Pathology of the Endocrine, Skeletal, and Muscular Systems
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Questions and Answers

What is the most common type of functional adenoma of the anterior pituitary?

  • Microadenoma
  • Hyperprolactinemia (correct)
  • Macroadenoma
  • Non-functional adenoma

    • Which condition in females is most commonly associated with hyperprolactinemia?

  • Decreased libido
  • Amenorrhea (correct)
  • Gynecomastia
  • Sterility

    • What size classification differentiates microadenomas from macroadenomas?

  • More than 10mm (correct)
  • Less than 5mm
  • Less than 10mm (correct)
  • Exactly 10mm

    • Which hormone associated with the anterior pituitary suppresses FSH and LH secretion?

    <p>Prolactin</p> Signup and view all the answers

    What is the typical clinical presentation of hyperprolactinemia in males?

    <p>Decreased libido and impotency</p> Signup and view all the answers

    What hormone is primarily responsible for stimulating the production of testosterone in males?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    Which condition is characterized by excessive growth hormone before the epiphyses of the bones have fused?

    <p>Gigantism</p> Signup and view all the answers

    What is the most common cause of death in individuals with excessive growth hormone?

    <p>Heart disease</p> Signup and view all the answers

    What is the effect of bromocriptine treatment?

    <p>Inhibits prolactin secretion</p> Signup and view all the answers

    What happens to the bones in acromegaly?

    <p>They grow wider only</p> Signup and view all the answers

    What can cause excessive water retention in patients?

    <p>SIADH</p> Signup and view all the answers

    Which option is NOT a symptom associated with hyperthyroidism?

    <p>Weight gain</p> Signup and view all the answers

    What is the primary treatment method for pituitary dwarfism?

    <p>Growth hormone injections</p> Signup and view all the answers

    Which of the following is a potential cause of diabetes insipidus?

    <p>Head injuries</p> Signup and view all the answers

    Which condition is characterized by a deficiency of growth hormone from birth?

    <p>Pituitary dwarfism</p> Signup and view all the answers

    Most hypersecretions of the anterior pituitary are caused by microadenomas.

    <p>False</p> Signup and view all the answers

    In males, hyperprolactinemia typically presents as a microadenoma.

    <p>False</p> Signup and view all the answers

    Galactorrhea is a common clinical presentation of hyperprolactinemia in females.

    <p>True</p> Signup and view all the answers

    Oxytocin is primarily responsible for producing milk in females.

    <p>False</p> Signup and view all the answers

    Macroadenomas do not secrete hormones but can cause tissue compression.

    <p>False</p> Signup and view all the answers

    Match the types of adenomas with their descriptions:

    <p>Microadenomas = Less than 10mm in size, often functional Macroadenomas = Greater than 10mm in size, often non-functional Functional adenomas = Cause secretion of excess hormones Non-functional adenomas = Do not secrete hormones, may cause tissue compression</p> Signup and view all the answers

    Match the clinical presentations with the corresponding gender for hyperprolactinemia:

    <p>Females = More common as microadenoma Males = More common as macroadenoma</p> Signup and view all the answers

    Match the hormones with their primary functions:

    <p>Prolactin = Produces milk, suppresses FSH &amp; LH Oxytocin = Secretes milk FSH in females = Prepares the uterus to receive a mature egg FSH in males = Stimulates sperm production</p> Signup and view all the answers

    Match the terms with their definitions:

    <p>Adenoma = Tumor of the pituitary Hyperprolactinemia = Excess secretion of prolactin Galactorrhea = Milk production unrelated to childbirth Amenorrhea = Absence of menstruation</p> Signup and view all the answers

    Match the descriptions of macroadenomas and microadenomas:

    <p>Macroadenomas = Greater than 10mm in size Microadenomas = Less than 10mm in size</p> Signup and view all the answers

    What is the primary cause of Nelson's syndrome?

    <p>Removal of the adrenals in Cushing's disease</p> Signup and view all the answers

    Which of the following is a common characteristic of pheochromocytoma?

    <p>Hypertension with very high blood pressure</p> Signup and view all the answers

    What is the third most common malignancy in children?

    <p>Neuroblastoma</p> Signup and view all the answers

    Which syndrome is associated with tumors of the thyroid, parathyroid, and adrenal medulla?

    <p>MEN type IIa</p> Signup and view all the answers

    What is a common outcome of Waterhouse-Friderichsen syndrome?

    <p>Usually fatal septicemia</p> Signup and view all the answers

    What is a common cause of secondary hyperparathyroidism?

    <p>Renal failure</p> Signup and view all the answers

    Which of the following is associated with hypoparathyroidism?

    <p>DiGeorge syndrome</p> Signup and view all the answers

    What effect is commonly observed in primary hyperparathyroidism?

    <p>Increased PTH with hypercalcemia</p> Signup and view all the answers

    Which sign is indicative of hypocalcemia in hypoparathyroidism?

    <p>Both A and C</p> Signup and view all the answers

    What marks the distinction of pseudohypoparathyroidism?

    <p>Inability to calcify bone</p> Signup and view all the answers

    What is a consequence of secondary hyperparathyroidism due to low vitamin D?

    <p>Low bone density</p> Signup and view all the answers

    What is a characterizing symptom of Albright's hereditary osteodystrophy?

    <p>Short stature and obesity</p> Signup and view all the answers

    What is the primary enzyme deficiency related to adrenogenital syndrome?

    <p>21-hydroxylase</p> Signup and view all the answers

    Which condition is characterized by high PTH levels but signs of hypoparathyroidism?

    <p>Pseudohypoparathyroidism</p> Signup and view all the answers

    Which effect is NOT associated with secondary hyperparathyroidism?

    <p>Increased blood calcium levels</p> Signup and view all the answers

    Waterhouse-Friderichsen syndrome is usually non-fatal.

    <p>False</p> Signup and view all the answers

    Pheochromocytoma is a neoplasm of chromaffin cells that produces catecholamines.

    <p>True</p> Signup and view all the answers

    Nelson's syndrome occurs after the removal of the adrenals to treat Cushing's disease.

    <p>True</p> Signup and view all the answers

    Neuroblastoma is the most common malignancy in children.

    <p>False</p> Signup and view all the answers

    Tumors involved in Multiple Endocrine Neoplasia type I include the pancreas, producing excess insulin.

    <p>True</p> Signup and view all the answers

    Match the following adrenal diseases with their descriptions:

    <p>Pheochromocytoma = Neoplasm of chromaffin cells producing catecholamines Waterhouse-Friderichsen syndrome = Bilateral hemorrhaging into the adrenal glands with septicemia Nelson's syndrome = Occurs after adrenal removal for Cushing's disease Neuroblastoma = Third most common malignancy in children</p> Signup and view all the answers

    Match the types of Multiple Endocrine Neoplasia (MEN) syndromes with their features:

    <p>MEN type I = Tumors of parathyroid, pancreas and pituitary MEN type IIa = Tumors of thyroid, parathyroid and adrenal medulla MEN type IIb = Tumors of thyroid, adrenal, and ganglioneuromas at extra-endocrine sites MEN type I syndromes = Autosomal dominant on chromosome #11</p> Signup and view all the answers

    Match the following symptoms with their associated conditions:

    <p>Hypercalcemia = Present in MEN type I and MEN type IIa Hypertension = Common in Pheochromocytoma Excess calcitonin = Characteristic of Medullary carcinoma in MEN type IIa Zollinger-Ellison syndrome = Causes ulcers throughout the GI tract</p> Signup and view all the answers

    Match the following tumors with their characteristics:

    <p>Ganglioneuroma = Benign tumor with neural crest cell origin Neuroblastoma = Malignant tumor, can spread to eyes and liver Pheochromocytoma = Associated with high blood pressure and VMA in urine Nelson's syndrome = Result of adrenal gland removal affecting Cushing's patients</p> Signup and view all the answers

    Match the adrenal disease with its associated complication:

    <p>Waterhouse-Friderichsen syndrome = Commonly associated with meningococcal meningitis Pheochromocytoma = Causes excessive catecholamine release Nelson's syndrome = Develops after treatment for Cushing's syndrome Neuroblastoma = Can spread to bone marrow</p> Signup and view all the answers

    What is a primary characteristic of Type I diabetes mellitus?

    <p>The body produces little to no insulin.</p> Signup and view all the answers

    Which of the following diagnoses indicates diabetes mellitus?

    <p>Fasting glucose level of 130 mg/dL.</p> Signup and view all the answers

    Which type of diabetes is most commonly seen due to obesity?

    <p>Type II diabetes mellitus</p> Signup and view all the answers

    What distinguishes gestational diabetes mellitus from other types of diabetes?

    <p>It occurs specifically during pregnancy.</p> Signup and view all the answers

    Which component is NOT typical in the diagnosis of diabetes mellitus?

    <p>Normal glucose tolerance test after 2 hours.</p> Signup and view all the answers

    What is the most common cause of death in a diabetic person?

    <p>Cardiac failure</p> Signup and view all the answers

    Which condition is least likely to be associated with diabetic ketoacidosis?

    <p>Type II Diabetes Mellitus</p> Signup and view all the answers

    What is the primary characteristic of a Grade 1 sprain?

    <p>Mild injury without significant damage</p> Signup and view all the answers

    In Type I Diabetes Mellitus, what is primarily indicated by the presence of autoantibodies?

    <p>Loss of beta cell function</p> Signup and view all the answers

    What is a possible event that could lead to avascular necrosis of the femoral head?

    <p>Dislocation of the hip</p> Signup and view all the answers

    Which of the following is a symptom associated with both Type I and Type II Diabetes Mellitus?

    <p>Excessive thirst</p> Signup and view all the answers

    What is the typical cause of meniscus injuries in the knee?

