What is characteristic of the Paget's disease?
increased osteoblast and osteoclast activity
"bone pain" generally in one area, commonly pelvis and spine
structurally disorganized bone matrix with both excessive bone mass and bone resorption
increased osteoblast but decreased osteoclast activity
uniform concentric rings of organized bone matrix
"bone pain" spreading out to different areas of the body
Osteoblasts mature into these cells once trapped in the bone matrix; they activate bone formation via and apoptosis.
What do osteoblasts do?
synthesize new bone matrix
absorb and resorb more bone matrix
control bone metabolism
What is characteristic of osteoclasts?
from hematopoeitic stem cells
acts as macrophages
resorb bone
make more bone matrix
acts as fibroblasts
from mesenchymal stem cells
Where would you have the most interstitial growth?
epiphysis
metaphysis
diaphysis
epiphyseal growth plates
periosteum
growth is growth. This is due to increased number of matrix-depositing cells. growth is growth. This is due to increased matrix deposition by the same number cells.
In terms of calcium metabolism, the thyroid releases what hormone?
calcitonin
TSH (thyroid-stimulating hormone)
T4
T3
PTH (parathyroid hormone)
Calcitonin causes increased calcium deposition in bone by inhibiting bone resorption.
What does parathyroid hormone do?
increase osteoclast activity
increase osteoblast activity
increase osteocyte activity
decrease osteoclast activity
decrease osteoblast activity
decrease osteocyte activity
Falling onto an outstretched hand/wrist causes what type of fracture most commonly?
scaphoid fracture
radial styloid fracture
humeral fracture
3rd metacarpal fracture
ulnar styloid process
lunate fracture
What are bones of the hand?
What nerve would you damage if you were to break the shaft of the humerus?
radial
axillary
musculocutaneous
medial
ulnar
If the radial nerve is damaged, how might it present?
wrist drop even with fully extended forearm/arm
inability to abduct arm
inability to flex elbow
inability to flex shoulder
Benedict claw with fully extended forearm/arm
What does the musculocutaneous innervate muscle-wise?
flexor muscles of the arm
flexor muscles of the forearm
extensor muscles of the arm
extensor muscles of the forearm
3.5 fingers of the hand
What does the axillary innervate muscle-wise?
deltoid, teres minor (shoulder muscles)
posterior arm flexor muscles
posterior forearm extensor muscles
What does the radial nerve NOT innervate muscle-wise?
posterior arm
posterior forearm
posterior medial 2 fingers of the hand
What does musculocutaneous innervate muscle-wise?
anterior forearm
anterior arm
anterior 3 medial fingers
posterior 3 medial fingers
What does ulnar nerve innervate muscle-wise?
posterior forearm muscles
posterior arm muscles
anterior forearm muscles
anterior arm muscles
anterior medial 2 fingers
posterior lateral 2 fingers
If there is loss of elbow flexion (can't flex biceps), there is damage to the nerve.
if there is shoulder weakness or you're unable to abduct shoulder, then there is damage to the nerve.
A hand of benediction is sign of damage to the nerve.
Being unable to abduct or adduct the last 2 fingers is indicative of damage to the nerve.
What does the ulnar provide sensory innervation to?
posterior and anterior 1.5 medial fingers
posterior and anterior lateral 2.5 fingers
What does the median provide sensory innervation to?
anterior 3.5 lateral fingers
posterior 3.5 lateral fingers
anterior 1.5 lateral fingers
posterior 1.5 lateral fingers
What does radial nerve provide sensory innervation to?
lateral arm
posterior hand
anterior hand
medial arm
The axillary nerve innervates the...in sensory wise
regimental badge area
anatomical snuffbox area
radial styloid badge area
Musculocutaneous provides sensory innervation to lateral forearm down to the thenar prominence (at the base of the thumb.)
Numbness at the back of the wrist and hand is due to damage to the sensory innervation by the nerve.
