Vitamin D and Related Hormones
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Vitamin D and Related Hormones

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Questions and Answers

What is the primary effect of Parathyroid Hormone (PTH) on calcium levels in the body?

  • Increases calcium via bone and kidney resorption (correct)
  • Increases calcium via dietary absorption
  • Decreases calcium via urinary excretion
  • Decreases calcium by enhancing calcitonin activity

    • What vitamin deficiency is most commonly associated with Rickets?

  • Vitamin D (correct)
  • Vitamin K
  • Vitamin E
  • Vitamin A

    • Which statement is true regarding calcitonin's function?

  • Has no effect on calcium levels
  • Decreases calcium by inhibiting osteoclast activity (correct)
  • Increases calcium via osteoclast activity
  • Increases calcium reabsorption in the kidneys

    • What impact does liver disease have on vitamin D metabolism?

    <p>Reduces 1-hydroxylase activity</p> Signup and view all the answers

    What condition is characterized by elevated 1,25(OH)2D levels and alopecia?

    <p>Rickets resistant to Vitamin D</p> Signup and view all the answers

    What is the immediate treatment for severe hypocalcemia?

    <p>Calcium gluconate IV</p> Signup and view all the answers

    Which hormone increases phosphate resorption but decreases its excretion?

    <p>Parathyroid Hormone</p> Signup and view all the answers

    What is a common consequence of hypervitaminosis D?

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

    What is the likely outcome of a lumbar puncture that incorrectly punctures the posterior longitudinal ligament?

    <p>Introducing infection</p> Signup and view all the answers

    Which of the following types of spina bifida involves only a protrusion of meninges?

    <p>Spina Bifida Meningocele</p> Signup and view all the answers

    Which structure can be damaged in a hangman's fracture?

    <p>Pars interarticularis</p> Signup and view all the answers

    What defines a chance fracture?

    <p>Transverse fracture with anterior compression</p> Signup and view all the answers

    Which anatomical structure is involved with caudal anesthesia?

    <p>Sacral hiatus</p> Signup and view all the answers

    What is the defining characteristic of spondylolisthesis?

    <p>Anterior vertebral displacement</p> Signup and view all the answers

    What is the main role of the dorsal rami in the spinal cord?

    <p>Innervation of deep intrinsic back muscles</p> Signup and view all the answers

    Which condition is characterized by a tuft of hair and a small dimple?

    <p>Spina Bifida Occulta</p> Signup and view all the answers

    What is the most common site for a lumbar puncture?

    <p>Between L4/L5</p> Signup and view all the answers

    Which condition involves the protrusion of both meninges and central nervous system tissue?

    <p>Spina Bifida Myelomeningocele</p> Signup and view all the answers

    What is the characteristic feature of a Jefferson fracture?

    <p>Burst fracture of C1/C2</p> Signup and view all the answers

    Which ligament is typically involved in a laminectomy procedure?

    <p>Ligamentum Flavum</p> Signup and view all the answers

    In which space is a caudal anesthetic administered during pregnancy?

    <p>Epidural Space</p> Signup and view all the answers

    Which of the following describes a chance fracture?

    <p>Transverse fracture with anterior compression of the vertebral body</p> Signup and view all the answers

    What is the primary anatomical feature of spina bifida occulta?

    <p>Tuft of hair and small dimple</p> Signup and view all the answers

    What happens during a burst fracture?

    <p>Severe compression with vertebral body spreading in all directions</p> Signup and view all the answers

    Which structure is affected by a hangman’s fracture?

    <p>Cervical Vertebra C2</p> Signup and view all the answers

    Which muscle group's innervation is primarily attributed to the dorsal rami?

    <p>Deep Intrinsic Back Muscles</p> Signup and view all the answers

    What is the primary function of cholecalciferol in vitamin D metabolism?

    <p>Converts to 25-hydroxyvitamin D in the liver</p> Signup and view all the answers

    Which of the following conditions is directly associated with hypocalcemia?

    <p>Vitamin D deficiency</p> Signup and view all the answers

    How does parathyroid hormone (PTH) affect phosphate levels in the body?