    <p>Sudden pivot or direct blow to the knee</p> Signup and view all the answers

    What distinguishes hyperosmolar non-ketotic coma from diabetic ketoacidosis?

    <p>Ketoacidosis development</p> Signup and view all the answers

    Which statement accurately describes the pathogenesis of Type II Diabetes Mellitus?

    <p>Direct insulin resistance due to obesity</p> Signup and view all the answers

    What is the most common location for shoulder dislocations?

    <p>Glenohumeral joint</p> Signup and view all the answers

    Alpha cells of the pancreas produce insulin and beta cells produce glucagon.

    <p>False</p> Signup and view all the answers

    Diabetes mellitus can be diagnosed through a fasting glucose exam by determining if the level is above 125.

    <p>True</p> Signup and view all the answers

    Type II diabetes is primarily characterized by the total lack of insulin production in the body.

    <p>False</p> Signup and view all the answers

    Gestational diabetes mellitus occurs in non-pregnant women experiencing hyperglycemia.

    <p>False</p> Signup and view all the answers

    The most common type of diabetes is Type I, also known as juvenile-onset diabetes.

    <p>False</p> Signup and view all the answers

    Match the pancreatic cells with their respective hormone production:

    <p>Beta cells = Insulin Delta cells = Somatostatin PP cells = Pancreatic polypeptide Alpha cells = Glucagon</p> Signup and view all the answers

    Match the types of diabetes mellitus with their characteristics:

    <p>Type I = Insulin dependent, no insulin production Type II = Non-insulin dependent, insulin present Gestational = Occurs during pregnancy Secondary = Due to other medical conditions</p> Signup and view all the answers

    Match the test results with their diabetes mellitus classifications:

    <p>Fasting glucose &gt; 125 mg/dL = Positive for diabetes mellitus 2-hour glucose tolerance test &gt; 200 mg/dL = Positive for diabetes mellitus Fasting glucose &lt; 100 mg/dL = Normal 2-hour glucose tolerance test &lt; 140 mg/dL = Normal</p> Signup and view all the answers

    Match the type of diabetes mellitus with its previous name:

    <p>Type I = Juvenile-onset Type II = Adult-onset Gestational = Pregnancy-related Secondary = Resulting from other diseases</p> Signup and view all the answers

    Match the term with its definition regarding diabetes:

    <p>Hyperglycemia = High blood sugar Diabetes mellitus = Sweet urine due to glucose Insulin = Hormone that lowers blood glucose Glucagon = Hormone that raises blood glucose</p> Signup and view all the answers

    What type of benign bone tumor is most commonly found in flat bones, such as the skull?

    <p>Osteoma</p> Signup and view all the answers

    Which of the following tumors secretes prostaglandins and causes increased pain with alcohol consumption?

    <p>Osteoid osteoma</p> Signup and view all the answers

    Which type of tumor is classified as the most common primary malignant bone tumor?

    <p>Osteosarcoma</p> Signup and view all the answers

    Which of the following conditions is associated with multiple enchondromas and a risk of malignancy?

    <p>Ollier's disease</p> Signup and view all the answers

    Where are osteochondromas most commonly located?

    <p>In the knee joint</p> Signup and view all the answers

    What is the most common primary malignant tumor found in the bone marrow?

    <p>Multiple myeloma</p> Signup and view all the answers

    Which genetic disease is also known as 'brittle bone disease'?

    <p>Osteogenesis imperfecta</p> Signup and view all the answers

    What characterizes Ewing's sarcoma radiologically?

    <p>Onion-skin laying lesions</p> Signup and view all the answers

    Which type of bone metastasis is primarily associated with the prostate?

    <p>Osteosclerotic</p> Signup and view all the answers

    Cleidocranial dysplasia is characterized by the absence of which bones?

    <p>Clavicles</p> Signup and view all the answers

    What type of genetic defect does osteopetrosis involve?

    <p>Decreased bone remodeling</p> Signup and view all the answers

    Which feature is commonly seen in multiple myeloma?

    <p>Fractures and 'punched-out' lytic lesions</p> Signup and view all the answers

    Which genetic disorder leads to unstable crosslinks between elastin fibers?

    <p>Marfan syndrome</p> Signup and view all the answers

    Which type of tumor is most commonly found in the bone as a result of metastasis?

    <p>Secondary metastases</p> Signup and view all the answers

    What is a common clinical manifestation of osteogenesis imperfecta?

    <p>Multiple fractures</p> Signup and view all the answers

    Osteochondroma is classified as the most common primary malignant bone tumor.

    <p>False</p> Signup and view all the answers

    Chondrosarcoma is classified as the second most common primary tumor overall.

    <p>True</p> Signup and view all the answers

    The pain from an osteoid osteoma is decreased by alcohol use.

    <p>False</p> Signup and view all the answers

    Osteosarcoma most often occurs in the areas around the elbow joint.

    <p>False</p> Signup and view all the answers

    Chondroblastoma is commonly found in the upper femur, tibia, and humerus.

    <p>True</p> Signup and view all the answers

    Match the benign bone-forming tumors with their characteristics:

    <p>Osteoma = Most commonly found in flat bones like the skull Osteoid osteoma = Contains osteoid tissue surrounded by a 'halo' of bone formation Osteoblastoma = Not as painful as osteoid osteoma Osteosarcoma = Most common primary malignant bone tumor</p> Signup and view all the answers

    Match the bone and cartilage-forming tumors with their primary sites:

    <p>Osteosarcoma = Areas around the knee joint Chondrosarcoma = 2nd most common primary tumor overall Osteoblastoma = Less commonly around the proximal humerus Chondroma = Found mostly in metacarpals and phalanges</p> Signup and view all the answers

    Match the benign cartilage-forming tumors with their definitions:

    <p>Osteochondroma = Most common primary benign bone tumor with a mushroom-like bulge Chondroma = Typically found in the hands and feet Ollier's disease = Classified as multiple enchondromas Maffuci syndrome = Classified as multiple chondromas with hemangiomas</p> Signup and view all the answers

    Match the following tumors with their characteristics:

    <p>Osteoid osteoma = Extremely painful and secretes prostaglandins Chondrosarcoma = Considered the 2nd most common primary tumor overall Ollier's disease = Tendency to become malignant leading to enchondromatosis Chondroblastoma = Common in the upper femur, tibia, and humerus</p> Signup and view all the answers

    Match the tumor types with their classification:

    <p>Osteoma = Benign bone-forming tumor Chondrosarcoma = Malignant cartilage-forming tumor Osteosarcoma = Malignant bone-forming tumor Osteochondroma = Benign cartilage-forming tumor</p> Signup and view all the answers

    What characterizes Still disease?

    <p>Rheumatoid arthritis with a rash, fever, and lymphadenopathy</p> Signup and view all the answers

    Which type of muscle atrophy occurs due to disuse and glucocorticoid use?

    <p>Type 2 myofiber atrophy</p> Signup and view all the answers

    What is a primary cause of secondary gout?

    <p>Inability to excrete uric acid due to renal disease</p> Signup and view all the answers

    Which condition is characterized by antibodies destroying acetylcholine receptor sites?

    <p>Myasthenia gravis</p> Signup and view all the answers

    What antigen is associated with approximately 80% of reactive arthritis cases?

    <p>HLA-B27 antigen</p> Signup and view all the answers

    Which of the following muscle disorders is associated with neurogenic causes?

    <p>Type 1 myofiber atrophy</p> Signup and view all the answers

    Which symptom is NOT associated with myasthenia gravis?

    <p>Persistent joint pain</p> Signup and view all the answers

    Which statement is true about Paget disease?

    <p>It is characterized by stages including increased blood calcium levels in Stage 1.</p> Signup and view all the answers

    What is a significant characteristic of fibrous dysplasia?

    <p>It typically leads to a 'shepherd's crook' deformity.</p> Signup and view all the answers

    Which joint disease is characterized by a bacterial infection producing pus?

    <p>Suppurative arthritis</p> Signup and view all the answers

    How is scoliosis most commonly classified?

    <p>As postural or structural</p> Signup and view all the answers

    Legg-Calve-Perthes disease is primarily defined as what?

    <p>Osteonecrosis of the proximal femoral epiphysis.</p> Signup and view all the answers

    Which condition is associated with a high female to male ratio in occurrence?

    <p>Scoliosis</p> Signup and view all the answers

    Which statement about McCune-Albright Syndrome is correct?

    <p>It is characterized by fibrous dysplasia along with pigmentation and endocrine symptoms.</p> Signup and view all the answers

    What characterizes Slipped femoral epiphysis?

    <p>It affects the growth plate of the femoral head.</p> Signup and view all the answers

    Paget disease results in smaller bone than normal.

    <p>False</p> Signup and view all the answers

    Fibrous dysplasia is defined as the replacement of bone by cellular connective tissues, which are then replaced by increased cancellous bone.

    <p>True</p> Signup and view all the answers

    Legg-Calve-Perthes disease is a form of osteonecrosis that affects the proximal femoral epiphysis and is typically bilateral.

    <p>False</p> Signup and view all the answers

    Scoliosis is more common in males with a ratio of 8:1 compared to females.

    <p>False</p> Signup and view all the answers

    Rheumatoid arthritis is characterized by a pannus formation with radial deviation of fingers.

