Week 6 Flashcards
(87 cards)
1
Q
What type of joint is the pubic symphysis? What is its function?
A
secondary cartilaginous joint
shock absorption
2
Q
What structure separates the greater and lesser sciatic notches?
A
the ischial spine
3
Q
What 3 lines on the ilium mark the attachment of the gluteal muscles?
A
posterior, anterior and inferior gluteal lines
4
Q
Where does the superior pubic ramus meet with the ilium?
A
iliopubic eminence
5
Q
Between which two structures does the arcuate line extend?
A
- iliopubic eminence
- auricular surface
6
Q
Give the name of the pit found on the head of the femur?
A
fovea
7
Q
What two structures join the greater and lesser trochanters, anteriorly and posteriorly respectively?
A
ANTERIOR: intertrochanteric line
POSTERIOR: intertrochanteric crest
8
Q
On which bony struture is the gluteal tuberosity of the femur found?
A
linea aspera
9
Q
Which bony structures of the femur line up the popliteal surface?
A
the medial and lateral supracondylar lines
10
Q
Where on the femur would you find the adductor tubercle?
A
medial supracondylar ridge, just superior to the medial condyle
11
Q
What type of bone is the patella?
A
a sesamoid bone
12
Q
Which area of the tibia separates the anterior and posterior intercondylar areas?
A
intercondylar eminence
13
Q
Which way does the soleal line travel?
A
inferiorly it passes from lateral to medial
14
Q
Which two surfaces of the tibia does the interosseous membrane separate?
A
the posterior surface and the anterolateral surface
15
Q
What is the tibio-fibular syndesmosis?
A
a small, flattened area of the fibula that articulates into a fibrous joint with the tibia
16
Q
Which part of the superior trochlear facet of the talus is wider?
A
the anterior part
17
Q
Which tendon is found in the groove between the medial and lateral tubercles of the talus?
A
flexor hallucis longus
18
Q
Which part of the talus articulates with the navicular bone?
A
the head
19
Q
What is the sustentaculum tali?
A
the prominent flange of bone on the medial surface of the calcaneus, just inferior to and supporting the talus
20
Q
What structure passes through the groove on the inferior surface of the cuboid?
A
the tendon for fibularis longus
21
Q
Which metatarsal shows a distinct tuberosity on its base?
A
5th metatarsal
22
Q
Where would you find the jugular notch?
A
in the midline between the medial ends of tha clavicle and on the superior border of the manubrium
23
Q
Which part of the scapula is likely to be evident without palpation when the shoulder is elevated?
A
the inferior angle of the scapula
24
Q
Which border of the scapula is the most palpable?
A
the lateral border
25
How could you estimate the height of a patient that is unable to stand up?
by measuring the length of the ulna
26
At what level does the deep palmar arch lies?
1cm below the level of the distal border of the extended thumb
27
What are the boundaries of the anatomical snuffbox?
- tendon of extensor pollicis longus laterally
| - tendons of extensor pollicis brevis and abductor pollicis longus medially
28
What are the three autonomous areas for sensory testing of the hand, and which nerve do they respectively belong to?
- pad of little finger: ulnar nerve
- pad of index: median nerve
- skin overlying the first dorsal interosseous on the dorsum of the hand: radial nerve
29
Name and explain the 4 different types of cell growth.
MULTIPLICATIVE
making more of one specific type of cell
AUXILIC
enlargement of existing cells
ACCRETIONARY
growth of extracellular matrix
COMBINED
interdependent
30
Name the 2 different ways increased growth can be characterized by. Give two examples for each, one physiological, one pathological.
HYPERPLASIA
increase in number
physiological --> adaptation to altitude (more RBCs in blood) or preparation of mammary glands to lactation
pathological --> psoriasis (abnormal dermis and stratum corneum)
HYPERTROPHY
increase in size
physiological --> athletes' muscles
pathological --> right ventricular hypertrophy (compensation to decreased blood flow to the lungs)
31
Give four example of when hyperplasia is normally physiological, but if exaggerated can be pathological.
- angiogenesis
- wound healing
- liver regeneration
- heart scarring
32
Define atrophy. Give 2 examples of physiological atrophy.
