Podcast
Questions and Answers
What is a Colles fracture most commonly caused by?
What is a Colles fracture most commonly caused by?
Which type of fracture typically requires surgery or a splint for four weeks?
Which type of fracture typically requires surgery or a splint for four weeks?
What imaging technique is often used to detect a Snuff Box fracture?
What imaging technique is often used to detect a Snuff Box fracture?
What is a common characteristic of stress fractures?
What is a common characteristic of stress fractures?
Signup and view all the answers
What is the main diagnostic feature for a radial head fracture in adults?
What is the main diagnostic feature for a radial head fracture in adults?
Signup and view all the answers
Which Salter Harris classification indicates a fracture through the growth plate and metaphysis?
Which Salter Harris classification indicates a fracture through the growth plate and metaphysis?
Signup and view all the answers
In pediatric fractures, what signifies an increased risk of osteoarthritis?
In pediatric fractures, what signifies an increased risk of osteoarthritis?
Signup and view all the answers
What complication is commonly associated with anterior shoulder dislocations?
What complication is commonly associated with anterior shoulder dislocations?
Signup and view all the answers
What is the primary hormone responsible for triggering ovulation?
What is the primary hormone responsible for triggering ovulation?
Signup and view all the answers
What effect does estradiol have on the endometrium?
What effect does estradiol have on the endometrium?
Signup and view all the answers
During which phase is there a surge in estradiol that stimulates FSH and LH secretion?
During which phase is there a surge in estradiol that stimulates FSH and LH secretion?
Signup and view all the answers
Which cells produce testosterone in the ovaries?
Which cells produce testosterone in the ovaries?
Signup and view all the answers
What is the result of progestin withdrawal at the end of the luteal phase?
What is the result of progestin withdrawal at the end of the luteal phase?
Signup and view all the answers
Which hormone’s secretions are predominantly inhibited during most of the menstrual cycle by estrogen?
Which hormone’s secretions are predominantly inhibited during most of the menstrual cycle by estrogen?
Signup and view all the answers
When is thymectomy generally indicated for patients with myasthenia gravis?
When is thymectomy generally indicated for patients with myasthenia gravis?
Signup and view all the answers
What is the main purpose of plasmapheresis in the treatment of myasthenia gravis?
What is the main purpose of plasmapheresis in the treatment of myasthenia gravis?
Signup and view all the answers
Which of the following is a potential precipitating factor for a myasthenic crisis?
Which of the following is a potential precipitating factor for a myasthenic crisis?
Signup and view all the answers
Why is thymectomy not recommended for patients with MuSK antibodies?
Why is thymectomy not recommended for patients with MuSK antibodies?
Signup and view all the answers
What is the role of oral glucocorticoids in the management of myasthenia gravis?
What is the role of oral glucocorticoids in the management of myasthenia gravis?
Signup and view all the answers
Which of the following is true regarding the timing of thymectomy?
Which of the following is true regarding the timing of thymectomy?
Signup and view all the answers
What leads to the production of insulin-like growth factor-1 in the liver?
What leads to the production of insulin-like growth factor-1 in the liver?
Signup and view all the answers
At what age range does menarche typically occur?
At what age range does menarche typically occur?
Signup and view all the answers
What is a primary reason parents bring children in for evaluation of precocious puberty?
What is a primary reason parents bring children in for evaluation of precocious puberty?
Signup and view all the answers
Which of the following is NOT a common clinical feature observed in central precocious puberty?
Which of the following is NOT a common clinical feature observed in central precocious puberty?
Signup and view all the answers
Which sequence correctly describes the progression of puberty in girls?
Which sequence correctly describes the progression of puberty in girls?
Signup and view all the answers
What might a strong family history of male-limited precocious puberty indicate?
What might a strong family history of male-limited precocious puberty indicate?
Signup and view all the answers
What percentage of girls with major growth restriction will be below the 5th percentile for height as adults?
What percentage of girls with major growth restriction will be below the 5th percentile for height as adults?
Signup and view all the answers
Which physical change is typically observed in boys during precocious puberty?
Which physical change is typically observed in boys during precocious puberty?
Signup and view all the answers
What is the role of kisspeptin neurons in the arcuate nucleus?
What is the role of kisspeptin neurons in the arcuate nucleus?
Signup and view all the answers
How do LH and FSH affect the reproductive system?
How do LH and FSH affect the reproductive system?
Signup and view all the answers
What is the first sign of puberty in girls?
What is the first sign of puberty in girls?
Signup and view all the answers
What hormone is involved in the conversion of cholesterol to testosterone?
What hormone is involved in the conversion of cholesterol to testosterone?
Signup and view all the answers
At what age does pubarche typically begin?
At what age does pubarche typically begin?