    <p>False</p> Signup and view all the answers

    Match the following bone diseases with their characteristics:

    <p>Paget disease = Larger bone than normal in older adults Fibrous dysplasia = Replacement of bone by cellular connective tissues Juvenile osteochondrosis = Aseptic ischemic necrosis Legg-Calve-Perthes disease = Osteonecrosis of proximal femoral epiphysis</p> Signup and view all the answers

    Match the following pediatric bone diseases with their definitions:

    <p>Osgood Schlatter disease = Microfractures of tibial tuberosity Slipped femoral epiphysis = Disorder of the growth plate of the femoral head Scoliosis = Curvature of the spine that can be structural or postural Legg-Calve-Perthes disease = Unilateral osteonecrosis in childhood</p> Signup and view all the answers

    Match the following joint diseases with their descriptions:

    <p>Congenital dislocation of the hip = Improperly formed acetabulum allowing dislocation Suppurative arthritis = Bacterial infection leading to pus accumulation Rheumatoid arthritis = Characterized by pannus formation in joints Lyme disease = Infection from tick bite causing skin rash</p> Signup and view all the answers

    Match the following types of scoliosis with their causes:

    <p>Congenital scoliosis = Disturbances during development Neuromuscular scoliosis = Caused by neuropathic or myopathic diseases Idiopathic scoliosis = Most common form of structural scoliosis Postural scoliosis = Curve that can be corrected with bending</p> Signup and view all the answers

    Match the following features of clubfoot with their types:

    <p>Talipes equinovarus = Foot turned medially with plantarflexion Calcaneovalgus = Foot turned laterally with dorsiflexion Spina bifida = Neural tube defect not related to clubfoot Congenital clubfoot = Most common type seen in newborns</p> Signup and view all the answers

    Study Notes

    Diseases of the Anterior Pituitary Gland

    • Master gland regulation primarily by the hypothalamus.
    • Anterior pituitary known as adenohypophysis; posterior as neurohypophysis.
    • Most hypersecretions arise from adenomas, categorized as microadenomas (< 10mm, typically functional) or macroadenomas (> 10mm, usually non-functional).
    • Treatment for adenomas involves surgical removal and potential hormone replacement therapy (HRT).

    Hyperprolactinemia

    • Most prevalent functional adenoma; high prolactin levels.
    • In females, often manifests as microadenoma causing galactorrhea, amenorrhea, and infertility.
    • In males, typically presents as macroadenoma resulting in decreased libido, impotency, sterility, and gynecomastia.
    • Hormones involved: Prolactin (milk production, inhibits FSH & LH), Oxytocin (milk secretion), FSH and LH (regulate reproductive functions).
    • Treatment includes bromocriptine to lower prolactin via dopamine-like effects.

    Excessive Growth Hormone

    • Characterized by decreased GHRH and increased somatotropin.
    • Second most common pituitary adenoma, with heart disease as a leading cause of death.
    • Gigantism occurs pre-epiphyseal fusion, with symptoms including organomegaly and spade-like hands.
    • Acromegaly occurs post-epiphyseal fusion, leads to bone width growth, cardiomegaly, and prognathism.

    Cushing Disease

    • Decreased CRH leading to increased ACTH and cortisol levels.
    • Commonly results from pituitary adenoma; significantly more prevalent in males (10:1 ratio).
    • Causes bilateral adrenal hyperplasia and may elevate MSH.

    Hyposecretion

    Simmonds's Disease

    • Results in panhypopituitarism (global decrease in anterior pituitary hormones).
    • Causes include Sheehan's syndrome (post-partum necrosis), non-functional tumors, and infiltrative diseases.

    Pituitary Dwarfism

    • Isolated growth hormone deficiency, often congenital.
    • Growth hormone injections during puberty can aid treatment.

    Diseases of the Posterior Pituitary Gland

    Excessive ADH Secretion

    • Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) may result from CNS diseases, ectopic production, or drug use.
    • Leads to excessive water retention and hyponatremia.

    Insufficient ADH Secretion

    • Diabetes insipidus arises from idiopathic causes or head injuries.
    • Symptoms include polyuria, excessive thirst (polydipsia), but not increased hunger (polyphagia).

    Diseases of the Thyroid Gland

    Goiter

    • Can present as diffuse (smooth) or focal (nodular).
    • Potentially compresses trachea, esophagus, or recurrent laryngeal nerve.

    Hyperthyroidism

    • Grave's disease involves decreased TRH and TSH but increased T3/T4 due to autoimmune activity (Type II hypersensitivity).
    • Primarily affects females (7:1 to 10:1 ratio).
    • Features: elevated BMR, sweating, heat intolerance, weight loss, exophthalmos, tachycardia, and characteristic lid lag.

    Granulomatous Thyroiditis (De Quervian thyroiditis)

    • Viral origin can cause transient hyperthyroidism; condition typically resolves without intervention.

    Hypothyroidism

    Cretinism

    • Hypothyroidism in childhood linked to iodine deficiency or maternal goiter, leading to developmental delays and physical abnormalities.

    Myxedema

    • Adult hypothyroidism most commonly attributed to Hashimoto's thyroiditis (Type IV hypersensitivity).
    • Symptoms include decreased BMR, cold intolerance, weight gain, and potential depression.

    Riedel Thyroiditis

    • Presents as chronic non-caseous granulomas causing thyroid gland fibrosis ("Woody thyroid").

    Thyroid Neoplasms

    Follicular Adenoma

    • Benign, most common thyroid neoplasm, occurring more frequently in females, presents as "cold" nodules.

    Thyroid Carcinoma

    • Includes different types:
      • Papillary Carcinoma: Most common, slow-growing, often with lymph node involvement, featuring psammoma bodies.
      • Follicular Carcinoma: Second most common, follicular epithelial origin.
      • Anaplastic Carcinoma: More prevalent in females over 50, aggressive malignancy.

    Diseases of the Anterior Pituitary Gland

    • Master gland regulation primarily by the hypothalamus.
    • Anterior pituitary known as adenohypophysis; posterior as neurohypophysis.
    • Most hypersecretions arise from adenomas, categorized as microadenomas (< 10mm, typically functional) or macroadenomas (> 10mm, usually non-functional).
    • Treatment for adenomas involves surgical removal and potential hormone replacement therapy (HRT).

    Hyperprolactinemia

    • Most prevalent functional adenoma; high prolactin levels.
    • In females, often manifests as microadenoma causing galactorrhea, amenorrhea, and infertility.
    • In males, typically presents as macroadenoma resulting in decreased libido, impotency, sterility, and gynecomastia.
    • Hormones involved: Prolactin (milk production, inhibits FSH & LH), Oxytocin (milk secretion), FSH and LH (regulate reproductive functions).
    • Treatment includes bromocriptine to lower prolactin via dopamine-like effects.

    Excessive Growth Hormone

    • Characterized by decreased GHRH and increased somatotropin.
    • Second most common pituitary adenoma, with heart disease as a leading cause of death.
    • Gigantism occurs pre-epiphyseal fusion, with symptoms including organomegaly and spade-like hands.
    • Acromegaly occurs post-epiphyseal fusion, leads to bone width growth, cardiomegaly, and prognathism.

    Cushing Disease

    • Decreased CRH leading to increased ACTH and cortisol levels.
    • Commonly results from pituitary adenoma; significantly more prevalent in males (10:1 ratio).
    • Causes bilateral adrenal hyperplasia and may elevate MSH.

    Hyposecretion

    Simmonds's Disease

    • Results in panhypopituitarism (global decrease in anterior pituitary hormones).
    • Causes include Sheehan's syndrome (post-partum necrosis), non-functional tumors, and infiltrative diseases.

    Pituitary Dwarfism

    • Isolated growth hormone deficiency, often congenital.
    • Growth hormone injections during puberty can aid treatment.

    Diseases of the Posterior Pituitary Gland

    Excessive ADH Secretion

    • Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) may result from CNS diseases, ectopic production, or drug use.
    • Leads to excessive water retention and hyponatremia.

    Insufficient ADH Secretion

    • Diabetes insipidus arises from idiopathic causes or head injuries.
    • Symptoms include polyuria, excessive thirst (polydipsia), but not increased hunger (polyphagia).

    Diseases of the Thyroid Gland

    Goiter

    • Can present as diffuse (smooth) or focal (nodular).
    • Potentially compresses trachea, esophagus, or recurrent laryngeal nerve.

    Hyperthyroidism

    • Grave's disease involves decreased TRH and TSH but increased T3/T4 due to autoimmune activity (Type II hypersensitivity).
    • Primarily affects females (7:1 to 10:1 ratio).
    • Features: elevated BMR, sweating, heat intolerance, weight loss, exophthalmos, tachycardia, and characteristic lid lag.

    Granulomatous Thyroiditis (De Quervian thyroiditis)

    • Viral origin can cause transient hyperthyroidism; condition typically resolves without intervention.

    Hypothyroidism

    Cretinism

    • Hypothyroidism in childhood linked to iodine deficiency or maternal goiter, leading to developmental delays and physical abnormalities.

    Myxedema

    • Adult hypothyroidism most commonly attributed to Hashimoto's thyroiditis (Type IV hypersensitivity).
    • Symptoms include decreased BMR, cold intolerance, weight gain, and potential depression.

    Riedel Thyroiditis

    • Presents as chronic non-caseous granulomas causing thyroid gland fibrosis ("Woody thyroid").

    Thyroid Neoplasms

    Follicular Adenoma

    • Benign, most common thyroid neoplasm, occurring more frequently in females, presents as "cold" nodules.

    Thyroid Carcinoma

    • Includes different types:
      • Papillary Carcinoma: Most common, slow-growing, often with lymph node involvement, featuring psammoma bodies.
      • Follicular Carcinoma: Second most common, follicular epithelial origin.
      • Anaplastic Carcinoma: More prevalent in females over 50, aggressive malignancy.

    Diseases of the Anterior Pituitary Gland

    • Master gland regulation primarily by the hypothalamus.
    • Anterior pituitary known as adenohypophysis; posterior as neurohypophysis.
    • Most hypersecretions arise from adenomas, categorized as microadenomas (< 10mm, typically functional) or macroadenomas (> 10mm, usually non-functional).
    • Treatment for adenomas involves surgical removal and potential hormone replacement therapy (HRT).

