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Questions and Answers

What is a Colles fracture most commonly caused by?

Fall on a flexed hand

Fall with an outstretched hand (correct)

Overuse during sports activities

Direct blow to the wrist

Which type of fracture typically requires surgery or a splint for four weeks?

Non-displaced fracture

Snuff Box fracture

Radial head fracture

Reverse Colles fracture (correct)

What imaging technique is often used to detect a Snuff Box fracture?

Ultrasound

MRI (correct)

CT scan

X-ray

What is a common characteristic of stress fractures?

Result from repeated pressure on a bone Signup and view all the answers

What is the main diagnostic feature for a radial head fracture in adults?

Presence of fat density posteriorly Signup and view all the answers

Which Salter Harris classification indicates a fracture through the growth plate and metaphysis?

Type II Signup and view all the answers

In pediatric fractures, what signifies an increased risk of osteoarthritis?

Fracture involving the epiphysis Signup and view all the answers

What complication is commonly associated with anterior shoulder dislocations?

Hills Sachs deformity Signup and view all the answers

What is the primary hormone responsible for triggering ovulation?

Luteinizing hormone (LH) Signup and view all the answers

What effect does estradiol have on the endometrium?

Stimulates growth and development of the endometrium Signup and view all the answers

During which phase is there a surge in estradiol that stimulates FSH and LH secretion?

Midcycle phase Signup and view all the answers

Which cells produce testosterone in the ovaries?

Theca cells Signup and view all the answers

What is the result of progestin withdrawal at the end of the luteal phase?

Menstrual bleeding Signup and view all the answers

Which hormone’s secretions are predominantly inhibited during most of the menstrual cycle by estrogen?

Follicle-stimulating hormone (FSH) Signup and view all the answers

When is thymectomy generally indicated for patients with myasthenia gravis?

For patients with thymoma or specific antibody presence under 65 Signup and view all the answers

What is the main purpose of plasmapheresis in the treatment of myasthenia gravis?

To remove AChR or MuSK antibodies from circulation Signup and view all the answers

Which of the following is a potential precipitating factor for a myasthenic crisis?

Surgery Signup and view all the answers

Why is thymectomy not recommended for patients with MuSK antibodies?

It has not shown significant benefits in this population Signup and view all the answers

What is the role of oral glucocorticoids in the management of myasthenia gravis?

Indicated if symptoms persist despite pyridostigmine therapy Signup and view all the answers

Which of the following is true regarding the timing of thymectomy?

It should be performed when the patient is stable enough for surgery Signup and view all the answers

What leads to the production of insulin-like growth factor-1 in the liver?

Various hormonal signals Signup and view all the answers

At what age range does menarche typically occur?

Between 9 and 16 years Signup and view all the answers

What is a primary reason parents bring children in for evaluation of precocious puberty?

Short stature for age Signup and view all the answers

Which of the following is NOT a common clinical feature observed in central precocious puberty?

Highly advanced mental development Signup and view all the answers

Which sequence correctly describes the progression of puberty in girls?

Thelarche → Pubarche → Menarche Signup and view all the answers

What might a strong family history of male-limited precocious puberty indicate?

A potential genetic predisposition Signup and view all the answers

What percentage of girls with major growth restriction will be below the 5th percentile for height as adults?

30% Signup and view all the answers

Which physical change is typically observed in boys during precocious puberty?

Growth of testes to a volume ≥ 4 mL Signup and view all the answers

What is the role of kisspeptin neurons in the arcuate nucleus?

They stimulate the release of GnRH. Signup and view all the answers

How do LH and FSH affect the reproductive system?

They induce the secretion of androgens from testes and ovaries. Signup and view all the answers

What is the first sign of puberty in girls?

Development of breast bud. Signup and view all the answers

What hormone is involved in the conversion of cholesterol to testosterone?

LH Signup and view all the answers

At what age does pubarche typically begin?

8-15 years Signup and view all the answers

What are the characteristics of the growth spurt during puberty?

There is a 3-10 cm increase in height per year. Signup and view all the answers

Which hormones are primarily responsible for the characteristics of adrenarche?

DHEA and androgens Signup and view all the answers

Which of the following accurately describes the role of granulosa cells in females?

They convert androgens to estradiol. Signup and view all the answers

Which condition is characterized by early activation of the HPO axis and is isosexual in development?

Gonadotropin Dependent precocious puberty Signup and view all the answers

What is the most common cause of Gonadotropin Independent precocious puberty in girls?