= reduction in cell size or number or both
- regressive alteration of the thymus after 10yrs old
- ageing
33
Give 1 example of pathological atrophy matching each of the following categories: muscle, nerves, blood supply, pressure, diet.
```
muscle - immobility due to fracture
nerve - paraplegia
blood supply - diabetic foot
pressure - bed sore
diet - anorexia
```
34
Give 5 influencing factors in systemic growth disorders.
- hormones and growth factors
- genetics
- nutrition
- environmental factors (pollution, lead, housing, fetal alcohol syndrome)
- secondary effect of disease (cystic fibrosis, chronic kidney disease)
35
Give 3 examples of proportionate alterations of skeletal growth and explain the mechanism of disease.
TURNER'S SYNDROME
female with XO karyotype --> haploinsufficiency of SHOX gene, coding for transcription factors in the hypertrophic zone of growth plates --> reduced hypertrophy --> short individuals
BECKWITH-WIEDEMANN SYNDROME
two copies of a paternal chromosome, and none from mother --> increased expression of IGF-2 + decreased expression of H19 --> overgrowth in early childhood (particularly enlarged tongue
PITUITARY GIGANTISM
in childhood (in adulthood: acromegaly)
often involves pituitary tumours
increased IGF-1 + increased growth hormone --> tall individuals (long bones)
36
Explain the mechanism of disease of achondroplasia.
```
autosomal dominant mutation of FGFR3 (fibroblast growth factor receptor 3) gene
98% of mutations are the same
normal receptors (tyrosine kinase) pair when activated by dimer and lead to lyosome degradation --> limits growth
in achondroplasia: receptor constitutively active --> no way to switch off the signal --> suppressed proliferation in chondrocytes --> individual too small
```
37
Give 6 triggers of differentiation.
- positional factors (vitamin A...)
- hormones (insulin, sex hormones...)
- paracrine factors
- autocrine factors
- environmental factors (mutagens...)
- extracellular matrix
38
Define metaplasia. Give one example.
= change of differentiated cell type as a response to altered cellular environment
epithelium of trachea and bronchi of smokers from columnar to squamous
39
Define dysplasia and neoplasia and indicate how they link to malignancy.
DYSPLASIA
= increased cell proliferation with an atypical morphology and decreased differentiation (immature cells)
often pre-malignant
NEOPLASIA
= abnormal, uncontrolled, uncoordinated excessive cell proliferation, that persists after withdrawal of the stimulus
not always malignant, but often a hallmark
40
Name, define and give one example for each of 5 anomalies of organogenesis.
AGENESIS
failure to develop an organ or structure
--> renal agenesis
ATRESIA
failure to develop a lumen
--> oesophageal atresia, duodenal atresia or imperforate anus
HYPOPLASIA
failure of an organ or segment of an organ to develop to normal size
--> optic nerve hypoplasia
ECTOPIA/HETEROTOPIA
small areas of mature tissue from one organ present in another
--> endometriosis
MALDIFFERENTIATION
failure of normal differentiation which leads to the persistence of primitive embryological features
--> multicystic renal dysplasia
41
Where would you find Wilm's tumour? What type(s) of tissue do they contain?
kidney
cartilage, bone, smooth muscle
42
At what age range is bone mass most stable?
25-35yrs old
43
What 3 features differentiates a healthy bone from an osteoporotic bone at microscopic level?
- decreased size of osteons
- thinning and weakening of trabeculae
- enlargement of Haversian and marrow space
44
What is the estimated prevalence of osteoporosis in men and in women?
men: 1 in 12
women: 1 in 3
45
Give 5 risk factors for osteoporosis and one example for each factor.