    Hyperprolactinemia

    • Most prevalent functional adenoma; high prolactin levels.
    • In females, often manifests as microadenoma causing galactorrhea, amenorrhea, and infertility.
    • In males, typically presents as macroadenoma resulting in decreased libido, impotency, sterility, and gynecomastia.
    • Hormones involved: Prolactin (milk production, inhibits FSH & LH), Oxytocin (milk secretion), FSH and LH (regulate reproductive functions).
    • Treatment includes bromocriptine to lower prolactin via dopamine-like effects.

    Excessive Growth Hormone

    • Characterized by decreased GHRH and increased somatotropin.
    • Second most common pituitary adenoma, with heart disease as a leading cause of death.
    • Gigantism occurs pre-epiphyseal fusion, with symptoms including organomegaly and spade-like hands.
    • Acromegaly occurs post-epiphyseal fusion, leads to bone width growth, cardiomegaly, and prognathism.

    Cushing Disease

    • Decreased CRH leading to increased ACTH and cortisol levels.
    • Commonly results from pituitary adenoma; significantly more prevalent in males (10:1 ratio).
    • Causes bilateral adrenal hyperplasia and may elevate MSH.

    Hyposecretion

    Simmonds's Disease

    • Results in panhypopituitarism (global decrease in anterior pituitary hormones).
    • Causes include Sheehan's syndrome (post-partum necrosis), non-functional tumors, and infiltrative diseases.

    Pituitary Dwarfism

    • Isolated growth hormone deficiency, often congenital.
    • Growth hormone injections during puberty can aid treatment.

    Diseases of the Posterior Pituitary Gland

    Excessive ADH Secretion

    • Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) may result from CNS diseases, ectopic production, or drug use.
    • Leads to excessive water retention and hyponatremia.

    Insufficient ADH Secretion

    • Diabetes insipidus arises from idiopathic causes or head injuries.
    • Symptoms include polyuria, excessive thirst (polydipsia), but not increased hunger (polyphagia).

    Diseases of the Thyroid Gland

    Goiter

    • Can present as diffuse (smooth) or focal (nodular).
    • Potentially compresses trachea, esophagus, or recurrent laryngeal nerve.

    Hyperthyroidism

    • Grave's disease involves decreased TRH and TSH but increased T3/T4 due to autoimmune activity (Type II hypersensitivity).
    • Primarily affects females (7:1 to 10:1 ratio).
    • Features: elevated BMR, sweating, heat intolerance, weight loss, exophthalmos, tachycardia, and characteristic lid lag.

    Granulomatous Thyroiditis (De Quervian thyroiditis)

    • Viral origin can cause transient hyperthyroidism; condition typically resolves without intervention.

    Hypothyroidism

    Cretinism

    • Hypothyroidism in childhood linked to iodine deficiency or maternal goiter, leading to developmental delays and physical abnormalities.

    Myxedema

    • Adult hypothyroidism most commonly attributed to Hashimoto's thyroiditis (Type IV hypersensitivity).
    • Symptoms include decreased BMR, cold intolerance, weight gain, and potential depression.

    Riedel Thyroiditis

    • Presents as chronic non-caseous granulomas causing thyroid gland fibrosis ("Woody thyroid").

    Thyroid Neoplasms

    Follicular Adenoma

    • Benign, most common thyroid neoplasm, occurring more frequently in females, presents as "cold" nodules.

    Thyroid Carcinoma

    • Includes different types:
      • Papillary Carcinoma: Most common, slow-growing, often with lymph node involvement, featuring psammoma bodies.
      • Follicular Carcinoma: Second most common, follicular epithelial origin.
      • Anaplastic Carcinoma: More prevalent in females over 50, aggressive malignancy.

    Adrenal Disorders

    • Nelson's Syndrome: Results from adrenal removal to treat Cushing's syndrome when Cushing's disease is actually present.
    • Waterhouse-Friderichsen Syndrome: Characterized by bilateral adrenal hemorrhaging associated with septicemia, often linked to meningococcal meningitis, and is usually fatal.

    Diseases of the Adrenal Medulla

    • Pheochromocytoma: Neoplasm of chromaffin cells producing catecholamines, leading to severe hypertension (e.g., blood pressure of 200/120). Urinary vanillylmandelic acid (VMA) levels are elevated.
    • Ganglioneuroma: A benign tumor originating from neural crest cells.
    • Neuroblastoma: The third most common malignancy in children, capable of metastasizing to the eyes, liver, and bone marrow.

    Multiple Endocrine Neoplasia (MEN) Syndromes

    • MEN Type I (Wermer Syndrome):
      • Autosomal dominant, chromosome #11.
      • Include parathyroid tumors (hypercalcemia), pancreatic tumors (excess insulin, Zollinger-Ellison syndrome), and pituitary tumors (hyperprolactinemia).
    • MEN Type IIa (Sipple Syndrome):
      • Features thyroid tumors (medullary carcinoma with excess calcitonin), parathyroid tumors (hypercalcemia), and adrenal medulla tumors (pheochromocytoma).
    • MEN Type IIb (William Syndrome):
      • Involves tumors of the thyroid, adrenal medulla, and extra-endocrine ganglioneuromas.

    Parathyroid Gland Disorders

    • Hyperparathyroidism:

      • Primary Hyperparathyroidism: Caused by primary adenoma; characterized by increased PTH and hypercalcemia. Can lead to metastatic hypercalcemia and osteitis fibrosa cystica.
      • Secondary Hyperparathyroidism: Often due to renal failure; PTH levels are increased but calcium may be normal or low, resulting in renal osteodystrophy.

    • Hypoparathyroidism:

      • Causes: Could be due to DiGeorge syndrome, thyroidectomy, or idiopathic.
      • Effects: Hypocalcemia leads to tetany and convulsions, indicated by Trousseau's sign and Chvostek's sign.
      • Pseudohypoparathyroidism: Normal parathyroid function, but with insensitivity to PTH receptors; associated with high PTH and Albright's hereditary osteodystrophy (short stature, obesity, brachydactyly, and mental retardation).

    Adrenal Cortex Diseases

    • Hyperfunction:

      • Adrenogenital Syndrome: Congenital deficiency of enzyme 21-hydroxylase, leads to decreased glucocorticoids and increased ACTH, causing overproduction of androgens. Symptoms include enlarged genitalia in males and ambiguous genitalia in females.
      • Hyperaldosteronism: Primarily due to a functional adenoma; leads to Conn's syndrome associated with hypertension and hypokalemia.
      • Cushing's Disease: 70% due to pituitary adenoma causing excess ACTH; leads to elevated ACTH levels.
      • Cushing's Syndrome: Characterized by decreased ACTH; caused by corticosteroid therapy, small-cell lung cancer, or adrenal adenomas.

    • Hypofunction:

      • Addison's Disease: Primary adrenal insufficiency with idiopathic atrophy, increased ACTH, and decreased cortisol; the receptor sites for cortisol are insensitive.
      • Secondary Adrenocortical Deficiency: Often steroid-induced, leading to a compromise in adrenal function.

    Adrenal Disorders

    • Nelson's Syndrome: Results from adrenal removal to treat Cushing's syndrome when Cushing's disease is actually present.
    • Waterhouse-Friderichsen Syndrome: Characterized by bilateral adrenal hemorrhaging associated with septicemia, often linked to meningococcal meningitis, and is usually fatal.

    Diseases of the Adrenal Medulla

    • Pheochromocytoma: Neoplasm of chromaffin cells producing catecholamines, leading to severe hypertension (e.g., blood pressure of 200/120). Urinary vanillylmandelic acid (VMA) levels are elevated.
    • Ganglioneuroma: A benign tumor originating from neural crest cells.
    • Neuroblastoma: The third most common malignancy in children, capable of metastasizing to the eyes, liver, and bone marrow.

    Multiple Endocrine Neoplasia (MEN) Syndromes

    • MEN Type I (Wermer Syndrome):
      • Autosomal dominant, chromosome #11.
      • Include parathyroid tumors (hypercalcemia), pancreatic tumors (excess insulin, Zollinger-Ellison syndrome), and pituitary tumors (hyperprolactinemia).
    • MEN Type IIa (Sipple Syndrome):
      • Features thyroid tumors (medullary carcinoma with excess calcitonin), parathyroid tumors (hypercalcemia), and adrenal medulla tumors (pheochromocytoma).
    • MEN Type IIb (William Syndrome):
      • Involves tumors of the thyroid, adrenal medulla, and extra-endocrine ganglioneuromas.

    Parathyroid Gland Disorders

    • Hyperparathyroidism:

      • Primary Hyperparathyroidism: Caused by primary adenoma; characterized by increased PTH and hypercalcemia. Can lead to metastatic hypercalcemia and osteitis fibrosa cystica.
      • Secondary Hyperparathyroidism: Often due to renal failure; PTH levels are increased but calcium may be normal or low, resulting in renal osteodystrophy.

    • Hypoparathyroidism:

      • Causes: Could be due to DiGeorge syndrome, thyroidectomy, or idiopathic.
      • Effects: Hypocalcemia leads to tetany and convulsions, indicated by Trousseau's sign and Chvostek's sign.
      • Pseudohypoparathyroidism: Normal parathyroid function, but with insensitivity to PTH receptors; associated with high PTH and Albright's hereditary osteodystrophy (short stature, obesity, brachydactyly, and mental retardation).