Autonomously functioning ovarian cysts Signup and view all the answers

What symptom might indicate a central nervous system issue in girls under 6 years experiencing precocious puberty?

Severe headaches 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?

McCune-Albright Syndrome 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?

Evaluation for potential CNS issues Signup and view all the answers

Which diagnostic test is used to determine bone age in girls experiencing precocious puberty?

X-ray of the left hand Signup and view all the answers

What is the primary function of human placental lactogen (hPL) during pregnancy?

Stimulate milk production and nourish the fetus Signup and view all the answers

Which hormone is primarily responsible for providing negative feedback to gonadotropes?

Inhibins Signup and view all the answers

What condition is characterized by sustained muscle contraction leading to repetitive twitching movements or abnormal postures?

Dystonia Signup and view all the answers

Which of the following is NOT a primary cause associated with dystonia?

Multiple sclerosis Signup and view all the answers

What physiological change can be tracked to determine ovulation?

Increased body temperature Signup and view all the answers

What role does oxytocin play during the end of pregnancy?

Stimulates milk production and aids in labor Signup and view all the answers

What is a hallmark clinical feature of Wilson's disease?

Kayser-Fleischer ring Signup and view all the answers

Which hormone's rising levels during the first trimester may contribute to nausea and vomiting?

Human chorionic gonadotropin (hCG) Signup and view all the answers

Which diagnosis is most sensitive for detecting Wilson's disease?

Increased 24-hour urine copper Signup and view all the answers

During which period is the secretion of activins maximized in the ovaries?

Midcycle phase Signup and view all the answers

What is a characteristic feature of Brown-Sequard syndrome?

Ipsilateral weakness and joint position sense loss Signup and view all the answers

Which of the following is not a function of estrogen during pregnancy?

Promoting emotional stability Signup and view all the answers

Which Salter-Harris fracture type has a prognosis indicating the highest risk of complications like osteoarthritis?

Type III Signup and view all the answers

What distinguishes β-hCG as a major analyte for establishing pregnancy?

It is secreted by the developing embryo. Signup and view all the answers

What are the clinical features associated with Wilson's disease categorized under ABCD?

A: Asterixis; B: Basal ganglia symptoms; C: Cirrhosis; D: Dementia Signup and view all the answers

What is the primary management approach for Wilson's disease?

Chelation therapy Signup and view all the answers

Which symptom is considered an early sign of asymmetrical weakness in patients with motor neuron disease?

Foot drop Signup and view all the answers

What is the primary pharmacological treatment for mild to moderate forms of myasthenia gravis?

Acetylcholinesterase inhibitors Signup and view all the answers

Patients with what type of myasthenia gravis condition are typically managed on an outpatient basis?

Ocular myasthenia gravis Signup and view all the answers

Which of the following conditions is more likely to lead to hospitalization in myasthenia gravis patients?

Progressive deterioration Signup and view all the answers

What is a common complication experienced by patients due to immobility associated with motor neuron disease?

Constipation Signup and view all the answers

Which symptom is NOT typically associated with frontotemporal dementia?

Extrapyramidal symptoms Signup and view all the answers

What is the effect of acetylcholinesterase inhibitors in patients with myasthenia gravis?

They increase the availability of acetylcholine Signup and view all the answers

Which of the following is NOT a motor symptom observed in patients with motor neuron disease?

Pupillary dilation Signup and view all the answers

What hormone is primarily responsible for stimulating the production of estradiol in the ovaries?

Follicle-Stimulating Hormone (FSH) Signup and view all the answers

What is the primary effect of neurokinin B and dynorphin released by kisspeptin neurons?

Stimulate pulsatile release of GnRH Signup and view all the answers

In which stage of puberty does breast development with the formation of the breast bud occur?

Thelarche Signup and view all the answers

Which hormone primarily regulates the conversion of cholesterol to testosterone in the Leydig cells?

Luteinizing Hormone (LH) Signup and view all the answers

Which cells are primarily targeted by LH in females to promote androgen production?

Theca cells Signup and view all the answers

What defines the onset of the pubarche stage during puberty?

Growth of pubic and armpit hair Signup and view all the answers

What hormonal changes occur first in boys during puberty?

Pulsatile release of GnRH Signup and view all the answers

What effect do sex steroids predominantly have during the growth spurt in puberty?

Stimulation of bone density 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.

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