Pathology Quiz and Test Review
Infantile Cerebral Palsy is a progressive disease.
False
Multiple Sclerosis is a virus infection that can be successfully treated if diagnosed early.
False
Peripheral neuropathy is an inconvenient but otherwise harmless minor complication of diabetes.
False
The pain level of burn injuries correlates with the burn degree classification (1 = mild, 4 = excruciating)
False
The risk of life-threatening complications is greater in an aseptic bone necrosis than in a septic bone necrosis.
False
The symptoms of spina bifida occulta are usually more severe than the symptoms of spina bifida cystica
False
Wearing of prescription grade compression stockings by healthy individuals increases health risks and is therefore not recommended.
False
WHat is described as noninvasive and least expensive treatment option for phantom limb pain in the paper by Collins et al (2018)?
Mirror therapy
What is recommended to prevent joint contractures after surgery?
Passive motion of joints in regular intervals
What is usually recommended to a patient that is undergoing the Ilizarov bone lengthening method?
Patients are asked to regularly adjust the length of the fixator several times a day.
What is the main disease mechanism of Erb's palsy?
Perinatal injury
How is clonus usually triggered for diagnostic purposes?
Stretching of muscle
How did the authors treat the condition?
Surgical release of the right thumb flexor tendon sheath
What is the technical term for club foot?
Talipes Equinovarus
Traumatic rupture of the Achilles tendon will usually lead to...?
Talipes calcaneus
Who defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"?
The World Health Organization
What did Calder et al conclude?
The amputation group had better function and less pain.
What is the Cobb angle?
The angle between vertebrae, used to quantify the severity of scoliosis
A patient has been diagnosed with both Varicosis and Atherosclerosis in the lower extremities. Which of the usual treatment options for either condition may be problematic and why?
The both conditions occur predominantly in people with low physical activity, poor nutritional habits, and the associated medical conditions. They affect blood vessels in different ways, so treatments have contradicting aims. Atherosclerosis results in the build-up of plaque in the arteries that may form blockages or clots, thus preventing blood flow. Varicosis is signified by veins that thicken, twist and dilate, so that blood pools in them. Improving dietary habits and promoting an active lifestyle will address the root of both conditions. Some treatments, such as bypass surgery for Atherosclerosis may be prohibited by poor quality of harvestable vessels due to Varicosis. Compression therapy would help with Varicosis but be detrimental to Atherosclerosis.
What did Feulliet et al describe in their article "Brain of a white-collar worker" of 2007?
The brain of a 44 year old civil servant who had developed a severe non-communicating hydrocephalus
Hip dysplasia can often be completely cured by using hip abduction bracing in the first few months of life
True
Losing weight decreases the risk of plantar fasciitis.
True
In patients with vascular disease who undergo lower limb amputation, the risk of needing amputation surgery on their other leg within the next five years is approximately 5 to 10%.
false
In order to avoid folliculitis in prosthesis users, it is recommended to shave the skin on the residual limb daily.
false
Joint contractures after amputation, when accommodated properly in a prosthesis, often disappear after patients start using their prosthesis regularly.
false
Medical marijuana has proven 100% effective in curing phantom limb pain.
false
Morbus Crohn is a specific form of ulcerative colitis.
false
Contortionists (and many gymnasts as well) are able to expand the range of motion of their spine and hip joints well beyond the physiological extent. How is that possible and what could be concerns with respect to the long term effects of such extraordinary joint mobility?
ossible aspects to be discussed were: (1) Repetitive (over)stretching of the joints, especially in a young age, will make them more flexible. This is a physiological response to the demand, but it likely goes along with tissue injuries at a microscopic scale. (2) Genetic disposition can play a role in joint laxity. Such laxity can occur over a wide spectrum which includes clearly pathological conditions where habitual joint dislocations are common. Genetics and exercise in conjunction may lead to the described hypermobility. (3) As cartilage is stretched beyond normal conditions, it will contribute less to joint stability. This may be compensated by muscle strength and a low body weight (which reduces the forces on the joints). However, changes in muscle strength and body weight over a lifetime are potential greater than the respective changes in cartilage laxity that would be required to maintain the same joint stability. As a consequence, these athletes are at a higher risk of joint hypermobility and the associated comorbidities (e.g., degeneration, injuries).