    Adrenal Cortex Diseases

    • Hyperfunction:

      • Adrenogenital Syndrome: Congenital deficiency of enzyme 21-hydroxylase, leads to decreased glucocorticoids and increased ACTH, causing overproduction of androgens. Symptoms include enlarged genitalia in males and ambiguous genitalia in females.
      • Hyperaldosteronism: Primarily due to a functional adenoma; leads to Conn's syndrome associated with hypertension and hypokalemia.
      • Cushing's Disease: 70% due to pituitary adenoma causing excess ACTH; leads to elevated ACTH levels.
      • Cushing's Syndrome: Characterized by decreased ACTH; caused by corticosteroid therapy, small-cell lung cancer, or adrenal adenomas.

    • Hypofunction:

      • Addison's Disease: Primary adrenal insufficiency with idiopathic atrophy, increased ACTH, and decreased cortisol; the receptor sites for cortisol are insensitive.
      • Secondary Adrenocortical Deficiency: Often steroid-induced, leading to a compromise in adrenal function.

    Adrenal Disorders

    • Nelson's Syndrome: Results from adrenal removal to treat Cushing's syndrome when Cushing's disease is actually present.
    • Waterhouse-Friderichsen Syndrome: Characterized by bilateral adrenal hemorrhaging associated with septicemia, often linked to meningococcal meningitis, and is usually fatal.

    Diseases of the Adrenal Medulla

    • Pheochromocytoma: Neoplasm of chromaffin cells producing catecholamines, leading to severe hypertension (e.g., blood pressure of 200/120). Urinary vanillylmandelic acid (VMA) levels are elevated.
    • Ganglioneuroma: A benign tumor originating from neural crest cells.
    • Neuroblastoma: The third most common malignancy in children, capable of metastasizing to the eyes, liver, and bone marrow.

    Multiple Endocrine Neoplasia (MEN) Syndromes

    • MEN Type I (Wermer Syndrome):
      • Autosomal dominant, chromosome #11.
      • Include parathyroid tumors (hypercalcemia), pancreatic tumors (excess insulin, Zollinger-Ellison syndrome), and pituitary tumors (hyperprolactinemia).
    • MEN Type IIa (Sipple Syndrome):
      • Features thyroid tumors (medullary carcinoma with excess calcitonin), parathyroid tumors (hypercalcemia), and adrenal medulla tumors (pheochromocytoma).
    • MEN Type IIb (William Syndrome):
      • Involves tumors of the thyroid, adrenal medulla, and extra-endocrine ganglioneuromas.

    Parathyroid Gland Disorders

    • Hyperparathyroidism:

      • Primary Hyperparathyroidism: Caused by primary adenoma; characterized by increased PTH and hypercalcemia. Can lead to metastatic hypercalcemia and osteitis fibrosa cystica.
      • Secondary Hyperparathyroidism: Often due to renal failure; PTH levels are increased but calcium may be normal or low, resulting in renal osteodystrophy.

    • Hypoparathyroidism:

      • Causes: Could be due to DiGeorge syndrome, thyroidectomy, or idiopathic.
      • Effects: Hypocalcemia leads to tetany and convulsions, indicated by Trousseau's sign and Chvostek's sign.
      • Pseudohypoparathyroidism: Normal parathyroid function, but with insensitivity to PTH receptors; associated with high PTH and Albright's hereditary osteodystrophy (short stature, obesity, brachydactyly, and mental retardation).

    Adrenal Cortex Diseases

    • Hyperfunction:

      • Adrenogenital Syndrome: Congenital deficiency of enzyme 21-hydroxylase, leads to decreased glucocorticoids and increased ACTH, causing overproduction of androgens. Symptoms include enlarged genitalia in males and ambiguous genitalia in females.
      • Hyperaldosteronism: Primarily due to a functional adenoma; leads to Conn's syndrome associated with hypertension and hypokalemia.
      • Cushing's Disease: 70% due to pituitary adenoma causing excess ACTH; leads to elevated ACTH levels.
      • Cushing's Syndrome: Characterized by decreased ACTH; caused by corticosteroid therapy, small-cell lung cancer, or adrenal adenomas.

    • Hypofunction:

      • Addison's Disease: Primary adrenal insufficiency with idiopathic atrophy, increased ACTH, and decreased cortisol; the receptor sites for cortisol are insensitive.
      • Secondary Adrenocortical Deficiency: Often steroid-induced, leading to a compromise in adrenal function.

    Diseases of Endocrine Pancreas

    • Alpha cells produce glucagon; beta cells produce insulin.
    • Diabetes Mellitus: Greek for “sweet urine” indicating glucose presence.
    • Diagnosis:
      • Hyperglycemia detected with fasting glucose ≥125 mg/dL.
      • Abnormal glucose tolerance test: Post 2-hour glucose level ≥200 mg/dL.
    • Classification:
      • Primary Diabetes Mellitus:
        • Type I: Insulin-dependent, characterized by no insulin production. Often juvenile onset.
        • Type II: Non-insulin dependent, often associated with obesity, produces insufficient insulin. Most common type.
        • Gestational Diabetes Mellitus: Hyperglycemia during pregnancy.
      • Secondary Diabetes Mellitus:
        • Caused by chronic pancreatitis (often due to alcoholism) or hormonal tumors (like pheochromocytoma).
        • Can result from hemochromatosis (iron overload) or drugs (like glucocorticoids).
    • Incidence:
      • Lifetime risk for Type I: 0.5%; for Type II: 5-7%.
    • Type I Pathogenesis:
      • Loss of beta cell function; autoantibodies against islet cells present.
    • Type I Metabolic Derangements:
      • Symptoms include polyphagia, polyuria, polydipsia, potential ketoacidosis leading to coma.
    • Type II Pathogenesis:
      • Obesity leads to hyperglycemia, causing increased beta cell insulin secretion over time.
    • Type II Metabolic Derangements:
      • Rare ketoacidosis; hyperosmolar non-ketotic coma can occur, with dehydration and polyuria.
    • Complications:
      • Most common cause of death: cardiac failure.
      • Second cause: kidney failure.

    Diseases of the Skeletal System

    • Injuries:
      • Soft Tissue Injuries:
        • Contusions classified as petechiae (pinpoint) and purpura (bruises).
        • Hematoma and lacerations also considered.
      • Joint Injuries:
        • Strains: Stretching/tearing of muscles/tendons, pain with stretching.
        • Sprains: Stretching/tearing of ligaments, classified by severity (Grades 1-4).
        • Treatment includes RICE (rest, ice, compression, elevation) and immobilization.
        • Dislocations: Common in the shoulder; causes include congenital, traumatic, and pathologic factors.
        • Loose bodies in joints: Small cartilage/bone pieces present.
        • Knee injuries typically involve meniscus, with medial meniscus linked to MCL injuries. Chondromalacia prevalent in young females.
        • Hip injuries: Posterior hip dislocation common, with potential for avascular necrosis of femoral head.
    • Fractures:
      • Classified by location, open vs. closed, complete vs. incomplete, and configuration (transverse vs. oblique).
    • Bone Healing:
      • Stages: Hematoma formation, fibrocartilaginous callus formation, bony callus formation, and remodeling.
    • Complications of Fractures:
      • Fracture blister: Blisters form due to swelling.
      • Compartment syndrome: Increased pressure leading to reduced blood flow.
      • Complex regional pain syndrome: Pain not matching injury severity.
      • Pulmonary fat embolism risk.

    Infections of Bone

    • Acute Suppurative Osteomyelitis:
      • Most common post-trauma infection, primarily caused by Staphylococcus aureus; Salmonella in sickle-cell patients.
      • Pathogenesis involves sequestrum (dead bone) and involucrum (new bone encasement).
    • Miliary Tuberculosis:
      • Primarily pulmonary, but can affect other regions.
      • Pott Disease: Tuberculosis in the spine, discharging caseous material; does not invade IVD.
    • Osteonecrosis:
      • Results from any ischemic condition.

    Diseases of Endocrine Pancreas

    • Alpha cells produce glucagon; beta cells produce insulin.
    • Diabetes Mellitus: Greek for “sweet urine” indicating glucose presence.
    • Diagnosis:
      • Hyperglycemia detected with fasting glucose ≥125 mg/dL.
      • Abnormal glucose tolerance test: Post 2-hour glucose level ≥200 mg/dL.
    • Classification:
      • Primary Diabetes Mellitus:
        • Type I: Insulin-dependent, characterized by no insulin production. Often juvenile onset.
        • Type II: Non-insulin dependent, often associated with obesity, produces insufficient insulin. Most common type.
        • Gestational Diabetes Mellitus: Hyperglycemia during pregnancy.
      • Secondary Diabetes Mellitus:
        • Caused by chronic pancreatitis (often due to alcoholism) or hormonal tumors (like pheochromocytoma).
        • Can result from hemochromatosis (iron overload) or drugs (like glucocorticoids).
    • Incidence:
      • Lifetime risk for Type I: 0.5%; for Type II: 5-7%.
    • Type I Pathogenesis:
      • Loss of beta cell function; autoantibodies against islet cells present.
    • Type I Metabolic Derangements:
      • Symptoms include polyphagia, polyuria, polydipsia, potential ketoacidosis leading to coma.
    • Type II Pathogenesis:
      • Obesity leads to hyperglycemia, causing increased beta cell insulin secretion over time.
    • Type II Metabolic Derangements:
      • Rare ketoacidosis; hyperosmolar non-ketotic coma can occur, with dehydration and polyuria.
    • Complications:
      • Most common cause of death: cardiac failure.
      • Second cause: kidney failure.

