative management
surgery
What is bridging calcification of the ligaments that makes an acute angle to the disc margin less than 45 degrees?
syndesmophyte
What is the fluid that lubricates joints and keeps the cartilage smooth and healthy?
synovial fluid
What is a thin lining membrane inside a joint capsule?
synovium
What is a fluid-filled cavity that develops in the spinal cord (called syringomyelia), in the brain stem (called syringobulbia) or in both? Hint: can be present at birth or develop later because of an injury or a tumor
syrinx
What ligament extends laterally to the inferior surface of the clavicle from the coracoid process of the scapula and provides vertical stability?
tapezoid ligament
What can be used to help determine classification of spondylolysis/spondylolisthesis because acute lesion will appear as "hot spots" on the scans while chronic lesions will show no increased uptake in the pars?
technetium 99 bone scan
What are tough, fibrous cords that connect muscle to bone?
tendon
What phase of adhesive capsulitis involves pain is resolved, motion improves but may remain less than initial?
thawing
What do you get vitamin D from?
the diet and sun, less than 10% comes from dietary sources in the absence of food fortification or use of supplements
What is a deformed thoracic rib cage that leads to impaired and restricted lung growth and function (restrictive lung disease) and is an early onset idiopathic scoliosis complication?
thoracic insufficiency syndrome
What develop after about a decade in untreated gout patients, are collections of urate crystals in the soft tissues including cartilage, bursae and tendons, even in bones, tend to develop earlier in women, particularly those receiving diuretics, classic location is along the helix of the ear (but can find on fingers, toes, preptellar bursa & resemble rheumatoid nodules)?
tophi
what are absolute indications for xanthine oxidase inhibitors?
tophi and stones
What type of surgery for OA: -tone when pain is severe and function is significantly limited
total joint replacement
Why is hyperlordosis and/or anterior weight-bearing line a risk factor for spondylolisthesis/spondylolysis?
transfers weight from vertebral bodies to the facet joints, more likely to induce slippage/fracture
What is the most common cause of SC joint injury?
trauma (fall on lateral shoulder)
T/F: 7% loss of body weight occurs during an infant's first few days of life
true
T/F: Currently, there is insufficient evidence to support specific recommendations for particular nutrients, foods, or eating plans in the treatment of osteoarthritis and rheumatoid arthritis
true
T/F: Vitamin D deficiency is an issue for both developed and developing countries
true
T/F: a bone scan is sensitive but not specific
true
T/F: a diet for patients with rheumatoid arthritis should reflect weight goes and strive to attain an ideal weight
true
T/F: a levoscoliosis is more common in the lumbar spine
true
T/F: acute vertebral fractures due to osteoporosis can have pain, cause height loss, and cause kyphosis
true
T/F: adhesive capsulitis can be primary idiopathic, post-traumatic, post-surgical, or associated with diabetes, scleroderma, thyroid, CVA, mastectomy, RA, lung cancer, TB, and COPD
true
T/F: adolescent athletes have a higher incidence of isthmic spondylolisthesis
true
T/F: back bending activities (football, gymnastics, weightlifting, diving, wrestling, rowing, volleyball, dancing, and military) are risk factors for spondylolisthesis/spondylolysis
true
T/F: breast milk and formula are protective against scurvy (ascorbic acid (vitamin C) deficiency)
true
T/F: chondrosarcomas are typically radiation and chemotherapy resistant
true
T/F: conservative treatment is still needed even after patients with spondylolisthesis undergo surgery
true
T/F: corticosteroids, paradoxically, can worsen cartilage damage despite being used for OA treatment
true
T/F: different organizations have different recommendations for scoliosis screening during well child checks
true
T/F: ewing's sarcomas are radiation and chemotherapy sensitive
true
T/F: females are more susceptible to osteoarthritis than males (especially with hand and knee OA)
true
T/F: gout and heart disease are important concurrent diseases
true
T/F: gout is 2-3x more prevalent in men than women, 30 and 60 for men and 70s for women
true
T/F: imaging is not likely needed with subacromial impingement, but start with XRAY if direct trauma occurred, suspected fracture, or concern for OA
true
T/F: in patients with a risser grading of 4 and 5, you cannot brace because skeletally too mature
true
T/F: joint movement commonly elicits bony crepitus in knee osteoarthritis
true
T/F: knee osteoarthritis may have effusions, but they are generally small and NOT warm/red
true
T/F: males are twice as likely to be affected by spondylolisthesis than females
true
T/F: metabolic needs are related to physical, cognitive, and social decline as well as growth & development
true
T/F: metabolic needs in health individuals change throughout the lifespan
true
T/F: not 100% of patients with rheumatoid arthritis (RA) will be positive for rheumatoid factor
true
T/F: not all spondylolisthesis are caused by spondylolyis
true
T/F: not all spondylolysis develop into spondylolisthesis
true
T/F: older adults tend to ingest inadequate amounts of calcium and vitamin D
true
T/F: osteosarcoma is chemotherapy sensitive
true
T/F: osteosarcoma is usually radiation therapy resistant
true
T/F: other diseases can give you a positive rheumatoid factor that are not specifically rheumatoid arthritis (RA)