Hallus rigidus is a debilitating condition that often restricts patients' mobility.
true
Roughly 30% of the world's population is infected with tuberculosis.
True
Tuberculosis, if untreated, is a fatal disease.
True
What is the distraction rate recommended by Ilizarov in his article "Clinical Application of the Tension-Stress Effect for Limb Lengthening" (1990)?
1 mm per day
A "walk-trainer" exoskeleton that controls limb motion in how many degrees of freedom?
6 degrees of freedom
Avoiding elevators and escalators helps in the prophylaxis of venous insufficiency.
true
In the treatment of congenital limb deficiencies, it often comes to the question of whether or not to amputate a dysfunctional limb. Please provide some general arguments both for and against amputation and illustrate your reasoning with examples.
"Congenital limb deficiencies" usually describes rather severe deformities, such as the (partial) absence of a limb (i.e. fibula deficiency). The answer should give a thorough account of risks and benefits of either treatment (surgery complications and long term effects of limb loss vs. limited function, increased injury, adverse effects of compensatory strategies risk when retaining the disabled limb). The difference between lower and upper limb function (importance of bipedal locomotion) and how they may affect the decision process could be discussed as well. The ethical question of decision making on behalf of small children is also worth considering.
What of the following is covered by Wolff's law?
- When a martial arts fighter fractures a bone, the bone heals to be stronger than before. - When somebody plays a lot of tennis, bones in the arm with the racket will grow stronger.
What was the average necessary duration of treatment as reported by Morcuende et al?
20 days
In the case described in the article "Stenosing Tenosynovitis Due to Excessive Texting in an Adolescent Girl: A Case Report" by Johnson et al (2016), how many texts messages had the patient been sending over a 1-year period?
8,507 texts per month
What was the observed success rate of the Ponseti method, as reported in Morcuende et al: "Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method" (2004)?
98%
Which of the following amputation candidates has the best indication for a Van Nes - Borggreve rotation plasty?
A 10-year-old child who has been diagnosed with a large bone tumor in the knee
What is the difference between a concussion and a traumatic brain injury (TBI)?
A concussion is a minor-level TBI
In the paper "A comparison of functional outcome between amputation and extension prosthesis in the treatment of congenital absence of the fibula with severe limb deformity" (2017) by Calder et al, what do they mean by "extension prosthesis"?
A device that makes up the length difference of a deformed leg
A 65 year old, otherwise healthy patient is left with a guillotine amputation two inches below the knee after a railway accident. The surgical team is discussing three options for the level of a planned reamputation to close the wound: ultra-short trans-tibial, knee disarticulation, and long trans-femoral amputation. Please provide arguments for and against each of those options and explain how possible comorbidities would affect the decision!
A good summary of the pros and cons should include: (1) Short transtibial amputation has the benefit of preserving the knee joint but may be a problematic surgery (soft tissue coverage disallows for myodesis or myoplasty, might require skin graft to close). Surgery time may be burdensome for the elderly or unhealthy patient. The ultra-short residual is difficult to fit with prostheses and will have a reduced lever arm which would make knee flexion and extension difficult (joint contractures). The approach leaves the option of later revision to another amputation level if necessary. (2) Knee disarticulation surgery is often simple and less taxing (quick recovery), therefore recommendable for elderly or frail patients. Prosthetic socket fitting becomes difficult due to residual limb shape, and the selection of knee joints is limited. The prosthetic knee axis will be misaligned with the axis of the sound leg, though thigh lever arm and muscle length are good, and residual is capable of end bearing weight. (3) Transfemoral amputation removes the most tissue and results in the shortest residual of the three. Losing the knee will have a greater impact on gait patterns and efficiency. Prosthetic fitting options and componentry selection are more favorable than for the other levels.bv
What is the nature of "osseus torticollis"?