Signup and view all the answers
What are the characteristics of the growth spurt during puberty?
What are the characteristics of the growth spurt during puberty?
Signup and view all the answers
Which hormones are primarily responsible for the characteristics of adrenarche?
Which hormones are primarily responsible for the characteristics of adrenarche?
Signup and view all the answers
Which of the following accurately describes the role of granulosa cells in females?
Which of the following accurately describes the role of granulosa cells in females?
Signup and view all the answers
Which condition is characterized by early activation of the HPO axis and is isosexual in development?
Which condition is characterized by early activation of the HPO axis and is isosexual in development?
Signup and view all the answers
What is the most common cause of Gonadotropin Independent precocious puberty in girls?
What is the most common cause of Gonadotropin Independent precocious puberty in girls?
Signup and view all the answers
What symptom might indicate a central nervous system issue in girls under 6 years experiencing precocious puberty?
What symptom might indicate a central nervous system issue in girls under 6 years experiencing precocious puberty?
Signup and view all the answers
Which of the following syndromes is associated with café au lait spots and polyostotic fibrous dysplasia of the bone?
Which of the following syndromes is associated with café au lait spots and polyostotic fibrous dysplasia of the bone?
Signup and view all the answers
What is the primary evaluation required for all girls under the age of 8 who exhibit both thelarche and pubarche?
What is the primary evaluation required for all girls under the age of 8 who exhibit both thelarche and pubarche?
Signup and view all the answers
Which diagnostic test is used to determine bone age in girls experiencing precocious puberty?
Which diagnostic test is used to determine bone age in girls experiencing precocious puberty?
Signup and view all the answers
What is the primary function of human placental lactogen (hPL) during pregnancy?
What is the primary function of human placental lactogen (hPL) during pregnancy?
Signup and view all the answers
Which hormone is primarily responsible for providing negative feedback to gonadotropes?
Which hormone is primarily responsible for providing negative feedback to gonadotropes?
Signup and view all the answers
What condition is characterized by sustained muscle contraction leading to repetitive twitching movements or abnormal postures?
What condition is characterized by sustained muscle contraction leading to repetitive twitching movements or abnormal postures?
Signup and view all the answers
Which of the following is NOT a primary cause associated with dystonia?
Which of the following is NOT a primary cause associated with dystonia?
Signup and view all the answers
What physiological change can be tracked to determine ovulation?
What physiological change can be tracked to determine ovulation?
Signup and view all the answers
What role does oxytocin play during the end of pregnancy?
What role does oxytocin play during the end of pregnancy?
Signup and view all the answers
What is a hallmark clinical feature of Wilson's disease?
What is a hallmark clinical feature of Wilson's disease?
Signup and view all the answers
Which hormone's rising levels during the first trimester may contribute to nausea and vomiting?
Which hormone's rising levels during the first trimester may contribute to nausea and vomiting?
Signup and view all the answers
Which diagnosis is most sensitive for detecting Wilson's disease?
Which diagnosis is most sensitive for detecting Wilson's disease?
Signup and view all the answers
During which period is the secretion of activins maximized in the ovaries?
During which period is the secretion of activins maximized in the ovaries?
Signup and view all the answers
What is a characteristic feature of Brown-Sequard syndrome?
What is a characteristic feature of Brown-Sequard syndrome?
Signup and view all the answers
Which of the following is not a function of estrogen during pregnancy?
Which of the following is not a function of estrogen during pregnancy?
Signup and view all the answers
Which Salter-Harris fracture type has a prognosis indicating the highest risk of complications like osteoarthritis?
Which Salter-Harris fracture type has a prognosis indicating the highest risk of complications like osteoarthritis?
Signup and view all the answers
What distinguishes β-hCG as a major analyte for establishing pregnancy?
What distinguishes β-hCG as a major analyte for establishing pregnancy?
Signup and view all the answers
What are the clinical features associated with Wilson's disease categorized under ABCD?
What are the clinical features associated with Wilson's disease categorized under ABCD?
Signup and view all the answers
What is the primary management approach for Wilson's disease?
What is the primary management approach for Wilson's disease?
Signup and view all the answers
Which symptom is considered an early sign of asymmetrical weakness in patients with motor neuron disease?
Which symptom is considered an early sign of asymmetrical weakness in patients with motor neuron disease?
Signup and view all the answers
What is the primary pharmacological treatment for mild to moderate forms of myasthenia gravis?
What is the primary pharmacological treatment for mild to moderate forms of myasthenia gravis?
Signup and view all the answers
Patients with what type of myasthenia gravis condition are typically managed on an outpatient basis?
Patients with what type of myasthenia gravis condition are typically managed on an outpatient basis?
Signup and view all the answers
Which of the following conditions is more likely to lead to hospitalization in myasthenia gravis patients?
