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Flashcards in Week 1 Deck (46):
1

Most sensitive detection for radiographically occult trauma/fracture

Spinolaminar disruption

2

Clay shoveler fracture

1. Fracture of C6 or C7 spinous process
2. No neurologic impairment
3. Supraspinous ligament avulsion 
4. Stable fracture   

3

Flexion-teardrop fracture

1. Due to severe flexion cervical spine
2. Get retropulsion and can cause anterior cord syndrome which can lead to quadriplegia 

4

Atlantoaxial instability 

-predental space normal for adults and kids

-forward movement of atlas on axis is restricted by?

1. PREDENTAL SPACE

Adults - 3 mm

Kids - 5 mm

2. TRANSVERSE LIGAMENT

5

Hangman fracture

1. Fractures of posterior elements of C2 and displacement of C2 body anterior to C3


2. Usually doesn’t cause neurologic impairment but is an unstable fracture

6

Chance fracture

1. Most occur at T12-L2


2. Look for acute flexion injury, widening of posterior aspect of spinal canal and narrowing of anterior vertebral bodies


3. High degree of correlation with peritoneal injury 

7

Burst fracture

•  Axial load usually secondary to MVC or fall

•  Comminuted vertical fracture through the vertebral body

•  May resemble flexion-teardrop fracture

•  FD fracture injures the anterior and posterior ligamentous structures

•  Burst fracture don’t necessarily have to injure the anterior or posterior ligamentous
structures

•  Considered stable if there is no neurologic deficit or if there are no retropulsed fragments.

8

Anterior compression (wedge) fracture

-most commonly seen in

1. Usually seen in osteoporotic patients

2. Can also be in young due to weight lifting

3. Very important to correlate clinically to rule out acute fracture
a. Check for point tenderness

4. Can go on to cause severe neurological sequela 

9

Dens fracture

-most commonly associated with

-most common site of fracture

-when is it unstable?

1. MVC and falls

2. Base of dens at its attachment to C2

3. If fracture extends through body of C2

10

Ankylosing Spondylitis

i. Get ossification of outer fibers of annulus fibrosus
1. Outer aspect of intervertebral disc
2. Increases risk of fracture

ii. SI joint fusion 

11

Ossification of posterior longitudinal ligament often associated with what 2 conditions? 

What can occur?

DISH and alkylosing spondylitis 

Spinal stenosis 

 

12

Key point about defining a source of back pain

Must be done by integrating the findings on clinical exam and MRI

13

1. Disc Bulge

2. Disc protrusion

3. Disc extrusion 

1. Disk Bulge
•  A diffusely bulging disk that extends symmetrically and circumferentially by more than 2mm.

2. Disk Protrusion
•  Focal, asymmetric extension of disk tissue beyond the vertebral body margin usually
into spinal canal or neural foramen

3. Disk Extrusion
•  More pronounced form of a protrusion and often is responsible for symptoms.

•  Disruption of the outer fibers of the annulus, and the disk abnormality usually is greater in its AP dimension than its base (medial/lateral dimension).

14

Paracentral vs lateral disc bulge

Paracentral -> will compress the spinal nerve associated with the lower vertebrae

Lateral -> will get the rootlet above

EXAMPLE
L4-L5 disc

1. Lateral disc bulge -> L4 root will be affected
2. Central or paracentral disc bulge -> L5 root will be affected

15

Central canal stenosis

•  Usually result of facet joint osteophytes and inward buckling of the ligamentum flavum posteriorly with disc bulging anteriorly

16

Neural foramen Stenosis

•  Occurs from degenerative osteophytes of the facet joints or of unconvertebral joints in the cervical spine, inward buckling of the ligamentum flavum, a foraminal disc protrusion, extrusion, diffuse disc bulge, or postoperative fibrosis.

17

Lateral Recess Stenosis 

•  Usually is caused by hypertrophic degenerative changes of the facet joints or less
commonly by a disk fragment or postoperative fibrosis.

•  Nerve roots lie in this recess after leaving the thecal sac, but before entering the exiting neural foramen.

18

Spondylolysis

-sign?

Defect in the pars interarticularis

-scotty's dog -> presence of collar displays the defect

 

19

Which part of vertebral body affected 1st with spine infection?

Marrow region of a verterbal body endplate 

20

 Lack of appropriate rectal tone/sensation points to a problem here

Sacral nerve roots S2-4

21

Sciatic nerve

-roots

-physical exam test

L45S123

straight leg raise

22

Fermoral nerve strech test assess problem at which levels?