A wedge-shaped vertebra
How many of the respondents in the study Skin disorders in amputees (Lyon et al, 2000) had skin problems?
About one third of them
Why is it usually not recommended to start ambulation on prostheses early after lower limb amputation surgery?
Actually, it is recommended to start prosthesis ambulation early after surgery.
Scheuermann reports that the specific kyphosis dorsalis occurs...
Almost exclusively (88%) in boys
What was the chief complaint by the patient described in Mettu et al: Total Bilateral Tarsal Coalition: A Case Report?
Ankle pain
According to the paper "Kyphosis Dorsalis Juvenilis" (Scheuermann 1921), which of the following terms had been previously used for Scheuermann's disease?
Apprentice kyphosis
Which application of Osseointegration is not explicitly mentioned in the article (Brånemark, 2001)?
Body modifications
According to "The Challenge of Global Poliomyelitis Eradication" (Garon et al, 2015), how much has the worldwide number of poliomyelitis cases been reduced since 1988?
By 99%
In children between the ages of 5 and 15 years, which of the following is the most common cause for limb loss?
Cancer
Which of the following was not listed as a possible complication of varicose veins by London & Nash (2000)?
Cluster headache
What is the difference between a traumatic brain injury (TBI) and a concussion?
Concussion is a mild form of TBI
What did the authors of "Outcome of Conservative Management in the Treatment of Symptomatic Spondylolysis and Grade I Spondylolisthesis" (Boyd et al) conclude?
Conservative management is effective in relieving pain and restoring function
What is a general principle surgeons consider with respect to lower limb amputation?
Consider options for prosthesis fitting when determining the residual limb length!
What is most likely to cause a paralysis?
Damage to the nervous system
How is the healthy human spine formed (seen from lateral)?
Double-S-shaped
How well did it work (the method described in Graves et al)?
Efficacy was mixed, with many material failures compounding analysis
Which of the following is not primarily a foot amputation technique?
Ertl
What did Baunsgaard et al conclude in their article "Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics" (2017)?
Exoskeleton training has potential benefits on gait function and balance
By tendency, symptoms of pectus carinatum are more severe than those of pectus excavatum.
False
In spastic paresis, muscles are usually hypotonic.
False
Why are males more likely than females to inherit a recessive X-linked disorder, such as Duchenne Muscular Dystrophy?
Females have two X chromosomes, both of which would have to be affected to develop the disorder
You meet a friend who has a Medianus paresis. How should you not greet him?
Fist bump
What is the essential function principle of hybrid exoskeletons, as described in the article by Del-Ama et al. (2012) "Review of hybrid exoskeletons to restore gait following spinal cord injury"?
Force that is generated from FES is combined with motion control provided by the exoskeleton
According to Lyon et al, what is a common cause of contact dermatitis?
Friction, Allergy, and Chemical Irritation
Please order the following conditions by prevalence, beginning with the least prevalent!
Guillan-Barre Syndrome, Amyotrophic Lateral Sclerosis, Multiple sclerosis, Traumatic Brain Injury, Stroke
What is often accompanying a pes transversoplanus?
Hallux valgus
How is the gait pattern of patients with fibularis paresis altered?
High stepping gait
Which of the following birth defects is most prevalent?
Hip dysplasia
Sort the following diseases by their effect on the patient's body height, from tallest to shortest.
Hypolordosis, Myogelosis, Degenerative disk disease, Ankylosing spondylosis
Osteointegration allows the attachment of prosthetic components without a socket. Based on your knowledge about the risks and complications of that method and about the epidemiology of major limb loss, please estimate how many potential candidates for osteointegration surgery there are in the United States! Explain your reasoning!
I am looking for valid reasoning with some actual numbers discussed. How many candidates there actually are is very much up for debate and I would allow a wide range of suggestions as long as they are grounded in available facts. The relevant total number of limb loss patients (not including minor amputations) is at around 2 million for the U.S. This could be reduced to traumatic amputations in otherwise healthy people. Limits on weight and activity levels as well as the consideration of life expectancy could have been mentioned as well, together with indications and contraindications for osteointegration.