Which of the following conditions is more likely to lead to hospitalization in myasthenia gravis patients?
Signup and view all the answers
What is a common complication experienced by patients due to immobility associated with motor neuron disease?
What is a common complication experienced by patients due to immobility associated with motor neuron disease?
Signup and view all the answers
Which symptom is NOT typically associated with frontotemporal dementia?
Which symptom is NOT typically associated with frontotemporal dementia?
Signup and view all the answers
What is the effect of acetylcholinesterase inhibitors in patients with myasthenia gravis?
What is the effect of acetylcholinesterase inhibitors in patients with myasthenia gravis?
Signup and view all the answers
Which of the following is NOT a motor symptom observed in patients with motor neuron disease?
Which of the following is NOT a motor symptom observed in patients with motor neuron disease?
Signup and view all the answers
What hormone is primarily responsible for stimulating the production of estradiol in the ovaries?
What hormone is primarily responsible for stimulating the production of estradiol in the ovaries?
Signup and view all the answers
What is the primary effect of neurokinin B and dynorphin released by kisspeptin neurons?
What is the primary effect of neurokinin B and dynorphin released by kisspeptin neurons?
Signup and view all the answers
In which stage of puberty does breast development with the formation of the breast bud occur?
In which stage of puberty does breast development with the formation of the breast bud occur?
Signup and view all the answers
Which hormone primarily regulates the conversion of cholesterol to testosterone in the Leydig cells?
Which hormone primarily regulates the conversion of cholesterol to testosterone in the Leydig cells?
Signup and view all the answers
Which cells are primarily targeted by LH in females to promote androgen production?
Which cells are primarily targeted by LH in females to promote androgen production?
Signup and view all the answers
What defines the onset of the pubarche stage during puberty?
What defines the onset of the pubarche stage during puberty?
Signup and view all the answers
What hormonal changes occur first in boys during puberty?
What hormonal changes occur first in boys during puberty?
Signup and view all the answers
What effect do sex steroids predominantly have during the growth spurt in puberty?
What effect do sex steroids predominantly have during the growth spurt in puberty?
Signup and view all the answers
Study Notes
Types of Fractures
- Colles Fracture: Wrist fracture common from falling on an outstretched hand, affects distal radius and ulna just above the wrist.
- Reverse Colles Fracture: Caused by falling on a flexed hand, treatable with surgery or splinting for four weeks.
- Snuff Box Fracture: Caused by extreme dorsiflexion of an outstretched hand leading to scaphoid bone injury, diagnosed via MRI, treated with a thumb splint.
- Non-Displaced Fracture: Managed with a thumb splint followed by cast immobilization; requires follow-up imaging.
- Displaced Fractures: Require surgical fixation to protect the scaphoid’s fragile blood supply.
- Stress Fractures: Result from repetitive microfractures; often radiographs are negative, diagnosed using MRI or bone scans.
- Secondary Signs: May include joint effusion, periosteal reactions, or the formation of calluses.
- Radial Head Fracture: Most common elbow fracture in adults caused by displacement of extra synovial fat; posterior fat density suggests a fracture.
- Pediatric Supracondylar Fracture: Equivalent signs present in children, often due to similar mechanisms as adult fractures.
- Hills Sachs Deformity: Commonly associated with anterior shoulder dislocations.
- Spiral Fracture: Can extend into the joint space, leading to significant clinical implications.
- Pathologic Fracture: Characterized by abnormal bone density and geographic lytic lesions, such as in the humerus.
Pediatric Fractures
- Pediatric bones feature epiphyseal "growth plates" which are critical for development.
-
Salter Harris Classification:
- Type I: Fracture through the growth plate; generally good prognosis.
- Type II: Involves growth plate and metaphysis; most common, good prognosis.
- Type III: Involves growth plate and epiphysis, which may cause premature fusion and osteoarthritis.
- Type IV: Affects growth plate, epiphysis, and metaphysis; similar concerns as Type III.
- Type V: Represents severe cases that often need intervention.
Management of Myasthenia Gravis (MG)
- Plasmapheresis: Removes antibodies (AChR or MuSK) from circulation; used in emergencies but associated with risks.
- Thymectomy: Surgical removal of the thymus can lead to remission and reduced medication dependency; indicated for patients with thymoma or specific patient criteria.
- Management of Myasthenic Crisis: Exacerbation of symptoms leading to respiratory failure; can be triggered by infections, surgery, or certain medications. Intubation and rapid therapies like plasmapheresis and IVIG are crucial.
Hormonal Regulation
-
Menstrual Cycle Regulation:
- GnRH stimulates FSH and LH release; FSH promotes follicular development and estradiol production; LH triggers ovulation.
- Positive feedback mid-cycle leads to increased estradiol, influencing LH surge.