    Diseases of the Skeletal System

    • Injuries:
      • Soft Tissue Injuries:
        • Contusions classified as petechiae (pinpoint) and purpura (bruises).
        • Hematoma and lacerations also considered.
      • Joint Injuries:
        • Strains: Stretching/tearing of muscles/tendons, pain with stretching.
        • Sprains: Stretching/tearing of ligaments, classified by severity (Grades 1-4).
        • Treatment includes RICE (rest, ice, compression, elevation) and immobilization.
        • Dislocations: Common in the shoulder; causes include congenital, traumatic, and pathologic factors.
        • Loose bodies in joints: Small cartilage/bone pieces present.
        • Knee injuries typically involve meniscus, with medial meniscus linked to MCL injuries. Chondromalacia prevalent in young females.
        • Hip injuries: Posterior hip dislocation common, with potential for avascular necrosis of femoral head.
    • Fractures:
      • Classified by location, open vs. closed, complete vs. incomplete, and configuration (transverse vs. oblique).
    • Bone Healing:
      • Stages: Hematoma formation, fibrocartilaginous callus formation, bony callus formation, and remodeling.
    • Complications of Fractures:
      • Fracture blister: Blisters form due to swelling.
      • Compartment syndrome: Increased pressure leading to reduced blood flow.
      • Complex regional pain syndrome: Pain not matching injury severity.
      • Pulmonary fat embolism risk.

    Infections of Bone

    • Acute Suppurative Osteomyelitis:
      • Most common post-trauma infection, primarily caused by Staphylococcus aureus; Salmonella in sickle-cell patients.
      • Pathogenesis involves sequestrum (dead bone) and involucrum (new bone encasement).
    • Miliary Tuberculosis:
      • Primarily pulmonary, but can affect other regions.
      • Pott Disease: Tuberculosis in the spine, discharging caseous material; does not invade IVD.
    • Osteonecrosis:
      • Results from any ischemic condition.

    Diseases of Endocrine Pancreas

    • Alpha cells produce glucagon; beta cells produce insulin.
    • Diabetes Mellitus: Greek for “sweet urine” indicating glucose presence.
    • Diagnosis:
      • Hyperglycemia detected with fasting glucose ≥125 mg/dL.
      • Abnormal glucose tolerance test: Post 2-hour glucose level ≥200 mg/dL.
    • Classification:
      • Primary Diabetes Mellitus:
        • Type I: Insulin-dependent, characterized by no insulin production. Often juvenile onset.
        • Type II: Non-insulin dependent, often associated with obesity, produces insufficient insulin. Most common type.
        • Gestational Diabetes Mellitus: Hyperglycemia during pregnancy.
      • Secondary Diabetes Mellitus:
        • Caused by chronic pancreatitis (often due to alcoholism) or hormonal tumors (like pheochromocytoma).
        • Can result from hemochromatosis (iron overload) or drugs (like glucocorticoids).
    • Incidence:
      • Lifetime risk for Type I: 0.5%; for Type II: 5-7%.
    • Type I Pathogenesis:
      • Loss of beta cell function; autoantibodies against islet cells present.
    • Type I Metabolic Derangements:
      • Symptoms include polyphagia, polyuria, polydipsia, potential ketoacidosis leading to coma.
    • Type II Pathogenesis:
      • Obesity leads to hyperglycemia, causing increased beta cell insulin secretion over time.
    • Type II Metabolic Derangements:
      • Rare ketoacidosis; hyperosmolar non-ketotic coma can occur, with dehydration and polyuria.
    • Complications:
      • Most common cause of death: cardiac failure.
      • Second cause: kidney failure.

    Diseases of the Skeletal System

    • Injuries:
      • Soft Tissue Injuries:
        • Contusions classified as petechiae (pinpoint) and purpura (bruises).
        • Hematoma and lacerations also considered.
      • Joint Injuries:
        • Strains: Stretching/tearing of muscles/tendons, pain with stretching.
        • Sprains: Stretching/tearing of ligaments, classified by severity (Grades 1-4).
        • Treatment includes RICE (rest, ice, compression, elevation) and immobilization.
        • Dislocations: Common in the shoulder; causes include congenital, traumatic, and pathologic factors.
        • Loose bodies in joints: Small cartilage/bone pieces present.
        • Knee injuries typically involve meniscus, with medial meniscus linked to MCL injuries. Chondromalacia prevalent in young females.
        • Hip injuries: Posterior hip dislocation common, with potential for avascular necrosis of femoral head.
    • Fractures:
      • Classified by location, open vs. closed, complete vs. incomplete, and configuration (transverse vs. oblique).
    • Bone Healing:
      • Stages: Hematoma formation, fibrocartilaginous callus formation, bony callus formation, and remodeling.
    • Complications of Fractures:
      • Fracture blister: Blisters form due to swelling.
      • Compartment syndrome: Increased pressure leading to reduced blood flow.
      • Complex regional pain syndrome: Pain not matching injury severity.
      • Pulmonary fat embolism risk.

    Infections of Bone

    • Acute Suppurative Osteomyelitis:
      • Most common post-trauma infection, primarily caused by Staphylococcus aureus; Salmonella in sickle-cell patients.
      • Pathogenesis involves sequestrum (dead bone) and involucrum (new bone encasement).
    • Miliary Tuberculosis:
      • Primarily pulmonary, but can affect other regions.
      • Pott Disease: Tuberculosis in the spine, discharging caseous material; does not invade IVD.
    • Osteonecrosis:
      • Results from any ischemic condition.

    Neoplastic Diseases of Bone

    • Most prevalent malignant tumor is metastases, affecting bone, brain, liver, and gastrointestinal tract.

    Benign Bone-Forming Tumors

    • Osteoma: Typically located in flat bones, especially the skull.
    • Osteoid Osteoma: Uncommon but causes significant pain; found in metaphysis of long bones and vertebrae; secretes prostaglandins, with pain exacerbated by alcohol and alleviated by aspirin.
    • Osteoblastoma: Similar to osteoid osteoma but less painful.

    Malignant Bone-Forming Tumors

    • Osteosarcoma: Most prevalent primary malignant bone tumor; often arises near the knee joint and proximal humerus.

    Benign Cartilage-Forming Tumors

    • Osteochondroma: Most common primary benign bone tumor; characterized by a mushroom-like protrusion, primarily near the knee.
    • Chondroma: Typically occurs in the metacarpals and phalanges of hands and feet.
    • Ollier's Disease: Multiple enchondromas with potential for malignant transformation, known as enchondromatosis.
    • Maffuci Syndrome: Multiple chondromas associated with cavernous hemangiomas on the skin; hemangiomas present as birthmarks that fade with age.
    • Chondroblastoma: Slow-growing tumor found in upper femur, tibia, and humerus; features sharply defined borders.

    Malignant Cartilage-Forming Tumors

    • Chondrosarcoma: Second most common primary tumor; typically diagnosed after age 20; metastasizes primarily to lungs.

    Other Bone Tumors

    • Giant Cell Tumor: Noted for 'big bubbles' within bone structure.
    • Ewing's Sarcoma: Characterized by onion-skin lesions.

    Primary Malignant Tumors in Bone

    • Multiple Myeloma: Most common primary malignant tumor of bone marrow, comprising plasma cells; frequently observed in spine and ribs; presents with fractures and "punched-out" lytic lesions.
    • Secondary Metastases: The most common bone tumor; includes osteolytic (e.g., metastasizes to thyroid) and osteosclerotic types (e.g., metastasizes to prostate).

    Genetic Diseases of Bone

    • Osteogenesis Imperfecta (OI): Also known as brittle bone disease; results from abnormal type I collagen development; type 1 OI is the most common, inherits autosomal dominant, characterized by blue sclera and frequent fractures.

    • Achondroplasia: Affects the appendicular skeleton, while the axial system remains normal.

    • Osteopetrosis: Known as marble-bone disease; marked by a failure of bone remodeling, leading to abnormally dense bones and potential cranial nerve palsies.

    • Cleidocranial Dysplasia: Features include hypoplasia or absence of clavicles, facial skeleton abnormalities, numerous teeth, and "bird face" appearance.

    • Marfan Syndrome: Associated with stretchy crosslinks between elastin and type 1 collagen; characterized by long limbs, arachnodactyly, and risk of dissecting aortic aneurysm due to cystic medial necrosis; diagnostic signs include Steinberg and Walker-Murdoch signs.

    Metabolic Bone Diseases

    • General Information: Inorganic to organic bone component ratio is 2:1; calcium serves as the inorganic component, while osteoid represents the organic counterpart.

    • T-Score Classification: Normal range is 1.0 to -1, osteopenia is -1 to -2.5, and osteoporosis is below -2.5; typically leads to fractures of the femoral neck and Dowager's hump from vertebral collapse.

    Osteoporosis

    • Type 1 (Primary): Increased osteoclast activity, commonly in postmenopausal women.
    • Type 2 (Primary): Reduction in osteoblastic activity due to aging, affecting both sexes.
    • Secondary Osteoporosis: Observed in individuals immobilized, undergoing chemotherapy, or with neoplasia/malabsorption syndromes.

    Rickets and Osteomalacia

    • Result from issues with inorganic bone; rickets affects children due to vitamin D deficiency, while osteomalacia affects adults; both involve defective mineralization.

    Scurvy

    • Caused by vitamin C deficiency, impeding osteoid formation; vitamin C is crucial for collagen synthesis.

    Hyperparathyroidism

    • Primary Hyperparathyroidism: Results from hyperactive parathyroid glands due to benign tumors; leads to increased blood calcium levels.

    Neoplastic Diseases of Bone

    • Most prevalent malignant tumor is metastases, affecting bone, brain, liver, and gastrointestinal tract.

    Benign Bone-Forming Tumors

    • Osteoma: Typically located in flat bones, especially the skull.
    • Osteoid Osteoma: Uncommon but causes significant pain; found in metaphysis of long bones and vertebrae; secretes prostaglandins, with pain exacerbated by alcohol and alleviated by aspirin.
    • Osteoblastoma: Similar to osteoid osteoma but less painful.