    <p>Decreases renal excretion and increases bone resorption</p> Signup and view all the answers

    What is a likely consequence of excessive intake of vitamin D?

    <p>Enhanced calcium absorption leading to hypercalcemia</p> Signup and view all the answers

    Which vitamin D derivative is known as D2?

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

    In which condition would you expect low levels of 1,25 dihydroxyvitamin D?

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

    What skeletal deformity is primarily associated with Rickets?

    <p>Bow legs</p> Signup and view all the answers

    What is the role of calcitonin in calcium metabolism?

    <p>Lowers blood calcium levels by inhibiting osteoclast activity</p> Signup and view all the answers

    Which hormonal condition leads to hypercalcemia and high phosphate levels?

    <p>Hypervitaminosis D</p> Signup and view all the answers

    What is the main role of cholecalciferol in the body?

    <p>Enhance calcium absorption</p> Signup and view all the answers

    What causes elevated calcium levels in hypervitaminosis D?

    <p>Enhanced intestinal absorption of calcium</p> Signup and view all the answers

    Which condition is characterized by low levels of 1,25 dihydroxyvitamin D?

    <p>Kidney Disease</p> Signup and view all the answers

    What hormonal change is likely to occur in response to hypocalcemia caused by low parathyroid hormone levels?

    <p>Increased calcitonin secretion</p> Signup and view all the answers

    Which hormone is primarily responsible for stimulating the synthesis of 1,25 dihydroxyvitamin D?

    <p>Parathyroid hormone</p> Signup and view all the answers

    What is a likely effect of vitamin D deficiency in children?

    <p>Rickets with bow leg deformity</p> Signup and view all the answers

    What are the components of Calcitonin's action regarding calcium levels?

    <p>Decrease calcium resorption</p> Signup and view all the answers

    Which sign is commonly associated with severe hypocalcemia?

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

    What is the primary anatomical landmark for performing a lumbar puncture?

    <p>Highest Points of Iliac Crests</p> Signup and view all the answers

    Which type of spina bifida involves a protrusion of both the meninges and spinal cord tissue?

    <p>Spina Bifida Myelomeningocele</p> Signup and view all the answers

    What type of fracture is characterized by severe compression that spreads the vertebral body in all directions?

    <p>Burst Fracture</p> Signup and view all the answers

    Which condition involves a transverse fracture with anterior compression of the vertebral body?

    <p>Chance Fracture</p> Signup and view all the answers

    Damage to which ligament is typically identified in cases of a hangman’s fracture?

    <p>Transverse Ligament</p> Signup and view all the answers

    Which anatomical feature defines a Spondylolisthesis?

    <p>Vertebra slips anteriorly</p> Signup and view all the answers

    The Triangle of Petit is bordered medially by which muscle?

    <p>Latissimus Dorsi</p> Signup and view all the answers

    What is the result of compression of the dens or odontoid process?

    <p>Rupture of the Transverse Ligament</p> Signup and view all the answers

    What is the primary function of ergocalciferol (Vitamin D2)?

    <p>Increase calcium and phosphate resorption in the kidney</p> Signup and view all the answers

    What outcome can result from hypervitaminosis D?

    <p>Hypercalcemia and soft tissue calcification</p> Signup and view all the answers

    Which condition is characterized by low 1,25 dihydroxyvitamin D levels?

    <p>Vitamin D deficiency</p> Signup and view all the answers

    What is a consequence of parathyroidectomy regarding calcium levels?

    <p>Hypocalcemia due to low parathormone levels</p> Signup and view all the answers

    What is a primary physiological effect of parathyroid hormone (PTH)?

    <p>Increased renal excretion of phosphate</p> Signup and view all the answers

    Which condition might result from excess parathyroid hormone secretion?

    <p>Hypercalcemia and low phosphate levels</p> Signup and view all the answers

    What skeletal deformity is associated with severe vitamin D deficiency in children?

    <p>Bow leg deformity</p> Signup and view all the answers

    What is the consequence of reduced 25-hydroxylase activity in liver disease?