Damage to the nerve will lead to parethesia to the lateral 3 anterior fingers.
Loss of sensation in the median of the hand and the medial first 2 fingers is damage to the nerve.
Damage to the radial nerve leads to wrist drop. What are some pathologies in which the radial nerve gets hurt?
Radial nerve palsy
Saturday night nerve palsy
Humerus shaft fracture
Erb's palsy
Bell's palsy
Klumpke's palsy
How might you injure the axillary nerve?
dislocation of the humeral head
surgical neck of the humerus fracture
dislocation of the clavicle
pulling the deltoid muscle
You might harm the musculocutaneous nerve via a medial epicondyle fracture.
A winged scapula is indicative of damage to the (spinal roots C5-C7.)
The spinal roots of the musculocutaneous nerve are (in numerical order from least to greatest) are , , and .
The Axillary nerve is from the roots and (in numerical order.)
The radial nerve is from the spinal roots to .
The ulnar nerve is from the spinal roots of and .
The spinal roots of the median nerve is or to .
Which of these myotomes and action pairings are correct?
C4: shoulder elevation
C5: chicken abduction (wings)
C6: elbow flexion
C6: wrist extension
C7: elbow extension
C7: wrist flexion
C8: thumb extension (thumbs up)
T1: finger abduction (fanned fingers)
C6: wrist flexion
C6: elbow extension
What is true regarding Erb's palsy?
damage to the upper part of the brachial plexus (C5 and C6)
damage to the lower part of the brachial plexus (C7 C8 and T1)
motorbike accidents can cause this
improper birthing techniques (pull baby's head against pelvic bones while labor) can cause this
landing on an outstretched arm from a big height can cause this
results in a "waiter's tip"
results in a "clawed hand"
damage to the axillary nerve
damage to the suprascapular nerve
damage to the musculocutaneous nerve
What is the myasthenia gravis?
At the neuromuscular junction, the body produces antibodies against the acetylcholine receptors
Intense morning sickness that needs anti-emetics as treatment
the gradual degradation of muscle fibers, starting from top of the head to bottom of the feet
loss of sensation in some or all motor units of certain muscles
How might myasthenia gravis present?
ptosis
fluctuating fatiguability
dysphagia
limb weakness
fever
constant fatigue
slow reaction times
How would you manage myasthenia gravis?
acetylcholine esterase inhibitors
acetylcholine reuptake enhancers
acetylcholine esterase activators
acetylcholine agonists
The ❌ bifurcates into the ❌ and the ❌. The right illiac again bifurcates into the ❌ and the ❌. The external illiac becomes the ❌, which is the deep artery of the right thigh. In the popliteal fossa, the right femoral becomes the right ❌ artery. The right popliteal further bifurcates into the ❌ and the ❌ The right posterior tibial, which is the pulse felt at the ankle, becomes the ❌ The right anterior tibial becomes the right ❌.
Which of the following could cause carpal tunnel syndrome?
pregnancy
rheumatoid arthiritis
repetitive use of hands
septic arhritis
osteomalacia
osteoporosis
Compression of the nerve as it travels through the in the wrist is Carpal Tunnel Syndrome.
How does Carpal Tunnel Syndrome present?
numbness
parasthesia/pain over median nerve area
thumb muscle atrophy
worse at ngiht
worse at day
redness
swelling
What are management options of the carpal tunnel syndrome?
local corticosteroids
night time splinting
day time splinting
anabolic steroids
always surgical decompression
if severe surgical decompression
avoid further injury via strain
What are the nerves of the lower limb?
Femoral
Sciatic
Obturator
Common fibular
common fibular deep branch
common fibular superficial branch
tibial
sural
fibial
common femoral
The nerve only innervates sensory-wise. It innervates the skin of the leg and foot.
What does the sciatic innervate muscle-wise?
the posterior compartment of the thigh
the anterior compartment of the thigh
lateral compartment of the thigh
the medial compartment of the thigh
What does the femoral nerve innervate muscle-wise?
anterior thigh
posterior thigh
lateral thigh
medial thigh
What does the obturator nerve innervate muscle wise?