What is true about Y-linked disorders?
If a father is affected, every son will be affected
What is important to know about Post-Polio Syndrome (PPS)?
In America, typical orthotics patients with PPS are in their 70s and older
What kind of disease is Rheumatoid arthritis?
Inflammatory disease
What is true about the Ertl technique for amputation residuals?
It aims to improve end-bearing capabilities of amputation residuals.
What is true about phantom limb pain?
It can be a stabbing, burning, or shooting pain that is felt in the area of the lost limb.
Which of the following is most accurately describing the meaning of "idiopathic"?
It is impossible to determine the cause of the disease
In the article by Del-Ama et al, what is mentioned about functional electrical stimulation (FES) for gait compensation in SCI patients?
It leads to untimely muscle fatigue
What aspect of Morbus Scheuermann is referred to by its old colloquial name "Apprentice kyphosis"?
It often affects young men in an age traditionally reserved for apprenticeship
In their article "Joint contractures in the intensive care unit: quality of life and function 3.3 years after hospital discharge" (Clavet et al, 2015), what was the authors' main finding?
Joint contractures in ICU were associated with higher mortality
Which of the following sports are most likely to result in a paresis of the thoracicus longus?
Lacrosse
What is "Medical Student's Syndrome"?
Medical students often fear that they suffer from the diseases they are studying
How many cases of poliomyelitis cases are asymptomatic or consist of mild illness without Paralysis (according to Garon et al)?
More than 99%
What does the article "Musculoskeletal manifestations of diabetes mellitus" (Smith et al, 2003) claim about the Prevalence of musculoskeletal disorders in patients with or without diabetes? Correct Answer
Musculoskeletal disorders are more common in patients with diabetes
What do Leroux at al (2017) write about the treatment of Leg Calve Perthes Disease?
Non-operative treatment is not effective
What is true about structural and positional mal-posture?
Positional mal-posture can be actively or passively corrected
A historical, often self-prescribed, treatment approach for a hunchback was the perennial carrying of a heavy wicker basket on one's back, much like a modern-day backpack. Based on your knowledge about the different spine diseases that can cause a hunchback, how do you judge this idea? What are the strengths and weaknesses of that treatment principle?
Possible aspects to be discussed were: (1) A hunchback can be the result of different conditions, including ankylosing spondylitis, Scheuermann's kyphosis, scoliosis, or arthrosis of the spine. Depending on the underlying diagnosis, the deformity is more or less structural and cannot be corrected anymore. (2) If correctable, the basket may apply a corrective force, which however is likely not properly directed at the apex of the curvature. The added weight likely increases the negative effects of the exercise by depressing the shoulders, compressing the spine, and necessitating postural changes to accommodate the shift of the center of gravity. (3) One potential benefit of the basket would be that it conceals the deformity.
Many patients with bilateral upper limb aplasia (congenital limb absence, e.g., at the shoulder level) are not interested in using prosthetic devices. Based on your knowledge of relevant pathologies, please provide some general arguments both for and against the use of prosthetics in such patients and illustrate your reasoning with examples.
Possible aspects to be discussed were: (1) Bilateral aplasia means foregoing prostheses is only possible when the feet are used as hands. This has problematic long term consequences when the lower extremities start losing flexibility and mobility. This is an avoidable health issue in itself. Moreover, those elderly patients who have never learned how to use prostheses have a very hard time making the switch then. (2) Prostheses cannot be substituted for certain tasks, which entails a clear functional disadvantage for people who are not using them. A similar disadvantage is due to the circumstance that - even if somebody successfully uses their lower extremities to do the work of the upper extremities - those patients are still having fewer extremities at their disposal. So, they can either walk/stand or do something with their "hands", but not do this simultaneously or even in short succession. (3) Any arguments that may be brought forward against using prostheses (too heavy, slow, unintuitive, insensitive, costly, ...) may have merit in the short term. It is the responsibility of the health care professional to advocate for the long term interests of the patient - of course while considering the patient's immediate concerns and goals. There is no point in prescribing prostheses that the patient will never use.