    <p>Reduced conversion of cholecalciferol to 25-hydroxyvitamin D</p> Signup and view all the answers

    What structure must be pierced to correctly perform a lumbar puncture at the L4/L5 level?

    <p>Subarachnoid Space</p> Signup and view all the answers

    Which type of spina bifida includes the protrusion of both the meninges and central nervous system tissue?

    <p>Spina Bifida Myelomeningocoele</p> Signup and view all the answers

    Which anatomical landmark is used to identify the appropriate site for a lumbar puncture?

    <p>Highest Points of Iliac Crests</p> Signup and view all the answers

    What is the primary characteristic of a burst fracture?

    <p>Severe compression with vertebral body spread in all directions</p> Signup and view all the answers

    Which structure is most commonly affected in a hangman's fracture?

    <p>Pars Inter-articularis of C2</p> Signup and view all the answers

    What describes a Chance fracture?

    <p>Transverse fracture with anterior compression of the vertebral body</p> Signup and view all the answers

    What structure is involved in caudal anesthesia administered during pregnancy?

    <p>Epidural Space</p> Signup and view all the answers

    Which characteristic is true of spondylolisthesis?

    <p>Vertebra slips anteriorly</p> Signup and view all the answers

    Study Notes

    Vitamin D

    • Increases calcium resorption in the kidneys
    • Increases phosphate resorption in the kidneys
    • Ergocalciferol (Vitamin D2) is a plant derivative
    • Cholecalciferol (Vitamin D3) is an animal derivative
    • Sunlight converts 7-dehydrocholesterol to cholecalciferol
    • Cholecalciferol is converted to 25-hydroxy by 25-hydroxylase and then to 1,25-dihydroxy by 1-hydroxylase
    • Liver disease reduces 25-hydroxylase activity
    • Kidney disease reduces 1-hydroxylase activity

    Parathyroid Hormone (PTH)

    • Increases calcium via bone and kidney resorption, and also stimulates vitamin D synthesis
    • Increases phosphate via bone resorption, but decreases it via excretion

    Calcitonin

    • Decreases calcium via osteoclast activity

    Rickets (Vitamin D Deficiency)

    • Bow leg deformity
    • Rachitic rosary
    • Pigeon chest
    • Vitamin D resistant rickets may lead to alopecia and elevated 1,25(OH)2D, but decreased calcium levels from diet

    Osteomalacia (Vitamin D Deficiency)

    • Frequent fractures

    Hypervitaminosis D

    • Enhanced calcium absorption leads to hypercalcemia
    • Soft tissue calcification

    Hypocalcemia

    • Low PTH levels: Hypoparathyroidism
    • High PTH levels: Secondary HYPERParathyroidism
    • Low 25-hydroxyvitamin D levels: Vitamin D Deficiency
    • Low 1,25-dihydroxyvitamin D levels: Renal insufficiency
    • Low parathormone levels: Parathyroidectomy
    • Severe hypocalcemia may lead to tetany, cardiac arrhythmias, and breathing irregularities
    • Treatment consists of immediate calcium gluconate IV, calcium supplements, and vitamin D

    Hypercalcemia

    • Excessive PTH: High PTH, high Ca, low PO4
    • Hypervitaminosis D: High Ca, high PO4, high 1,25(OH)2D
    • Hypercalcemia may lead to bone pain, muscle weakness, abdominal pain, and kidney stones

    Hyperphosphatemia

    • Poor phosphate absorption (Vitamin D deficiency) and high phosphate excretion (excess PTH)