What does the common fibular deep branch innervate muscle wise?
anterior leg
posterior leg
lateral leg
medial leg
What does the superficial branch of the common fibular innervate muscle-wise?
What does the tibial nerve innervate muscle-wise?
sole of the foot
top of the foot
The femoral nerve's sensory innervation includes the thigh and leg.
The obturator nerve's sensory innervation is the thigh.
The branch of the common fibular's sensory innervation is the skin of the upper lateral leg.
The deep branch of the common fibular's sensory innervation is the leg and foot.
Both the nerve (which bifurcates in the fossa into the nerve and the common fibular nerve) and the nerve innervate (sensory-wise) the thigh and leg and foot.
The sciatic nerve's spinal roots are L4-S3 L2-S3 L1-L2 L3-S2 L4-S2( L4-S3, L2-S3, L1-L2, L3-S2, L4-S2 ).
Dorsiflexion is a sign of damage to what nerve?
deep branch of the common fibular
common fibular
femoral
Inability to dorsiflex (so basically having a foot drop) is indicative of damage to what nerve?
sciatic
obturator
superficial branch of the common fibular
What movements does the femoral nerve allow?
flexion of hips
extension of the knee
extension of the hips
flexion of the knees
abduction of the leg
adduction of the leg
What innervates hip extension and knee flexion?
Inferior gluteal
sciatic nerve
superior gluteal
The nerve allows hip adduction. On the other hand, the nerve allows hip abduction.
What are the main types of arthritis?
osteoarthritis
inflammatory arthritis
septic arthritis
rheumatoid arthritis
crystal-induced arthritis
osteoarthritis and osteoarthritis are the two types of osteoarthritis.
The three types of inflammatory arthritis: rheumatoid, and .
What are the two types of crystal-induced arthritis?
gout
pseudogout
rheumatoid
psoriatic
none of the above
What is a degenerative disease that affects the joints, often due to wear and tear of articular cartilage?
synovitis
crepitus
joint stiffness
subarticular sclerosis
How might osteoarthritis present?
joint stiffness in the evening/morning
generally worse after walking
palpable bony swelling on the hands' interphalangeal joints
reduced range of motion
crepitus in the joints
insomnia
generalized swelling around major joints
locked joints
An X-ray investigation of osteoarthritis will show...
reduced joint space
osteophytes
bony cysts
glued up joint space
cartilage cysts
osteocytes
For osteoarthritis, the only management is supportive/palliative.
What is an autoimmune disease that also ends in joint destruction?
What is characteristic of rheumatoid arthritis?
specific joint pain in the morning
specific joint pain in the evening
joints affected symetrically
joint inflammation
joints affected asymetrically
All of these are part of the management of rheumatoid arthritis BUT
NSAIDs
physiotherapy
Methtrexate
DMARDs
Antibiotics followed by corticosteroids
Which of the following regarding the investigation of rheumatoid arthritis is true?
will find rheumatoid factor in serum
x-ray will reveal bone erosion
x-ray will reveal reduced joint space
periarticular osteopenia
visible deformity
x-ray will reveal
excessive bone growth
The deposition of monosodium urate crystals in joints is a type of arthritis called . This usually happens if there are high levels of acid in the blood. The risk factors are and (one of the building blocks of DNA) rich food. The most common occurence is at the big joint. Symptoms include (swelling of the joint), (general ill-feeling), and (crystals.) These crystals are visible under polarized light microscopy. The primary way to test for this is to take fluid in the joint, gram stain it to rule out septic arthritis, and test the fluid for levels of uric acid.
The treatment plan is for what? 1. NSAIDs 2. Colchicine 3. Corticosteroids
chronic gout
acute gout
goutisis
Other than lifestyle changes to reduce urate levels, we give those with the drug allopurinol.