-
Estrogens and Progestins:
- Estradiol supports endometrial growth and follicular sensitivity to FSH.
- Progesterone prepares the endometrium for implantation and triggers menstrual bleeding when withdrawn.
Puberty Stages
- Thelarche: Initial breast development, primarily under the influence of estrogen; occurs between 7-14 years.
- Pubarche: Growth of pubic and axillary hair influenced by testosterone; onset between 8-15 years.
- Growth Spurt: Occurs about two years earlier in girls than boys, involves significant height increase driven by sex steroids and growth hormones.
- Menarche: First menstrual bleeding occurs between 9-16 years, typically following growth spurts.
Precocious and Delayed Puberty
- Precocious Puberty: Diagnosed when early signs are observed by parents; often includes abnormal short stature.
- Potential causes include CNS issues, exposure to endocrine disruptors, and strong family history.
- Expected clinical features manifest in normal developmental sequences for both genders, though height and physical maturity may advance.
Muscle Contraction Disorders
- Sustained muscle contractions can lead to abnormal postures or repetitive twitching movements.
- May be focal (blepharospasm, spasmodic dysphonia, torticollis, writer's cramp) or segmental/generalized.
- Causes are classified as idiopathic (primarily torsion dystonia with an autosomal dominant pattern) or secondary (related to Wilson’s disease, Huntington’s chorea, Parkinson's, anoxia, stroke, or drug effects).
Wilson's Disease
- Genetic disorder caused by autosomal recessive mutation affecting copper metabolism.
- Results in excessive copper levels in serum, with deposition in liver, kidneys, cornea, and CNS, especially in basal ganglia.
- Kayser-Fleischer rings signify free copper in the iris, appearing as golden-brown or green.
- Clinical presentation includes hyperkinetic movement, tremors, parkinsonism, dysarthria, and cognitive/personality disorders.
- Diagnosis involves increased serum copper, decreased ceruloplasmin, increased 24-hour urinary copper, and liver biopsy.
- Treatments include chelation therapy using agents like penicillamine and trientine; zinc is also used.
Brown-Sequard Syndrome
- Results from hemisection of the spinal cord, often due to trauma.
- Symptoms include ipsilateral weakness, loss of joint position sense, and contralateral loss of pain and temperature sensation.
- Rarely causes bowel or bladder dysfunction.
Salter-Harris Type III Fracture Complications
- Pediatric bones have growth plates; fractures affect growth potential.
- Salter-Harris classification outlines types:
- Type I and II: fractures through growth plate with good prognosis.
- Type III: fractures involving growth plate and epiphysis, potential for premature fusion and osteoarthritis.
- Type IV: fractures affecting growth plate, epiphysis, and metaphysis, similar issues as Type III.
Clinical Features of Neuromuscular Disorders
- Presentations include dysarthria, dysphagia, excessive yawning, and emotional incontinence (pseudobulbar affect).
- Frontotemporal dementia leads to behavioral changes and cognitive decline.
- Symptoms of muscle atrophy, weakness, spasticity, hyperreflexia, clonus, and poor motor control are noted.
- Progressive muscle weakness typically presents asymmetrically.
Myasthenia Gravis (MG) Treatment
- Hospitalization indicated for severe bulbar symptoms, respiratory difficulties, or significant weakness.
- Outpatient management feasible for ocular MG and mild symptoms.
- Acetylcholinesterase inhibitors (e.g., pyridostigmine) enhance acetylcholine availability, effective in mild to moderate MG.
Hormones and Pregnancy
- Key hormone β-hCG established signals of pregnancy; rises rapidly during the first trimester, indicating fetal development.
- Human placental lactogen aids fetal nourishment and mammary gland development.
- Estrogen is responsible for organ development and physical changes, while progesterone increases blood flow to the womb.
- Oxytocin increases towards term, assisting in labor and lactation processes.
Puberty Stages and Hormonal Changes
- Thelarche: Initial breast development in girls, occurring from ages 7-14, driven by estrogen.
- Pubarche: Appearance of pubic and axillary hair, occurring from ages 8-15, driven by androgens.
- Growth Spurts: Occurs earlier in girls, often about 2 years from first pubertal signs; sex steroids stimulate growth hormone production.
- Precocious puberty defined as onset before the typical age, requiring evaluation in children under 6 or with specific symptoms.
- Classification includes Gonadotropin Dependent (early HPO axis activation) and Gonadotropin Independent (excess sex steroids).
McCune-Albright Syndrome
- Documented mutations in the GNAS1 gene lead to distinctive symptoms including café au lait spots and polyostotic fibrous dysplasia.
- Associated with conditions like gigantism and adrenal hyperplasia.
- Evaluations may include bone age assessment through X-ray and hormonal stimulation tests.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
.