    Spinal Conditions

    • Hyperkyphosis: Hunchback, an increase in thoracic curvature
    • Crush fracture: Compression of the vertebral body
    • Wedge fracture: Small fractures around the vertebral body
    • Spinal canal stenosis syndrome: Hypertrophy of the ligamentum flavum
    • Lateral displaced scapula: Damage to dorsal scapular nerve / Rhomboid major/minor
    • Winged scapula: Damage to the long thoracic nerve
    • Disc herniation: Nucleus pulposus protrusion posterolaterally into intervertebral foramen
    • Spina bifida occulta: Tuft of hair and a small dimple
    • Spina Bifida Meningocele: Protrusion of the meninges through unfused vertebral arch
    • Spina Bifida Myelomeningocoele: Protrusion of meninges and CNS tissue
    • Spina Bifida Myeloschisis: Protrusion of spinal cord or spinal nerves and meninges
    • Spinal cord termination: L1/L2
    • Laminectomy: Ligamentum Flavum
    • Caudal anesthetic: Sacral hiatus, epidural space (given during pregnancy)
    • Drooping shoulder: Damage to spinal accessory nerve / Trapezius
    • Compression of Dens/Odontoid Process: Rupture of transverse ligament
    • Fracture/Compression of Pedicles: Rupture of cruciform ligament
    • Hangman's fracture: Pars inter-articularis ~ Spondylolysis of C2 (anterior displacement = spondylolisthesis)
    • Whiplash: Hyperextension injury + Torn anterior longitudinal ligament
    • Jefferson fracture: Burst fracture of C1/C2 ONLY, damage to anterior/posterior arches
    • Wedge/Compression fracture: Loss of height, vertebral compression
    • Chance fracture: Transverse fracture w. anterior compression of vertebral body @ T12-L2 - forward flexion (lap seatbelt injury)
    • Burst fracture: Severe compression, vertebral body spread out in all directions (Anything below C2)
    • Spondolysis: Fracture of superior/inferior articular process/ pars interarticularis
    • Spondolysthesis: Vertebra slips anteriorly
    • Epidural drainage: Internal vertebral plexus of Batson
    • Dorsal rami: Innervation of deep intrinsic back muscles
    • Ventral rami: Mixed spinal nerves to/from all body minus back and head cranial nerves

    Surface Anatomy

    • Triangle of Petit:
      • Medial Border: Latissimus Dorsi
      • Lateral Border: External Abdominal Oblique
      • Inferior Border: Iliac Crest
      • Floor: Internal Abdominal Oblique
    • Triangle of Auscultation: Lat Dorsi + Trapezius + Scapula

    Hernias

    • Indirect Inguinal Hernia: Located at the inguinal canal
    • Direct Inguinal Canal: Located at the Hesselbach's Triangle
    • Femoral Hernia: Located below the inguinal ligament

    Vitamin D & Calcium Metabolism

    • Vitamin D increases calcium reabsorption in the kidneys.
    • Vitamin D also increases phosphate reabsorption in the kidneys.
    • Parathyroid hormone (PTH) increases calcium levels by stimulating bone resorption and kidney reabsorption, as well as increasing vitamin D synthesis.
    • PTH increases phosphate levels by stimulating bone resorption, but decreases phosphate levels by promoting excretion.
    • Ergocalciferol (vitamin D2) is derived from plants.
    • Cholecalciferol (vitamin D3) is derived from animals.
    • Sunlight converts 7-dehydrocholesterol into cholecalciferol.
    • Cholecalciferol is converted to 25-hydroxycholecalciferol by 25-hydroxylase.
    • PTH activates 1-hydroxylase to convert 25-hydroxycholecalciferol into 1,25-dihydroxycholecalciferol.
    • Calcitonin decreases calcium levels by inhibiting osteoclast activity.
    • Liver disease impairs vitamin D metabolism by reducing 25-hydroxylase activity.
    • Kidney disease reduces vitamin D metabolism by decreasing 1-hydroxylase activity.

    Rickets & Osteomalacia

    • Rickets (vitamin D deficiency) presents with bow leg deformity, rachitic rosary (enlargement of costochondral junction), and pigeon chest.
    • Vitamin D-resistant rickets presents with alopecia (hair loss) and elevated 1,25-dihydroxycholecalciferol levels due to low calcium intake.
    • Osteomalacia (vitamin D deficiency) is characterized by frequent fractures.

