Lesson 1: Intro, Spinal, Rheumatology

Question 1

What are fractures associated with the physis?

Answer 1

Salter Harris Classification

Question 2

Salter type 1?

Answer 2

Through the growth plate.

Question 3

Salter type 2?

Answer 3

Through growth plate and metaphysis.

Question 4

Salter type 3?

Answer 4

Through growth plate and epiphysis.

Question 5

Salter type 4?

Answer 5

Through growth plate, metaphysis, and epiphysis.

Question 6

Salter type 5?

Answer 6

Crush injury of growth plate.

Question 7

What is the callus?

Answer 7

Formation of a bridging structure in healing of a fracture. It is fragile and must be protected by immobilization bc if there is any motion at the fracture sit they will break and the fracture will take longer to heal.

Question 8

How long does is take for large bone fractures to heal?

Answer 8

6-8 weeks.

Question 9

What is ossification/ osteogenesis?

Answer 9

Bone formation via osteoblasts.

Question 10

What is bone remodeling?

Answer 10

Replacement of the old bone tissues with new bone tissues.

Question 11

What are osteoblasts?

Answer 11

Form the new tissue.

Question 12

What are osteoclasts?

Answer 12

Absorb old tissue.

Question 13

What does osteoclast process require?

Answer 13

Vitamins D, C and A, Calcium, phosphorous, and magnesium.

Hormones like parathyroid hormone, growth hormone, and calcitonin.

Question 14

What % of bone mass is recycled every week?

Answer 14

5-7%.

Question 15

What is scoliosis?

Answer 15

Deviation of the spine from the vertical axis (Cobb angle) greater than 10 degrees. Lateral angle.

Question 16

In who is scoliosis more common in?

Answer 16

In girls or people with a positive family history.

Question 17

How much % of the population has scoliosis and what % do not need clinical intervention?

Answer 17

2-4% and 90% do not need to clinical intervention.

Question 18

When and how do you screen for scoliosis?

Answer 18

During routine peds exam and you use the “Adams forward bend test” using scoliometer.

Question 19

What curve is considered abnormal?

Answer 19

7 degree.

Question 20

What is the most sensitive test for scoliosis?

Answer 20

Adams forward bend test.

Question 21

What is definitive diagnosis for scoliosis?

Answer 21

X-rays show over 10 degrees as measured on AP and lateral x-ray.

Question 22

What does scoliosis treatment depend on?

Answer 22

How bad the angle is.
The progression of the curve.
The skeletal maturity of the pt.

Question 23

First thing to do when managing scoliosis?

Answer 23

Observe and monitor every 6-9 months for angles < 25 degrees.

Question 24

When and why is bracing used in scoliosis?

Answer 24

To stop the progression in pts with a flexible deformity and still skeletally immature.. It is used if Cobb angle increases 5 degrees or more over a 3-6 month period or if Cobb angle of 30-39.

Question 25

When is bracing contraindicated?

Answer 25

If skeletally mature, little growth remaining, Cobb angle > 50 degrees or < 20 degrees.

Question 26

Kyphosis?

Answer 26

Anterior angle. Hump on upper back.

Question 27

Lordosis?

Answer 27

Posterior angle. Indentation of lower back.

Question 28

What is MCC of lower back pain?

Answer 28

Lumbrosacral spain/strain. Acute strain or tear of paraspinal muscles, especially after twisting or lifting injuries

Question 29

Symptoms and PE of Lumbrosacral spain/strain?

Answer 29

Lower back pain and muscle spasms. No radiation or near symptoms. PE: Paraspinal muscle tenderness, Decreased ROM.

Question 30

Diagnose Lumbrosacral spain/strain?

Answer 30

Exam/clinical. | X-rays are NOT needed unless symptoms persistent (usually > 1 month) or alarm symptoms present.

Question 31

Management of Lumbrosacral spain/strain?

Answer 31

Analgesics (NSAIDs) and resume normal activities is preferred. Brief bed rest (max 2 days) if moderate pain. Muscle relaxants may help with spasms in some cases.

Question 32

What drug is usually used to treat autoimmune diseases?

Answer 32

Systemic glucocorticoid steroids to tamp down the immune system. Also use Disease Modifying AntiRheumatoid Drugs (DMARDS) which attempt to slow down disease effects on the body.

Question 33

Erythrocyte Sedimentation Rate (ESR)?

Answer 33

Measures how quickly red blood cells settle at the bottom of a test tube - if they settle faster than normal, it can mean inflammation in the body.

Question 34

Complement tests (C3, C4) ?

Answer 34

immune system proteins that normally shoot up dramatically just after an infection and injury. But in lupus, where the immune system is constantly “activated,” the levels go down because they stop responding as dramatically since there is a chronic disease state.

Question 35

What labs tests are commonly used with autoimmune diseases?

Answer 35

ESR, ANA, RF, ACPA, Complement Tests (C3,C4).

Question 36

Antinuclear Antibody (ANA)?

Answer 36

Detects antinuclear antibodies in the blood. The immune system normally makes antibodies to help fight infection, but ANTINUCLEAR antibodies often attack healthy body tissues - specifically targeting each cell’s nucleus. A positive test means the immune system has launched a misdirected attack on healthy tissue.

Question 37

Rheumatoid Factor (RF)?

Answer 37

Immune system protein that attacks healthy body cells. It is often used to diagnose rheumatoid arthritis, though the test itself is neither sensitive nor specific.

Question 38

Anti-citrullinated protein Antibody (ACPA)?

Answer 38

Autoantibodies that are directed against peptides and proteins that are citrullinated - this test allows for an EARLY diagnosis of RA.