true
T/F: patients should also be counseled and educated in how to follow proper weight-reduction strategies that include modification of food intake and calories, physical activity as appropriate for their condition, and attention to problematic eating-related habits that may be contributing to their overweight status
true
T/F: patients with severe rheumatoid arthritis have an elevated metabolic rate and chronic inflammation, thus energy and protein needs need to be adjusted accordingly
true
T/F: radiographs should be done STANDING
true
T/F: rheumatoid arthritis patients have an increased mortality rate and reduced life expectancy (death 10-15 years sooner than expected)
true
T/F: rheumatoid factor is NOT entirely specific for rheumatoid arthritis (RA), if the patient is positive for RF that does not automatically mean they have RA
true
T/F: school screening for scoliosis is controversial
true
T/F: smoking almost alway causes cancer
true
T/F: spondylolisthesis and spondylolysis is very rare to occur before standing upright and walking
true
T/F: the anti-inflammatory diet loves good sources of phytonutrients (colors), soy foods, tea, dark plain chocolate in moderation, and spices (ginger, curry, tumeric, and rosemary)
true
T/F: the frequency of rickets has been increasing internationally
true
T/F: the majority of vertebral fractures are asymptomatic
true
T/F: the subacromial bursa is not typically palpable (unless substantial bursitis is present)
true
T/F: there are no known diets to cure osteoarthritis
true
T/F: treated patients with idiopathic scoliosis may still have some curve progression
true
T/F: untreated chronic tophaceous gout can lead to severe joint destruction and renal impairment
true
T/F: you can brace someone who is skeletally immature
true
T/F: you can only view the pars interarticularis on oblique radiograph
true
T/F: you can see soft tissue swelling on XRAY
true
T/F: you can use contrast IV for blood vessel/circulation evaluation, IA for labrum/joint capsule evaluation, or intra-medullar for spinal cord/dura evaluation with MRI
true
T/F: you should use the terms "recommended" and "healthy" instead of "ideal" when discussing body weight because it places thee emphasis on health aspect v. visual presentation
true
Excision or other treatment of a(n) ____________ is needed if it is: -near a nerve -causes a pain (particularly if the bone fractures) -disturbs growth -appearance on XRAY suggests transformation into malignant chondrosarcoma
tumor
What type of osteogenesis imperfecta: -mild form -fractures begin during weight bearing years & decrease after puberty -blue sclerae -presenile hearing loss (30-60% of cases) due to fractures in ear bones or dislocations of ear bones -dentinogenesis imperfecta rare (type of dentin displasia resulting in discolored--often blue-grey or amber--translucent teeth that wear down or rapidly break) -hyperextensible joints, easy bruising, thin skin, joint laxity, scoliosis, wormian bones, hernia -normal stature
type 1
What type(s) of acromioclavicular (AC) joint injury involves a clavicle that is non-displaced and, therefore, pts do well with conservative treatment?
type 1 and 2
What type of osteogenesis imperfecta do infants usually die within months to 1 year?
type 2
What type of osteogenesis imperfecta: -lethal in perinatal period -multiple intrauterine fractures of long bones that have a crumpled appearance on radiograph -severe lung disease--multiple rib fractures create a beaded appearance and the small thorax contributes to respiratory insufficiency -micromelia and bowing of extremities -skull large for body size -blue sclera -cerebral cortex has multiple neuronal migration and other defects
type 2
What type of osteogenesis imperfecta renders patients wheelchair dependent and has clusters of mortality from pulmonary causes in early childhood, teenage years, and 40's?
type 3
What type of osteogenesis imperfecta: -most severe non-lethal form -progressive deforming -significant bone deformity secondary to multiple fractures -relative macrocephaly and triangular facies -blue sclera at birth that normalizes with age -short stature -scoliosis and vertebral compression fractures -mild restrictive lung disease -may have dentinogenesis imperfecta (type of dentin displasia resulting in discolored--often blue-grey or amber--translucent teeth that wear down or rapidly break), hearing loss, and kyphoscoliosis -bone deformity secondary to multiple fractures, many of which occur in utero -post-natal fractures occur from inconsequential trauma & heal with deformity, resulting in popcorn appearance at metaphyses
type 3
What type(s) of acromioclavicular (AC) joint injury involves AC and coracoclavicular ligament(s) fully torn, clavicle displaced and elevated, tx controversial?
type 3
What type of osteogenesis imperfecta: -moderately severe form -present at birth with in utero fractures or bowing of lower long bones -normal stature to moderate short stature -recurrent fractures after ambulation (fractures decrease after puberty) -normal to grey sclera -dentinogenesis imperfecta (type of dentin displasia resulting in discolored--often blue-grey or amber--translucent teeth that wear down or rapidly break)
type 4
What type(s) of acromioclavicular (AC) joint injury may require surgery?
type 4, type 5, and type 6
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as congenitally dysplastic?
type I
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as isthmic (defect at the pars interarticularis)?