Accumulation of monosodium urate monohydrate crystals in joints causes pseudogut as well.
What is of clinical importance regarding septic arthritis?
medical emergency
take the aspirate fluid in join and gram stain it
take a blood culture (full blood count) and see if there's a high amount of leukocytes
take a blood culture (full blood count) and see if there's a high amount of c-reactive protein
x-ray will show increased joint space
x-ray will show decreased joint space
chronic/gradual development
to manage, should drain aspirate fluid
to manage, should give antibiotics
presents like an infection plus reduced joint functionality and synovitis
Prostacyclin is prostaglandin , which is produced by the . Prostacyclin prevents excess during the platelet plug.
is when there are too few platelets in the body. It can be treated with , which will increase the platelet number. It takes days for progress to be apparent though.
Platelets only adhere to smooth epithelial surfaces.
Disease is when a person is missing vWF and therefore have difficulty with (the stopping of bloodloss.)
If there is a suspicion of liver disease, one should check if is affected because it very well could be.
Coagulation can be affected in:
diseases affecting
diseases of the clotting
There are 2 coagulation pathways: they meet up at factor .
The intrinsic pathway begins with factor . This is when the of the blood vessel gets damage without any necessary external damage. Ex: (erodes.)
The extrinsic pathways begin with factor . Damage from to the blood vessel. Usually accompanies tissue damage.
The outside aspect of a scab is called an .
What is true regarding vitamin K?
produces anticoagulant protein c
produces coagulant protein z
produces anticoagulant protein s
produces factor 7
produces factor 9
produces prothrombin
produces factor 10
produces fibrinogen
produces factor 5
Vitamin K helps with bone metabolism by increasing calcification.
Vitamin K is from kale and kiwi.
Vitamin K is stored in muscle
The "tea and toast" diet is associated with vitamin deficiency. Patients can present as , paresthesia (tingliness), and . Vegetarians and often have this. B12 helps make the in neurons.
is when the patient complains that "everything" is painful, even stimuli that are not usually painful.
is when you have an increased pain response to painful stimulus.
Primary healing is when you actively bring together both edges of the wound to stimulate heealing.
Secondary healing is when you leave the wound alone to heal
Warfarin is given following
a prothrombin time test
a K reductase time test
a Synacthen test
a plasmin time test
a water deprifation test
Warfarin is an anticoagulant.
Warfarin works essentially by blocking the enzyme , and thus blocks all the stuff said vitamin makes. It is prescribed for heart conditions--such as --and for thrombotic conditions-- thrombosis and embolisms are the classics. Also, it is given post surgery.
Vitamin K enhances the functionality of Warfarin.
Antithrombin III deficiency is a hereditary, relatively harmless, and common condition.
DVT and pulmonary embolisms are both complications of Antithrombin III deficiency.
Warfarin acts on the thrombus by dissolving it.
TPA ( ) is used in drugs dealing with thrombotic problems. It the clot.
What causes Hemophilia A?
Factor 8 deficiency
Factor 9 deficiency
Factor 12 deficiency
Factor 5 deficiency
What is Hemophilia B due to?
Factor 7 deficiency
Factor 11 deficiency
is the formation of new blood vessels completely from scratch from precursor cells.
Myofibroblasts need a lot of extracellular matrix.
Mature tissue contains collagen (collagen ) and blood channels. It is connective tissue.
What is true regarding Hypertrophic scars?
following physical injury
can be itchy
slightly raised
limit ability to move
appear shiny
What is true regarding contracture scars?
extremely tight skin
can limit ability to move
common with burns
shiny
very fine white line
What is true regarding keloid scars?
really noticeable
raised
usually after minor skin damage
not raised
fine white line
itchy
Sunken scars have a kind of appearance. An example: scars.
Scar treatment is often unecessary.
Which of these are ways to treat scars?
topical silicone gel
pressure dressings
steroids
make- up
cosmetic surgery
plastic surgery
flucloxacillin
acupuncture
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