    Malignant Bone-Forming Tumors

    • Osteosarcoma: Most prevalent primary malignant bone tumor; often arises near the knee joint and proximal humerus.

    Benign Cartilage-Forming Tumors

    • Osteochondroma: Most common primary benign bone tumor; characterized by a mushroom-like protrusion, primarily near the knee.
    • Chondroma: Typically occurs in the metacarpals and phalanges of hands and feet.
    • Ollier's Disease: Multiple enchondromas with potential for malignant transformation, known as enchondromatosis.
    • Maffuci Syndrome: Multiple chondromas associated with cavernous hemangiomas on the skin; hemangiomas present as birthmarks that fade with age.
    • Chondroblastoma: Slow-growing tumor found in upper femur, tibia, and humerus; features sharply defined borders.

    Malignant Cartilage-Forming Tumors

    • Chondrosarcoma: Second most common primary tumor; typically diagnosed after age 20; metastasizes primarily to lungs.

    Other Bone Tumors

    • Giant Cell Tumor: Noted for 'big bubbles' within bone structure.
    • Ewing's Sarcoma: Characterized by onion-skin lesions.

    Primary Malignant Tumors in Bone

    • Multiple Myeloma: Most common primary malignant tumor of bone marrow, comprising plasma cells; frequently observed in spine and ribs; presents with fractures and "punched-out" lytic lesions.
    • Secondary Metastases: The most common bone tumor; includes osteolytic (e.g., metastasizes to thyroid) and osteosclerotic types (e.g., metastasizes to prostate).

    Genetic Diseases of Bone

    • Osteogenesis Imperfecta (OI): Also known as brittle bone disease; results from abnormal type I collagen development; type 1 OI is the most common, inherits autosomal dominant, characterized by blue sclera and frequent fractures.

    • Achondroplasia: Affects the appendicular skeleton, while the axial system remains normal.

    • Osteopetrosis: Known as marble-bone disease; marked by a failure of bone remodeling, leading to abnormally dense bones and potential cranial nerve palsies.

    • Cleidocranial Dysplasia: Features include hypoplasia or absence of clavicles, facial skeleton abnormalities, numerous teeth, and "bird face" appearance.

    • Marfan Syndrome: Associated with stretchy crosslinks between elastin and type 1 collagen; characterized by long limbs, arachnodactyly, and risk of dissecting aortic aneurysm due to cystic medial necrosis; diagnostic signs include Steinberg and Walker-Murdoch signs.

    Metabolic Bone Diseases

    • General Information: Inorganic to organic bone component ratio is 2:1; calcium serves as the inorganic component, while osteoid represents the organic counterpart.

    • T-Score Classification: Normal range is 1.0 to -1, osteopenia is -1 to -2.5, and osteoporosis is below -2.5; typically leads to fractures of the femoral neck and Dowager's hump from vertebral collapse.

    Osteoporosis

    • Type 1 (Primary): Increased osteoclast activity, commonly in postmenopausal women.
    • Type 2 (Primary): Reduction in osteoblastic activity due to aging, affecting both sexes.
    • Secondary Osteoporosis: Observed in individuals immobilized, undergoing chemotherapy, or with neoplasia/malabsorption syndromes.

    Rickets and Osteomalacia

    • Result from issues with inorganic bone; rickets affects children due to vitamin D deficiency, while osteomalacia affects adults; both involve defective mineralization.

    Scurvy

    • Caused by vitamin C deficiency, impeding osteoid formation; vitamin C is crucial for collagen synthesis.

    Hyperparathyroidism

    • Primary Hyperparathyroidism: Results from hyperactive parathyroid glands due to benign tumors; leads to increased blood calcium levels.

    Neoplastic Diseases of Bone

    • Most prevalent malignant tumor is metastases, affecting bone, brain, liver, and gastrointestinal tract.

    Benign Bone-Forming Tumors

    • Osteoma: Typically located in flat bones, especially the skull.
    • Osteoid Osteoma: Uncommon but causes significant pain; found in metaphysis of long bones and vertebrae; secretes prostaglandins, with pain exacerbated by alcohol and alleviated by aspirin.
    • Osteoblastoma: Similar to osteoid osteoma but less painful.

    Malignant Bone-Forming Tumors

    • Osteosarcoma: Most prevalent primary malignant bone tumor; often arises near the knee joint and proximal humerus.

    Benign Cartilage-Forming Tumors

    • Osteochondroma: Most common primary benign bone tumor; characterized by a mushroom-like protrusion, primarily near the knee.
    • Chondroma: Typically occurs in the metacarpals and phalanges of hands and feet.
    • Ollier's Disease: Multiple enchondromas with potential for malignant transformation, known as enchondromatosis.
    • Maffuci Syndrome: Multiple chondromas associated with cavernous hemangiomas on the skin; hemangiomas present as birthmarks that fade with age.
    • Chondroblastoma: Slow-growing tumor found in upper femur, tibia, and humerus; features sharply defined borders.

    Malignant Cartilage-Forming Tumors

    • Chondrosarcoma: Second most common primary tumor; typically diagnosed after age 20; metastasizes primarily to lungs.

    Other Bone Tumors

    • Giant Cell Tumor: Noted for 'big bubbles' within bone structure.
    • Ewing's Sarcoma: Characterized by onion-skin lesions.

    Primary Malignant Tumors in Bone

    • Multiple Myeloma: Most common primary malignant tumor of bone marrow, comprising plasma cells; frequently observed in spine and ribs; presents with fractures and "punched-out" lytic lesions.
    • Secondary Metastases: The most common bone tumor; includes osteolytic (e.g., metastasizes to thyroid) and osteosclerotic types (e.g., metastasizes to prostate).

    Genetic Diseases of Bone

    • Osteogenesis Imperfecta (OI): Also known as brittle bone disease; results from abnormal type I collagen development; type 1 OI is the most common, inherits autosomal dominant, characterized by blue sclera and frequent fractures.

    • Achondroplasia: Affects the appendicular skeleton, while the axial system remains normal.

    • Osteopetrosis: Known as marble-bone disease; marked by a failure of bone remodeling, leading to abnormally dense bones and potential cranial nerve palsies.

    • Cleidocranial Dysplasia: Features include hypoplasia or absence of clavicles, facial skeleton abnormalities, numerous teeth, and "bird face" appearance.

    • Marfan Syndrome: Associated with stretchy crosslinks between elastin and type 1 collagen; characterized by long limbs, arachnodactyly, and risk of dissecting aortic aneurysm due to cystic medial necrosis; diagnostic signs include Steinberg and Walker-Murdoch signs.

    Metabolic Bone Diseases

    • General Information: Inorganic to organic bone component ratio is 2:1; calcium serves as the inorganic component, while osteoid represents the organic counterpart.

    • T-Score Classification: Normal range is 1.0 to -1, osteopenia is -1 to -2.5, and osteoporosis is below -2.5; typically leads to fractures of the femoral neck and Dowager's hump from vertebral collapse.

    Osteoporosis

    • Type 1 (Primary): Increased osteoclast activity, commonly in postmenopausal women.
    • Type 2 (Primary): Reduction in osteoblastic activity due to aging, affecting both sexes.
    • Secondary Osteoporosis: Observed in individuals immobilized, undergoing chemotherapy, or with neoplasia/malabsorption syndromes.

    Rickets and Osteomalacia

    • Result from issues with inorganic bone; rickets affects children due to vitamin D deficiency, while osteomalacia affects adults; both involve defective mineralization.

    Scurvy

    • Caused by vitamin C deficiency, impeding osteoid formation; vitamin C is crucial for collagen synthesis.

    Hyperparathyroidism

    • Primary Hyperparathyroidism: Results from hyperactive parathyroid glands due to benign tumors; leads to increased blood calcium levels.

    Miscellaneous Bone Diseases

    • Paget Disease (Osteitis Deformans): Characterized by enlarged bones, typically in older adults.

      • Stage 1: Increased osteoclast activity leads to bone resorption, elevated blood calcium levels, and alkaline phosphatase.
      • Stage 2: Osteoclast activity halts; bone deposition continues.
      • Stage 3: Decreased cellular activity results in disorganized bone structure.

    • Fibrous Dysplasia: Causes larger than normal bones, usually diagnosed earlier in life.

      • Results from the replacement of bone with non-mineralized cellular connective tissues leading to increased cancellous bone.
      • Notable feature: "Shepherd's crook" deformity of the proximal femur.

    • McCune-Albright Syndrome: Fibrous dysplasia associated with skin pigmentation and endocrine disorders.

    Pediatric Bone Diseases

    • Juvenile Osteochondrosis: Defined by aseptic ischemic necrosis affecting growing bones.

    • Legg-Calve-Perthes Disease: Osteonecrosis of the proximal femoral epiphysis; typically unilateral, affecting young children.

    • Osgood Schlatter Disease: Microfractures at tibial tuberosity where the patellar ligament attaches; common in adolescents.

    • Slipped Femoral Epiphysis: Disorder affecting the growth plate of the femoral head, leading to misalignment.

    • Scoliosis: More prevalent in females (8:1 female to male ratio).

      • Postural Scoliosis: Correctable curve with bending.
      • Structural Scoliosis: Fixed curvature not correctable by bending.
        • Types:
          • Congenital: Result of developmental disturbances.
          • Neuromuscular: Associated with conditions like cerebral palsy and Duchenne muscular dystrophy.
          • Idiopathic: Most common form of structural scoliosis.

    Joint Diseases

    • Congenital:

      • Congenital Dislocation of the Hip: Inadequate acetabulum formation leading to femoral head dislocation.
      • Clubfoot (Talipes Equinovarus): Most common, with medial turning and plantarflexion; calcaneovalgus denotes lateral turning and dorsiflexion.