GENETIC/BIOLOGICAL SEX
women lose more bone than men as menopause decreases the activity of osteoblasts
LIFESTYLE/NUTRITIONAL
- smoking
- excess alcohol
- sedentary lifestyle
- prolonged immobilisation
MEDICAL CONDITIONS
- anorexia nervosa
- rheumatoid arthritiS
- early menopause
- primary hypogonadism
- secondary amenorrhoea (>1yr)
- hyperthyroidism
- primary hyperparathyroidism
- multiple myeloma
- transplantation
- chronic renal/pulmonary/GI disease
- Cushing's syndrome
DRUGS
- chronic corticosteroid therapy
- excessive thyroid therapy
- GnRh agonist or antagonist
- anticoagulants
- anticonvulsants
- chemotherapy
PREVIOUS FRAGILITY FRACTURE
previous wrist fracture doubles the risk of a future hip fracture and triples that of a future vertebral fracture
46
Give 8 factors contributing to osteoporotic fracture risk, and indicate what they act on.
FRACTURE
- fall
- postural reflexes
- soft tissue padding
BONE STRENGTH
- shape and architecture
- bone mass
REMODELING
- hormones (also influence bone mass)
- nutrition (also influence bone mass)
- exercise and lifestyle
47
Name the three types of osteoporosis and give 3 features for each.
POST MENOPAUSAL (TYPE 1)
- affects mainly cancellous bone
- common fractures: vertebral, distal radius
- related to loss of oestrogen (increased osteoclast activity)
- female: male = 6:1
AGE-RELATED (TYPE 2)
- over 75yrs old
- affects both cancellous and cortical bone
- related to poor calcium absorption
- common fractures: hip, pelvis
- female:male = 2:1
DISUSE OSTEOPOROSIS
- caused by conditions resulting in prolonged immobilisation (dysania, neurological or muscle disease...) or by the absence of gravity
- nothing pathologically wrong with balance of osteoclast and osteoblast activity
- use it or lose it
48
Give the defining features of a fragility fracture. Give the 3 most common sites. Give the risks of hip fragility fracture after age of 50 in men and women.
low energy trauma: mechanical forces that would not ordinarily cause fracture
WHO: fall from a standing height or less
most common fractures: distal radius, neck of femur, vertebral body
women: 18% VS men: 6%
49
What is an adjusted hazard ratio?
A ratio adjusted for ethnicity and BMI
50
What are the possible outcomes of a hip fracture? What percentage does each outcome represent?
FATAL --> 20-30%
FULL RECOVERY --> 30%
PERMANENTLY DISABLED --> 50%
51
Which 4 investigations would you launch to diagnose osteoporosis in both men and women? Give two others used only in men.
ALL
- blood tests: FBC, serum biochemistry (calcium, CTX), bone profile
- thyroid function tests
- X-ray of L and T spine
- bone mineral density measurement (DEXA scanning)
MEN ONLY
testosterone and gonadotrophin levels
52
What is DEXA scanning? Give the full name.
dual-energy x-ray absorptiometry scan
low-dose X-ray with 2 distinct energy peaks (one absorned by soft tissue, the other by bone)
substracting one from the other gives the bone mineral density (BMD)
53
What are the DEXA scores?
allow prediction of the risk of fragility fractures
```
T-SCORE
comparison with a healthy young adult of the same sex with peak bone mass (in terms of standard deviations from normal)
normal = > -1
osteopenia = -1 to -2.5
osteoporosis = < -2.5
```
Z-SCORE
comparison of the patient's bone mineral density with data from the same age/sex/size
54
Give 5 possible lines of treatments of osteoporosis.
- bisphosphonates (alendronates, risedronate)
- anabolic agents (intermittent PTH, strontium ranelate)
- calcium supplements
- hormone replacement therapy
- increase exercise
55
Give 2 reasons for sampling blood.
- confirm/support/exclude a diagnosis
| - monitor progression of a disease
56
Give the normal ranges for haemoglobin and white blood cell count.
Hb
- -> men: 130-180g/L
- -> women: 115-160g/L
WBC
4-11 x 10^9 /L
57
What do haematinics measure? Define haematinics.
= substances required for the normal development of RBCs
IRON STUDIES
- serum ferritin
- serum iron
- TIBC (total iron binding capacity)
- transferrin
B12
SERUM FOLATE
58
Give two examples of blood test for antibodies.