Professional Basketball player Jeremy Lin described in an interview how, as a child, he tried to effect his growing taller by regularly letting himself hang upside down from the monkey bars at the playground. Please discuss how likely it is that this exercise contributed to his eventual height, and describe the mechanisms that would explain the effect!
Possible aspects to be discussed were: (1) Possible mechanisms to discuss in this context include Wolff's Law, the Hueter-Volkmann Law, or Ilizarov's bone lengthening method. Short term effects may have included an elongation of the spine from replenishment of the fluid contents of the intervertebral disks. (2) All of the processes that would result in increased bone length entail longer periods of time and/or higher expanding forces than could be achieved by occasionally "hanging out" at the playground. The whole exercise had at most minimal effect on his growth. (3) However, the story may be taken as an example of the dedication of the young Lin to his goal. A young child that is dedicated to realizing its growth potential can help this by observing recommended practices regarding nutrition, exercise, and injury prevention.
We learned that orthopedic deformities are often not considered treatment-worthy when they are minor in nature (e.g., ½ inch of leg length discrepancy, 2 inches of genu valgum, 20 degrees of scoliosis). How are those pathological thresholds determined? What would be arguments for and against adjusting those thresholds?
Possible aspects to be discussed were: (1) The threshold to treatment-worthiness is determined by what is essentially a cost-benefit assessment. In the example of spinal deformities, while a 10-degree scoliosis is acceptable for most intends and purposes, a perfectly straight spine would still be ideal to have with respect to the long term risks. Why not treat 1-degree scolioses? Because it is not worth the trade-off. The side effects and burdens of treatment outweigh the possible gains for the patient. If you want to argue for a different threshold for treatability, you will have to find a way to move the balance of the trade-off. Say - if there was a $5 pill without side effects that cures scoliosis, even the slightest scoliosis cases would be treated, etc. (2) As part of the above argument it should be remembered that there are usually no serious immediate health problems in low-medium grade deformities. The concern is about disease progression and possible long term effects, such as premature degeneration of the spine and increased risk for injuries. If that risk is considered minimal in a given case, the treatment criteria may be adjusted. (3) It is very difficult to achieve a very narrow target correction with conservative treatment (braces) and even surgery. A few degrees of deviation from the target one way or the other are inevitable. This may make it practically impossible to reliably correct minor deformations. (4) Scoliosis, in particular, is often a more complex deformity than can be expressed by simply measuring one Cobb angle. There may be multiple curvatures and rotations of the spine along with all manner of associated deformities of adjacent structures. Some may say that having a fixed threshold for treatment based on a simple measurement is not appropriate to address such a complex problem.
Duchenne Muscular Dystrophy and Amyotrophic Lateral Sclerosis have in some stages comparable symptoms. Yet treatment objectives are somewhat different. What are the main differences in treatment, and how do they relate to the differences between the two pathologies?
Possible aspects to discuss include: (1) While both diseases are incurable and fatal, life expectancy after diagnosis is longer (20-30 years) in DMD than ALS (3 years). On a continuum of treatment options from managing comorbidities and developing compensatory strategies on one side to relieving discomfort and maintaining function on the other side, the emphasis shifts with the pace of progression of the disease. For instance, a DMD patient will mostly benefit from surgery that corrects spinal deformities or optimizes upper extremity posture, whereas the discomforts and recovery periods after surgery would outweigh the benefits of such interventions for an ALS patient. (2) DMD affects exclusively young boys, whereas ALS can occur in people of all ages and sexes. The patient's sex does not have a big effect on treatment options, but the age, which is on average much higher in ALS patients, does. The circumstance that the skeletons of DMD patients are not fully mature and still growing makes them susceptible to deformities, such as scoliosis, that need to be treated to prevent complications. (3) Differences in symptoms can be attributed to different pathogeneses and, mostly, the swiftness of progression. ALS patients are often wheelchair bound within a short time after diagnosis, whereas DMD patients are able to maintain a, though decreasing, degree of bipedal locomotion throughout the first decade or so of the disease. This makes orthoses more relevant for this group, whereas ALS patients require mostly wheelchair customizations.
