Final Exam: Fractures - The End

Question 1

Overlying tissue is intact

Answer 1

Closed (simple) fractures

Question 2

Fracture site communicates with skin

Answer 2

Compound fracture

Question 3

Fractured bone undergoes splintering

Answer 3

Comminuted

‘Comminut-‘ Latin for “broken into pieces”

Question 4

Ends of bone at fracture site become misaligned

Answer 4

Displaced

Question 5

What type of fracture occurs in bone already altered by disease process (tumors, osteoporosis, etc)

Answer 5

Pathological fracture

Question 6

What fracture develops slowly during a period of increased physical activity in which the bone is subjective to new repetitive loads

Answer 6

Stress fracture

Question 7

Early reaction of bone fracture repair

Answer 7

Inflammation, phagocytosis

Question 8

Later changes in bone repair characterized by (3)

Answer 8

• Formation of provisional callus: cartilage, bone, CT
• Bone adjacent to fracture becomes necrotic and is resorbed
• well-formed callus appears w/in weeks and undergoes remodeling

Question 9

When bone repair goes very wrong:

Answer 9

• deformity if displaced fracture
• abnormality persists because bone fragments require resorption which delays healing and enlarges callus
• false joints (pseudoarthrosis) cause inadequate immobilization and movement inhibits callus formation

Question 10

Unilateral inflammatory joint disease and (2) defining features

Answer 10

Septic (pyogenic) arthritis

• Red, hot, swollen joint
• 2+ days = severe damage

Question 11

Asymmetrical inflammatory joint disease (most common joint disease) and (4) defining features

Answer 11

Osteoarthritis (DJD)

• joint mice (osteophites)
• subchondral cysts
• subchondral sclerosis
• NO BONY EROSIONS

Question 12

What is a severe, destructive and chronic joint disease that causes bony erosions and can lead to fusion/ankylosing of joint? What blood test do you do to diagnose and what is the mechanism?

Answer 12

Rheumatoid arthritis (RA)

• RA factor
• mechanism is inflammatory synovial response “proliferative synovitis”

Question 13

How does juvenile RA differ from RA? And 3 defining features

Answer 13

No Rf factor and rheumatoid nodules are usually absent

• more common in large joints
• systemic manifestations
• ANA

Question 14

What is a variant of RA? And triad for diagnosis:

Answer 14

Felty’s syndrome

• RA
• splenomegaly
• low white blood count (anemia, leukopenia)

Question 15

What is a common condition that is more severe in men and associated with HLA-B27?

Answer 15

Seronegative spondylo-arthropathies

Question 16

What are the 3 Seronegative spondylo-arthropathies

Answer 16

1. Ankylosing spondylitis
2. Reiter’s AKA reactive arthritis
3. Enteropathic arthropathy

Question 17

Ankylosing spondylitis population of people, spine characteristics and where does it start?

Answer 17

• Men, 19-35 yo
• “Bamboo spine”
• Starts in SI region

Question 18

Reiter’s syndrome is associated with (3)

Answer 18

Infectious arthritis
Conjunctivitis
Urethritis

Note: symptoms come and go and usually vanish after a few months

Question 19

Enteropathic arthropathy is an result of what 2 things?

Answer 19

Ankylosing spondylitis and GI issue (e.g. crohn’s disease or ulcerative colitis, etc)

Question 20

Hyperuricemia is associated with what

Answer 20

Gout and gouty arthritis

Question 21

General features of gout (3)

Answer 21

• Tophi (lesions of chronic gout)
• Red, hot, swollen joint
• uric acid formation in kidneys (could lead to stone formation)

Question 22

What is deposition of calcium pyrophosphate cyrstals in joint (e.g. knee, wrist)?

Answer 22

Chondrocalcinosis aka CCPD or pseudogout

Question 23

What is loss of peripheral sensation due to DM, vitamin D deficiency or other neuropathy? And what can this lead to?

Answer 23

Charcot joint (neuropathic arthropathy)

Leads to excessive and repetitive joint trauma because they don’t know where their feet are.

Question 24

Diverse groups of disease that affect muscle fibers

Answer 24

Myopathy

Question 25

Muscular dystrophy is a group of hereditary myopathies. Features include (5):

Answer 25

- Gower’s sign, unusual method of standing up - Pseudohypertrophy of muscles of calf due to fatty ingrowth of muscle - Winged scapula - Scoliosis - Cardiomyopathy (female)

Question 26

What is a functional blockade of myoneural junction

Answer 26

Myasthenia gravis where antibodies attach ACh receptors on postsynaptic membrane

Question 27

Features of Myasthenia gravis (4)

Answer 27

- thymoma (thymus cancer) - ptosis, double vision - weakness of extremity muscles and limited endurance - exacerbation and remissions

Question 28

Altered composition of bone “other” diseases (3)

Answer 28

1. Osteogenesis imperfecta - type 1 collagen deficiency 2. Osteopetrosis - albers-schönberg disease, “marble bones” 3. Achondroplasia - dwarfism

Question 29

Type 1 collagen deficiency (name) and 4 features

Answer 29

Osteogenesis imperfecta 1. Osteopenia - thinning and fracturing 2. Blue sclera - choroid shows thorugh 3. Hearing loss - abnormal ossicles 4. Small, misshapen teeth

Question 30

Overgrowth, sclerosis of bone (name) and 2 features

Answer 30

Osteopetrosis (Albers-schönberg disease, “marble bones”) - thickening of cortex and narrowing of medullary cavity - brittle and fracturing

Question 31

Long bones that are short due to premature ossification of epiphyseal plates (name) and 2 features about the bone structure (skull, spine)

Answer 31

Achondroplasia - dwarfism - skull = normal size - length of spine is normal but kyphoscoliosis is common

Question 32

Defect in collagen synthesis and structure (name) and 4 features

Answer 32

Ehlers-Danilo’s syndrome - hypermobility in joint - stretchy skin - abnormal heart valve - increased bruising

Question 33

What is a disorder of CT from defect in gene regulating fibrilin? (Name)

Answer 33

Marfan’s syndrome Fibrillin is a glycoproteins secreted by fibroblasts to forma. Microfibrillar network in ECM. Its absence appears to affect the proper deposition of CT fibers (elastin) and leads to changes in skeleton, eyes and cardiovascular system

Question 34

In marfan’s syndrome, what are typical changes in skeleton, eyes and cardiovascular system (7)

Answer 34

- Tall, slender build with arachnodactylyl - High, arched palate - Thoracic abnormalities - Hyperextensible joints - Weak suspensory ligaments of the lens - Weakening of aortic media which predisposes to dissecting aneurysm - Weakened cardiac valves “floppy valve syndrome”