APCA
| IFA
59
Why are there nitrites in urine in a bacterial infection of the urinary tract?
bacteria turn nitrates to nitrites in urine
60
What do presence of blood in the urine indicate?
damage to the urethra and/or bladder
61
Why are there high numbers of platelets in some forms of anaemia (for instance iron-deficiency anaemia)?
reactive haematopoiesis
62
What is ferritin? What does it indicate? When is it not affected?
protein-iron complex
indicator of iron stores --> reduced in iron deficiency
not affected in chronic disease anaemia or thalassaemia
63
Outline the steps of the clinical method by analytical strategy.
1. history (Hx)
2. differential diagnosis (DD)
3. examination
4. further refined DD
5. working diagnosis
6. proposed investigations to confirm provisional working diagnosis
7. results of investigations
8. management plan (Mx)
9. review of progress of management of disease process
64
What is the commonest cause of fever?
infection
65
Define menorrhagia.
abnormally heavy and prolonged, regular periods resulting in excessive blood loss
66
# Define and give two possible causes for each of the following abnormal WBC results:
- neutrophilia
- neutropaenia
- lymphocytosis
- lymphopaenia
- monocytosis
- eosinophilia
NEUTROPHILIA
increased percentage of neutrophils
--> acute bacterial infection, acute stress, rheumatoid arthritis, rheumatic fever, trauma
NEUTROPAENIA
decreased percentage of neutrophils
--> aplastic anaemia, chemotherapy & radiation therapy, viral infection, widespread bacterial infection
LYMPHOCYTOSIS
increased percentage of lymphocytes
--> chronic bacterial infection, infectious hepatitis, infectious mononucleosis, lymphocytic leukaemia, multiple myeloma, viral infection (mumps, measles...)
LYMPHOPAENIA
decreased percentage of lymphocytes
--> chemotherapy, HIV infection, leukaemia, radiation therapy, sepsis
MONOCYTOSIS
increased percentage of monocytes
--> chronic inflammatory disease (ulcerative colitis, Crohn's disease), parasitic infection, TB, viral infection (infectious mononucleosis, mumps, measles...)
EOSINOPHILIA
increased percentage of eosinophils
--> allergic reaction, cancer, collagen vascular disease, parasitic infection
67
Define anaemia.
insufficient haemoglobin to deliver oxygen to the cells
- Hb < 130g/L in adult males, < 115g/L in adult females
- can also be defined as a reduction in RBCs and haematocrit (Hct)
68
What is the haematocrit (Hct)?
packed cell volume (PCV) --> ratio between the volume of the RBCs to the total volume of blood (in %)
69
What is relative anaemia? What is its other name? What abnormal FBC result suggests that the anaemia could be relative?
anaemia caused by the presence of too much plasma (haemodilution)
spurious anaemia
lowered haematocrit
70
Give 5 non-specific symptoms of anaemia, and 5 non-specific signs.
NON-SPECIFIC SYMPTOMS
- tiredness/fatigue/lassitude/drowsiness
- headache
- weakness
- light headedness/dizziness/vertigo
- fainting
- breathlessness on exertion
- palpitations
- worsening ischaemic symptoms (angina, intermittent claudication)
- menstrual disturbances
NON-SPECIFIC SIGNS
- pallor
- pale conjunctiva
- pale palmar creases
- tachycardia
- postural hypotension
- signs of congestive heart failure (ankle swelling)
- murmur
71
Give two signs specific to iron deficiency anaemia. 2 signs specific to either of iron or B12 deficiency anaemia, and 1 sign specific to each of haemolytic anaemia, sickle cell disease and thalassaemia major.
IRON DEFICIENCY ANAEMIA
- brittle nails and koilonychia
- brittle hair
IRON AND B12 DEFICIENCY ANAEMIAS
- angular stomatitis
- glossitis
HAEMOLYTIC ANAEMIA
jaundice
SICKLE CELL ANAEMIA
leg ulcers
THALASSAEMIA MAJOR
bone deformities
72
Explain why haemolytic anaemia can lead to clinical jaundice.
increased destruction of RBCs --> increase in circulating unconjugated bilirubin --> bilirubin > 30-50micromole/L --> jaundice
73
Give two examples of each of the following 5 causes of anaemia: blood loss, nutrient deficiency/malabsorption, chronic system disease, immune disease, infections. Give 4 other general causes.