    • Infectious:

      • Suppurative Arthritis (Seplic Arthritis): Bacterial infection causing pus formation; most often caused by Staphylococcus aureus.
      • Lyme Disease: Infection from tick bite (Borrelia burgdorferi); symptoms include erythema migrans.

    • Immunological:

      • Rheumatoid Arthritis: Characterized by pannus formation and finger deformities.
        • Types:
          • Felty Syndrome: Chronic RA with splenomegaly.
          • Still Disease: Juvenile RA with rash, fever, and lymphadenopathy.
          • Sjogren Syndrome: RA with dry mouth and eyes.
      • Reactive Arthritis: Infection-associated arthritis, conjunctivitis, and non-gonococcal urethritis; linked to HLA-B27 antigen in ~80% of cases.

    • Degenerative:

      • Ankylosing Spondylitis: ~95% of cases associated with HLA-B27 antigen.
      • Osteoarthritis: Most common form of joint disease.

    • Metabolic:

      • Gouty Arthritis:
        • Primary Gout: Genetic enzyme defect causing abnormal purine metabolism.
        • Secondary Gout: Inability to excrete uric acid due to renal disease, leading to accumulation in joints.
        • Hyperuricemia: Necessary for gout manifestation.

    Muscle Disorders

    • Muscle Atrophy:

      • Type 1 Myofiber Atrophy: Neurogenic atrophy caused by loss of nerve supply.
      • Type 2 Myofiber Atrophy: Disuse atrophy affecting fast-twitch Type 2 muscle fibers, commonly in glucocorticoid users.

    • Myasthenia Gravis: Autoimmune disorder where antibodies destroy acetylcholine receptor sites at the neuromuscular junction.

      • Symptoms worsen throughout the day, starting with muscle weakness in the morning.

    • Eaton-Lambert Syndrome (Myasthenic Syndrome): Antibodies target calcium channels, causing muscle weakness that worsens with muscle use.

    Miscellaneous Bone Diseases

    • Paget Disease (Osteitis Deformans): Characterized by enlarged bones, typically in older adults.

      • Stage 1: Increased osteoclast activity leads to bone resorption, elevated blood calcium levels, and alkaline phosphatase.
      • Stage 2: Osteoclast activity halts; bone deposition continues.
      • Stage 3: Decreased cellular activity results in disorganized bone structure.

    • Fibrous Dysplasia: Causes larger than normal bones, usually diagnosed earlier in life.

      • Results from the replacement of bone with non-mineralized cellular connective tissues leading to increased cancellous bone.
      • Notable feature: "Shepherd's crook" deformity of the proximal femur.

    • McCune-Albright Syndrome: Fibrous dysplasia associated with skin pigmentation and endocrine disorders.

    Pediatric Bone Diseases

    • Juvenile Osteochondrosis: Defined by aseptic ischemic necrosis affecting growing bones.

    • Legg-Calve-Perthes Disease: Osteonecrosis of the proximal femoral epiphysis; typically unilateral, affecting young children.

    • Osgood Schlatter Disease: Microfractures at tibial tuberosity where the patellar ligament attaches; common in adolescents.

    • Slipped Femoral Epiphysis: Disorder affecting the growth plate of the femoral head, leading to misalignment.

    • Scoliosis: More prevalent in females (8:1 female to male ratio).

      • Postural Scoliosis: Correctable curve with bending.
      • Structural Scoliosis: Fixed curvature not correctable by bending.
        • Types:
          • Congenital: Result of developmental disturbances.
          • Neuromuscular: Associated with conditions like cerebral palsy and Duchenne muscular dystrophy.
          • Idiopathic: Most common form of structural scoliosis.

    Joint Diseases

    • Congenital:

      • Congenital Dislocation of the Hip: Inadequate acetabulum formation leading to femoral head dislocation.
      • Clubfoot (Talipes Equinovarus): Most common, with medial turning and plantarflexion; calcaneovalgus denotes lateral turning and dorsiflexion.

    • Infectious:

      • Suppurative Arthritis (Seplic Arthritis): Bacterial infection causing pus formation; most often caused by Staphylococcus aureus.
      • Lyme Disease: Infection from tick bite (Borrelia burgdorferi); symptoms include erythema migrans.

    • Immunological:

      • Rheumatoid Arthritis: Characterized by pannus formation and finger deformities.
        • Types:
          • Felty Syndrome: Chronic RA with splenomegaly.
          • Still Disease: Juvenile RA with rash, fever, and lymphadenopathy.
          • Sjogren Syndrome: RA with dry mouth and eyes.
      • Reactive Arthritis: Infection-associated arthritis, conjunctivitis, and non-gonococcal urethritis; linked to HLA-B27 antigen in ~80% of cases.

    • Degenerative:

      • Ankylosing Spondylitis: ~95% of cases associated with HLA-B27 antigen.
      • Osteoarthritis: Most common form of joint disease.

    • Metabolic:

      • Gouty Arthritis:
        • Primary Gout: Genetic enzyme defect causing abnormal purine metabolism.
        • Secondary Gout: Inability to excrete uric acid due to renal disease, leading to accumulation in joints.
        • Hyperuricemia: Necessary for gout manifestation.

    Muscle Disorders

    • Muscle Atrophy:

      • Type 1 Myofiber Atrophy: Neurogenic atrophy caused by loss of nerve supply.
      • Type 2 Myofiber Atrophy: Disuse atrophy affecting fast-twitch Type 2 muscle fibers, commonly in glucocorticoid users.

    • Myasthenia Gravis: Autoimmune disorder where antibodies destroy acetylcholine receptor sites at the neuromuscular junction.

      • Symptoms worsen throughout the day, starting with muscle weakness in the morning.

    • Eaton-Lambert Syndrome (Myasthenic Syndrome): Antibodies target calcium channels, causing muscle weakness that worsens with muscle use.

    Miscellaneous Bone Diseases

    • Paget Disease (Osteitis Deformans): Characterized by enlarged bones, typically in older adults.

      • Stage 1: Increased osteoclast activity leads to bone resorption, elevated blood calcium levels, and alkaline phosphatase.
      • Stage 2: Osteoclast activity halts; bone deposition continues.
      • Stage 3: Decreased cellular activity results in disorganized bone structure.

    • Fibrous Dysplasia: Causes larger than normal bones, usually diagnosed earlier in life.

      • Results from the replacement of bone with non-mineralized cellular connective tissues leading to increased cancellous bone.
      • Notable feature: "Shepherd's crook" deformity of the proximal femur.

    • McCune-Albright Syndrome: Fibrous dysplasia associated with skin pigmentation and endocrine disorders.

    Pediatric Bone Diseases

    • Juvenile Osteochondrosis: Defined by aseptic ischemic necrosis affecting growing bones.

    • Legg-Calve-Perthes Disease: Osteonecrosis of the proximal femoral epiphysis; typically unilateral, affecting young children.

    • Osgood Schlatter Disease: Microfractures at tibial tuberosity where the patellar ligament attaches; common in adolescents.

    • Slipped Femoral Epiphysis: Disorder affecting the growth plate of the femoral head, leading to misalignment.

    • Scoliosis: More prevalent in females (8:1 female to male ratio).

      • Postural Scoliosis: Correctable curve with bending.
      • Structural Scoliosis: Fixed curvature not correctable by bending.
        • Types:
          • Congenital: Result of developmental disturbances.
          • Neuromuscular: Associated with conditions like cerebral palsy and Duchenne muscular dystrophy.
          • Idiopathic: Most common form of structural scoliosis.

    Joint Diseases

    • Congenital:

      • Congenital Dislocation of the Hip: Inadequate acetabulum formation leading to femoral head dislocation.
      • Clubfoot (Talipes Equinovarus): Most common, with medial turning and plantarflexion; calcaneovalgus denotes lateral turning and dorsiflexion.

    • Infectious:

      • Suppurative Arthritis (Seplic Arthritis): Bacterial infection causing pus formation; most often caused by Staphylococcus aureus.
      • Lyme Disease: Infection from tick bite (Borrelia burgdorferi); symptoms include erythema migrans.

    • Immunological:

      • Rheumatoid Arthritis: Characterized by pannus formation and finger deformities.
        • Types:
          • Felty Syndrome: Chronic RA with splenomegaly.
          • Still Disease: Juvenile RA with rash, fever, and lymphadenopathy.
          • Sjogren Syndrome: RA with dry mouth and eyes.
      • Reactive Arthritis: Infection-associated arthritis, conjunctivitis, and non-gonococcal urethritis; linked to HLA-B27 antigen in ~80% of cases.

    • Degenerative:

      • Ankylosing Spondylitis: ~95% of cases associated with HLA-B27 antigen.
      • Osteoarthritis: Most common form of joint disease.

    • Metabolic:

      • Gouty Arthritis:
        • Primary Gout: Genetic enzyme defect causing abnormal purine metabolism.
        • Secondary Gout: Inability to excrete uric acid due to renal disease, leading to accumulation in joints.
        • Hyperuricemia: Necessary for gout manifestation.

    Muscle Disorders

    • Muscle Atrophy:

      • Type 1 Myofiber Atrophy: Neurogenic atrophy caused by loss of nerve supply.
      • Type 2 Myofiber Atrophy: Disuse atrophy affecting fast-twitch Type 2 muscle fibers, commonly in glucocorticoid users.

    • Myasthenia Gravis: Autoimmune disorder where antibodies destroy acetylcholine receptor sites at the neuromuscular junction.

      • Symptoms worsen throughout the day, starting with muscle weakness in the morning.

    • Eaton-Lambert Syndrome (Myasthenic Syndrome): Antibodies target calcium channels, causing muscle weakness that worsens with muscle use.

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