type II
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as spondylolytic, a stress fracture of the pars interarticularis?
type IIA
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as an elongation of the pars interarticularis?
type IIB
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as acute or traumatic fracture of pars interarticularis?
type IIC
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as degenerative, long-standing intersegmental instability?
type III
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as post-traumatic, defects of posterior elements ASIDE FROM the pars interarticularis?
type IV
Which Wiltse Classification of spondylolisthesis describes the spondylolisthesis as pathologic (cancer, bone disease, etc that caused the slippage)?
type V
What two types of osteogenesis imperfecta are compatible with full lifespan?
types 1 and 4
How do you diagnose osteopenia/osteoporosis?
typically by DEXA scan, history or presence of fragility (low trauma fractures), hip or vertebral fractures, long-term glucocorticoid steroid therapy, presence of several risk factors (includes family history)
What type of imaging involves no radiation, imaging via sound waves through a fluid medium, can show real-time static OR dyanmic imaging, is convenient to use, portable, and useful for bedside exams, and is operator dependent?
ultrasound
What type of imaging is cost-effective alternative and operator dependent?
ultrasound
compression fractures that are (stable/unstable) involve neurologic deficits, loss of greater than 50% of vertebral body height, greater than 20 degrees of spinal angulation, and compromise more than 50% of the spinal canal
unstable
humans lack _______ to complete the process of metabolizing urate into the water-soluble allantoin
uricase
The majority of _________ __________ are diagnosed by spinal radiographs, have increased kyphosis or increased height, are mostly asymptomatic, and have chronic back pain due to spinal changes that occur with vertebral compression
vertebral fractures
Dietary deficiency of __________ __ can occur in children, especially seen in Autism Spectrum Disorder or those who have a highly selective diet devoid of fruits and vegetables due to texture issues, aversions, etc.
vitamin C
Dietary deficiency of __________ __ can occur in infants if they are fed unsupplemented cow's milk or almond milk during first year of life or their diet is devoid of fruits and vegetables (note: there is some in cow's milk but there's about twice as much in breastmilk and formula)
vitamin C
What is actively absorbed in the distal small intestine, renally excreted, has the largest concentrations found in the pituitary, adrenal, brain, leukocytes, and eyes, usual dietary doses of up to 100mg/day completely absorbed, and will cause scurvy on an insufficiency?
vitamin C
What is involved in: -collagen synthesis & metabolism (hydroxylates lysine and proline) -antioxidant -fatty acid transport -prostaglandin metabolism -cholesterol metabolism (converts cholesterol to steroid hormones and bile acids) -neurotransmitter synthesis (converts dopamine to norepinephrine and tryptophan to serotonin) & thus may play a role in depression -iron absorption (transfers iron from transferrin to ferritin)
vitamin C
An estimates 1 billion people worldwide have a __________ __ deficiency or insufficiency
vitamin D
Excess _________ ___ can lead to hypercalcemia, muscle weakness, polyuric, and nephrocalcinosis
vitamin D
Without ____________ __, only 10-15% of dietary calcium and about 60% of phosphoroius is absorbed
vitamin D
what method of body composition assessment measures central obesity by placing a non-stretchable measuring table around the waist just above the bony crest of the hip, the tape runs parallel to the floor and is snug, but does not compress the skin?
waist circumference
What are some foods low in purines?
water, carbonated beverages, tea, coffee, cocoa, bread, pasta, rice, cake, cornbread, popcorn, salt, herbs, olives, pickles, relishes, vinegar, all dairy foods, all types of fats and oils except gavies and sauces made with meat, all fruits, eggs, nuts, peanut butter, soups made without meat, all vegetables except those high/moderate in purines, sugars, sweets, and gelatin
A positive test for PR-3 antibodies and a positive c-ANCA or p-ANCA are seen in more than 80% of patients with active __________
wegener's
What is the medical nutrition therapy for osteoarthritis?
weight management, adequate calcium, folate, vitamin B6, vitamin D, vitamin K, magnesium, and anti-inflammatory diet
What is the strongest modifiable risk factor for osteoarthritis?
weight status
benign giant cell tumor
what is this XRAY image showing?
osteoblastoma
what is this XRAY image showing?
osteoid osteoma
what is this XRAY image showing?
chondrosarcoma
what is this histology slide showing?
the anti-inflammatory diet favors the intake of ________ _______ like brown rice, bulgur wheat, amaranth, quinoa, and spelt
whole grains
Obese (men/women) are 4-5x more likely to have knee osteoarthritis
women
purine bases are metabolized by ________ ______ to the sparingly-soluble ion, urate
xanthine oxidase
What are some syndromes associated with congenital scoliosis? Hint: they're all things that can lead to vertebral malformations and congenital scoliosis
•Cleidocranial dysplasia •Ehlers-Danlos syndrome •Familial dysautonomia •Homocystinuria •Juvenile Paget Disease •Klippel-Feil syndrome •Marfan syndrome •Mucopolysccharidoses •Neurofibromatosis •Osteogenesis imperfecta •Sprengel deformity •Cerebral Palsy