L1234

23

Lumbar stenosis 

-sign

-gold standard tx

-shopping cart sign

lamininectomy 

24

McCune Albright Syndrome

-fibrous dysplasia of bone
-shepherd's cook deformity of femur neck

-cafe au lait (skin pigmentation)

-endocrinopathies (hyperfunctioning)

o Issue with progenitor cells
o Seen on one side of the body
o Mutation during embryogenesis (post-zygotic) 

25

Treacher Collins syndrome

o Autosomal dominant
o Ribosomal activity affected
o Leads to excessive apoptosis of neural crest cells
o Smaller jaw and hypoplastic midface 

26

Holt-Oram syndrome (halt-arm)

-aka

-heart-hand syndrome

o Skeletal abnormalities of upper limbs

o Heart defect usually present

o Autosomal dominant inheritance

o Defect involves mesenchymal progenitor of cartilage
• Cartilage is needed for endochondral ossification 

27

Achondroplasia

o Hard to notice at birth
o Hand will not reach thigh
o Causes is mutation in FGFR3
o Defective chondroblast development
o Most commonly associated w/ new mutations in gametes of older age fathers of normal height
o Autosomal dominant if inherited
o No neurological defect

28

Thanatophoric Dwarfism

o More severe than achondroplasia
o Most common lethal form of dwarfism
o Mutation also at FGFR3 gene but different region 

29

Clubfoot

o Males affected more than females
o Need to dx early to have the best outcome
o Talus bone too small and malformed
o Get inward turning of foot (varus config)
o Tx
• Use hand manipulation
• Surgery used sparingly 

30

Rickets

o Prolonged vitamin D deficiency
o Prevent with supplements
o Can get bowing of legs
o Get weakly mineralized bone  

31

Cretinism 

o Iodine deficiency
o Supplement pregnant women with iodine 

32

Osteogenesis imperfecta

o Mutation in collagen (type I)
o BLUE SCLERA – veins below
o Rate of fracture normalized in the 30s
o Type II fatal in utero

33

Pituitary Dwarfism

-growth hormone deficiency

-normal proportions maintained

-supplementation to tx

34

Renal Osteodystrophy

o Skeletal changes as a result of chronic renal disease
o Phosphate retention leading to 2ndary hyperparathyroidism
o Get short stature

35

Osteomalacia

o Vit D def in adults
o Adults prone to vertebral and femoral fractures 

36

Osteoporosis

-post-menopausal vs senile

o Osteopenia is a less severe form
o Secondary causes
• Immobilization
• Paraplegia
• Tumors 
o Divided into post-menopausal and senile
• The former -> increased osteoclast activity
• Latter -> decreased osteoblast activity

37

Osteopetrosis

o Increased mineralization due to defected osteoclasts
o Brittle bones 

-get mostly woven bone (primary)

38

Paget disease of bone

-population

-can present with

-elderly

-chalkstick fracture due to brittle bones

-increased osteoclast activity -> osteoblastic phase -> burnout phase (quiescience)

-Bisphosphonates to block osteoclasts 

-will see increased serum alk phos during osteoblastic phase 

39

Acromegaly

-pituitary adenoma secreting GH 

-in adults

40

Growth plate fractures

-how are they classified?

Salter Harris classification

• Increasing number = worse outcome
• Grade 5 -> death of growth plate. If it’s one side, then get bowing of bone
• Lower grades are treated with a cast and higher grades require surgery 

41

Rules for identifying skin regions

Thick skin
Apocrine glands
Hair

Thick skin  - palms of hands and soles of feet

Apocrine glands – axilla, pubic, areola of breast, circumanal region

Hair – everywhere, except thick skin, dense in scalp, with some variation, also axilla, groin

42

3 types of glands in skin

-fx

-type of secretion 

1. Sebaceous gland
o Secretes stuff into space b/w the shaft and follicle
o Has a complete turn over process = germinative cells
• Because “suicide secretion” mech
• Holocrine secretion
o Fx -> protection and moisturizer

2. Apocrine gland
o Fx -> sexual and social
o Also known as scent gland
o “Decapitation secretion”
• Apocrine secretion

3. Eccrine gland
o Sweat gland
o Secretes products into interfollicular epidermis
o Fx -> thermoregulation and electrolyte balance
o Merocrine secretion 

43

Where are Merkel cells found?

• Restricted to basal epithelium layer
• Found in fingertips, lips and genitalia
• Tactile sensitivity
• Attached to axon terminal of nerve coming from dermis
• Mechanoreceptor cell
• Fine touch perception
• Have dense core granules -> Seen on EM
• Neuroendocrine fx

44

Melonocytes are derived from

neural crest cells

45

Role of membrane coating (lamellar) granules secreting by keratinocytes of stratum spinosum

• Migrates to apical plasma membrane and release contents in EC space
• Highly specialized phospholipids and sphingolipids and amplify water impermeability characteristics of the skin

46