    Vitamin D Deficiency & Excess

    • Hypervitaminosis D, or vitamin D toxicity, leads to excessive calcium absorption, causing hypercalcemia.
    • Hypercalcemia can manifest as soft tissue calcification.

    Hypocalcemia

    • Hypocalcemia can be caused by low PTH levels in hypoparathyroidism.
    • Hypocalcemia can also be caused by high PTH levels in secondary hyperparathyroidism.
    • Low 25-hydroxyvitamin D levels can lead to hypocalcemia in vitamin D deficiency.
    • Renal insufficiency can lead to hypocalcemia by decreasing 1,25-dihydroxyvitamin D levels.
    • Parathyroidectomy leads to low parathormone levels and subsequent hypocalcemia.
    • Severe hypocalcemia can cause tetany, cardiac arrhythmias, respiratory problems.
    • Immediate treatment for severe hypocalcemia is to administer calcium gluconate IV.
    • Long-term treatment for hypocalcemia includes calcium supplements and vitamin D.

    Hypercalcemia

    • Excessive PTH levels lead to high PTH, high calcium, and low phosphate (hypercalcemia).
    • Hypervitaminosis D leads to high calcium, high phosphate, and high 1,25-dihydroxycholecalciferol levels (hypercalcemia).
    • Hypercalcemia can cause symptoms such as bone pain, muscle weakness, abdominal pain, and general weakness.

    Hyperphosphatemia

    • Hyperphosphatemia can be caused by poor phosphate absorption (vitamin D deficiency) and increased phosphate excretion (excess PTH).

    Spinal Anatomy

    • Hyperkyphosis ("hunchback") is an increased thoracic curvature.
    • A crush fracture is a compression of the vertebral body.
    • A wedge fracture is a small fracture around the vertebral body.
    • Spinal canal stenosis syndrome results from hypertrophy of the ligamentum flavum.
    • Lateral displaced scapula is caused by damage to the dorsal scapular nerve or rhomboid major/minor muscles.
    • Winged scapula is caused by damage to the long thoracic nerve.

    Spinal Cord & Meninges

    • Herpes zoster, or shingles, is located in the dorsal root ganglion.
    • A lumbar puncture is performed between L4/L5 in the subarachnoid space, passing through the supraspinous ligament.
    • An incorrect lumbar puncture may pierce the posterior longitudinal ligament.
    • The highest points of the iliac crests are landmarks for lumbar puncture (the Tuffier line).
    • Disc herniation occurs through the foramen when the nucleus pulposus protrudes posterolaterally.
    • Spina bifida occulta presents with a tuft of hair and a small dimple.
    • Meningocele is the protrusion of meninges through an unfused vertebral arch.
    • Myelomeningocoele is the protrusion of meninges and central nervous system (CNS) tissue.
    • Myeloschisis is the protrusion of spinal cord, spinal nerves, and meninges.
    • The spinal cord terminates at L1/L2.
    • Laminectomy is a surgical procedure involving removal of the ligamentum flavum.
    • Caudal anesthesia is administered through the sacral hiatus into the epidural space, often used during pregnancy.

    Neck and Upper Back

    • Drooping shoulder is caused by damage to the spinal accessory nerve or the trapezius muscle.
    • Compression of the dens (odontoid process) can occur due to rupture of the transverse ligament.
    • Fracture or compression of the pedicles can lead to rupture of the cruciform ligament.
    • Hangman's fracture, a pars interarticularis fracture of C2, can cause anterior displacement (spondylolisthesis).
    • Whiplash is a hyperextension injury causing damage to the anterior longitudinal ligament.
    • A Jefferson fracture is a burst fracture of C1/C2, resulting in damage to the anterior/posterior arches.
    • Wedge/compression fractures of the vertebrae cause loss of height.
    • A Chance fracture is a transverse fracture with anterior compression of the vertebral body, often seen at T12-L2 due to forward flexion (lap belt injury).
    • A burst fracture is a severe form of compression fracture with the vertebral body spreading in all directions.
    • Spondylolysis is fracture of the superior/inferior articular process or pars interarticularis.
    • Spondylolisthesis is the anterior slippage of a vertebra.