BLOOD LOSS
- acute haemorrhage (trauma)
- gradual, prolonged chronic bleeding resulting in iron deficiency (GI bleeding, menstrual bleeding...)
NUTRIENT DEFICIENCY/MALABSORPTION
- iron deficiency
- vitamin B12 deficiency
- folate deficiency
- malnutrition
CHRONIC SYSTEM DISEASE
- anaemia of chronic disease
- kidney failure
- liver disease
- thyroid disease
IMMUNE DISEASE
- autoimmune haemolytic anaemia
- transfusion reactions (ABO incompatibility...)
INFECTIONS
- cytomegalovirus (CMV)
- infectious mononucleosis
- malaria
OTHERS
- acquired bone marrow disease
- toxin exposure
- genetic disorders
- microvascular disease
- pregnancy
- burns...
74
What is the commonest cause of iron deficiency anaemia worldwide?
hookworm infection
75
Which classifications are most useful for anaemia? What are the associated terms?
MEAN CELL VOLUME (MCV)
- microcytic
- normocytic (80-100fl)
- macrocytic
MEAN CELL HAEMOGLOBIN (MCH)
- hypochromic
- normochromic (27-31 pg/cell)
- hyperchromic
76
Give three causes of each of microcytic, normocytic and macrocytic anaemia.
MICROCYTIC ANAEMIA
- chronic blood loss
- low iron stores (dietary lack, malabsorption)
- thalassaemia
- lead poisoning
NORMOCYTIC ANAEMIA
- acute blood loss
- endocrine disease (hypopituitary, thyroid, adrenal)
- combined deficiency
- chronic disease
- sepsis
- tumour
- aplastic anaemia
MACROCYTIC ANAEMIA
- megaloblastic anaemias
- hereditary anaemias
- drugs causing folate malabsorption
- liver disease
- hypothyroidism
- chemotherapy
- reticulocytosis
77
Define reticulocytosis.
increase in reticulocytes, which are immature with a relatively large size compared to mature RBCs, caused by accelerated haematopoiesis
78
Define megaloblastic anaemia. Describe the features of the RBCs involved.
= anaemia as a result of nutritional deficiency of either vitamin B12 or folic acid, or malabsorption of B12
- unusually large (macrocytic)
- nucleated
- erythroblasts (immature cells - development blocked by lack of B12 or folic acid)
79
Define pernicious anaemia.
form of megaloblastic anaemia caused by a specific autoimmune disorder in which the gastric mucosa is atrophic and there is intrinsic factor deficiency, leading to absorption of less than 1% of B12
80
Which type of anaemia can be the result of excessive alcohol abuse?
macrocytic megaloblastic anaemia
81
Which type of anaemia is associated with each of acute haemorrhage and gradual chronic blood loss?
ACUTE HAEMORRHAGE
normocytic normochromic anaemia
GRADUAL CHRONIC BLOOD LOSS
microcytic hypochromic anaemia
82
Define melanea. What is the cause?
= the passage of black tarry stools with an offensive smell, due to altered (digested) blood in the faeces
cause: bleed early in the GI (oesophagus, stomach, duodenum)
83
what happens to transferrin levels when there is too much iron in the body? How does this relate to the function of transferrin?
low transferrin levels
transferrin transports iron from the gut to the cells that use it. lowering transferrin levels --> less iron absorbed --> does not increase the levels of iron in the body
84
In terms of MCV, how do RBCs generally look in iron deficiency, folate deficiency and B12 deficiency anaemias?
IRON DEFICIENCY ANAEMIA
microcytic
FOLATE DEFICIENCY ANAEMIA
macrocytic
B12 DEFICIENCY ANAEMIA
macrocytic
85
Which 4 substances increase with excessive RBC destruction?
- unconjugated bilirubin in the blood
- urinary urobilinogen
- LDH (lactate dehydrogenase) in blood
- reticulocyte numbers in blood
86
What will blood work of anaemia of chronic disease typically show?
- normal MCV
- ferritin levels --> normal or high
- low serum iron
- high hepcidin
87
What is the role of hepcidin in iron transfer?
regulatory protein produced by the liver, that inhibits the export of iron into the blood