Many parents try to dissuade their children from making faces (e.g. cross-eyes) for fun, by warning that the effect may become irreversible. By which disease mechanisms would something like that happen? What is an example of an orthopedic condition that could be caused in a similar fashion?
Possible mechanisms by which deformities develop include 1.) Habitual postures - changes in bone and muscle geometry as the body adapts to the preferred posture may become permanent. Examples of this are some juvenile spinal mal-postures. 2.) Injury - overstraining muscles/tendons or exceeding the range of motion of joints can lead to acute injuries that cause symptoms. This could, for example, be associated with choice of footwear. 3.) Degeneration - repeated un-physiological loading/posture and associated micro-traumata will eventually lead to progressive deformities. Cartilage degradation from excessive weight may be an example. 4.) Birth defects and systemic diseases are common causes of orthopedic conditions, but are not usually considered to be modifiable by voluntary behavior, at least not directly. Lifestyle choices by the pregnant mother or the patient themselves may affect the respective disease risk indirectly. For example, malnutrition can lead to bone development deficits that may result in postural deformities.
What report Papavramidou and Christopoulou-Aletras in their article "Treatment of ''Hernia'' in the Writings of Celsus (First Century AD)" from 2005?
Some of the surgical principles described by Celsus, such as supine positioning or excision of unnecessary membranes, are still in use today.
What does the term "osseointegration", as introduced by Brånemark (2001), describe?
The modality for stable fixation of titanium to bone tissue
What is the main limitation of surgically repairing a neglected, now mature, clubfoot deformity?
The small bones in the foot have been deformed from unphysiological loading conditions and cannot easily be returned to the proper arrangement
What is discussed in the article by Staley and Richard "Use of Pressure to Treat Hypertrophic Burn Scars" from 1996?
The use of compression garments to prevent excessive scar tissue formation
What is the title of the article by Bodde et al (2011)?
Therapy-Resistant Complex Regional Pain Syndrome Type I: To Amputate or Not?
In "Magnetic Mini-Mover Procedure for pectus excavatum IV: FDA sponsored multicenter trial" (Graves et al), what intervention did the authors investigate?
They used a magnetic implant to gradually correct pectus excavatum deformities in their subjects
Which of the following procedures is elemental in targeted muscle reinnervation (TMR) surgery?
Transplanting residual nerve endings in existing muscle tissue
Ankylosing spondylitis is less likely in patients with acute Perthes disease than in the general population
True
What do London & Nash, in their article "Varicose Veins" (2000), say about surgery options?
Varicose veins may be stripped, e.g., pulled out through small incisions in the skin
Which of the following mechanisms is most likely to cause edemas in residual limbs?
Venous blood flow is restricted by a tight prosthetic socket.
Is there a difference in limb loss prevalence between the sexes?
Yes, males are more likely to incur an amputation
Which of the following is not among the typical symptoms of an inflammatory disease?
decreased body temperature
A Lisfranc disarticulation by trend promises better wound healing success than a Chopart procedure.
false
Arthrosis is a progressive disease because cartilage is fundamentally unable to regenerate after injury.
false
Benign bone tumors are generally only of concern when they degenerate into malignant tumors
false
The prevalence of Ebola infection has a larger (numerical) value than the incidence of Ebola infection.
false
Which of the following strategies is most promissing in preventing joint contractures?
minimize immobilization
Which of the following is least effective in increasing bone strength?
reducing body weight
Which is the most likely mechanism for spondylolysis to lead to spinal stenosis?
the associated inflammation causes swelling of the vertebra body and subsequent infraction of the spinal canal
An advantage of myoplasty over myodesis is that surgery is less time consuming.
true
Patients with hemipelvectomy on average have a shorter post-surgery life expectancy than patients with trans-femoral amputations.
true
The prevalence of Buerger's disease has recently declined with the declined popularity of cigarette smoking in the US.
true
The prevalence of limb loss has a larger (numerical) value than the incidence of limb loss.
true
What is true about osteoporosis?
unknown, midterm 1, question 8