    Back Muscles & Pain

    • The internal vertebral plexus of Batson allows for epidural drainage.
    • Dorsal rami innervate the deep intrinsic back muscles.
    • Ventral rami are mixed spinal nerves supplying and receiving signals from the entire body, except for the back and head (cranial nerves).

    Abdominal Wall

    • The triangle of Petit is a small anatomical region in the lower abdominal wall. Its boundaries are:
      • Medial border: Latissimus dorsi muscle.
      • Lateral border: External abdominal oblique muscle.
      • Inferior border: Iliac crest.
      • Floor: Internal abdominal oblique muscle.
    • The triangle of auscultation is located between the latissimus dorsi, trapezius, and scapula.

    Hernias

    • An indirect inguinal hernia is located in the inguinal canal.
    • A direct inguinal hernia occurs within Hesselbach's triangle.
    • A femoral hernia is located below the inguinal ligament.

    Vitamin D & Calcium Metabolism

    • Vitamin D increases calcium resorption in the kidney, increasing blood calcium levels
    • Vitamin D increases phosphate resorption in the kidney, increasing blood phosphate levels
    • Parathyroid hormone (PTH) increases calcium levels by increasing bone and kidney resorption and stimulating vitamin D synthesis
    • PTH increases phosphate levels by increasing bone resorption but decreases phosphate levels through increased excretion
    • Ergocalciferol (vitamin D2) is derived from plants
    • Cholecalciferol (vitamin D3) is derived from animals
    • Sunlight converts 7-dehydrocholesterol into cholecalciferol
    • Cholecalciferol is converted to 25-hydroxycholecalciferol by 25-hydroxylase, then to 1,25-dihydroxycholecalciferol by 1-hydroxylase, with PTH activating the last step.
    • Calcitonin decreases calcium levels by inhibiting osteoclast activity
    • Liver disease decreases 25-hydroxylase activity, impacting vitamin D metabolism
    • Kidney disease decreases 1-hydroxylase activity, impacting vitamin D metabolism

    Rickets & Osteomalacia

    • Rickets, a vitamin D deficiency in children, leads to bow leg deformities, rachitic rosary (beading of ribs), and pigeon chest
    • Vitamin D-resistant rickets is characterized by alopecia (hair loss) and elevated 1,25(OH)2D, likely due to poor calcium absorption from the diet
    • Osteomalacia, a vitamin D deficiency in adults, causes frequent fractures

    Hypervitaminosis D

    • Hypervitaminosis D, or vitamin D toxicity, leads to enhanced calcium absorption, causing hypercalcemia
    • Hypercalcemia can lead to soft tissue calcification

    Hypocalcemia

    • Hypocalcemia, low blood calcium levels, can be caused by low PTH (hypoparathyroidism)
    • Hypocalcemia can also be caused by high PTH (secondary hyperparathyroidism) as the body compensates for low calcium
    • Vitamin D deficiency leads to low 25-hydroxyvitamin D levels, contributing to hypocalcemia
    • Renal insufficiency can cause low 1,25-dihydroxyvitamin D levels, contributing to hypocalcemia
    • Parathyroidectomy lowers parathormone levels, which can cause hypocalcemia

    Severe Hypocalcemia

    • Severe hypocalcemia can lead to tetany, cardiac arrhythmias, and respiratory problems
    • Immediate treatment includes intravenous calcium gluconate, followed by calcium supplements and vitamin D

    Hypercalcemia

    • Excessive PTH leads to high PTH, high calcium, and low phosphate levels
    • Hypervitaminosis D leads to high calcium, high phosphate, and high 1,25(OH)2D, potentially causing bone pain, muscle weakness, abdominal pain, and kidney stones

    Hyperphosphatemia

    • Hyperphosphatemia, high phosphate levels, can be caused by poor phosphate absorption due to vitamin D deficiency or by increased phosphate excretion
    • Excess PTH can also contribute to hyperphosphatemia

    Spine Disorders

    • Hyperkyphosis (hunchback) involves increased thoracic curvature
    • Crush fracture is a compression of a vertebral body
    • Wedge fracture involves small fractures around a vertebral body
    • Spinal canal stenosis syndrome arises from hypertrophy of the ligamentum flavum

    Scapula Disorders

    • Laterally displaced scapula results from a damaged dorsal scapular nerve, affecting rhomboid major and minor muscles
    • Winged scapula is caused by damage to the long thoracic nerve

    Herpes Zoster

    • Herpes zoster, commonly known as shingles, affects the dorsal root ganglion

    Lumbar Puncture

    • Lumbar puncture is performed between L4/L5 in the subarachnoid space, passing through the supraspinous ligament
    • Incorrect puncture can damage the posterior longitudinal ligament
    • The landmark for lumbar puncture is the highest point of the iliac crests, also known as the Tuffier's line

    Disc Herniation

    • Disc herniation involves the protrusion of the nucleus pulposus posterolaterally into the intervertebral foramen

    Spina Bifida

    • Spina bifida occulta is characterized by a tuft of hair and a small dimple over an unfused vertebral arch, often asymptomatic
    • Spina bifida meningocele involves the protrusion of meninges through the unfused vertebral arch
    • Spina bifida myelomeningocele is the protrusion of meninges and central nervous system tissue
    • Spina bifida myeloshisis is the protrusion of the spinal cord or spinal nerves and meninges

    Other Spinal Anatomy

    • The spinal cord terminates at L1/L2
    • Laminectomy often targets the ligamentum flavum
    • Caudal anesthetic is delivered through the sacral hiatus into the epidural space, commonly used during pregnancy

    Neck and Shoulder Injuries

    • Drooping shoulder is associated with damage to the spinal accessory nerve or the trapezius muscle
    • Compression of the dens/odontoid process indicates a rupture of the transverse ligament
    • Fracture or compression of pedicles suggests a rupture of the cruciform ligament

    Vertebral Fractures

    • Hangman's fracture is a pars interarticularis fracture of C2 often causing anterior displacement, also known as spondylolisthesis
    • Whiplash is a hyperextension injury often leading to a torn anterior longitudinal ligament
    • Jefferson fracture involves a burst fracture of C1/C2 with damage to the anterior and posterior arches
    • Wedge/compression fractures result in a loss of vertebral body height from compression
    • Chance fracture involves a transverse fracture with anterior compression of the vertebral body, commonly occurring at T12-L2 due to forward flexion, often associated with lap seatbelt injuries
    • Burst fracture is a severe compression of the vertebral body with fragments displaced in all directions affecting any vertebrae below C2
    • Spondolysis is a fracture of the superior or inferior articular processes or pars interarticularis, typically treated with immobilization using a dog collar
    • Spondylolisthesis is when a vertebra slips anteriorly

    Spinal Drainage

    • Epidural drainage occurs through the internal vertebral plexus of Batson

    Spinal Nerve Innervation

    • Dorsal rami innervate deep intrinsic back muscles
    • Ventral rami are mixed spinal nerves that innervate all body parts except the back and head, which are innervated by cranial nerves.

    Body Cavities and Structures

    • Triangle of Petit:
      • Medial border: Latissimus dorsi
      • Lateral border: External abdominal oblique
      • Inferior border: Iliac crest
      • Floor: Internal abdominal oblique
    • Triangle of Auscultation: Located between the latissimus dorsi, trapezius, and scapula
    • Indirect inguinal hernia: Located within the inguinal canal
    • Direct inguinal hernia: Located within Hesselbach's triangle
    • Femoral hernia: Located below the inguinal ligament

    Vitamin D & Calcium

    • Increases calcium resorption in the kidneys
    • Increases phosphate resorption in the kidneys
    • Synthesized by sunlight on the skin, and then converted into active form by the kidneys

    Parathyroid Hormone

    • Increases calcium via bone and kidney resorption and vitamin D synthesis
    • Increases phosphate via bone resorption, but decreases it via excretion

    Vitamin D Deficiency

    • Caused by lack of sunlight exposure, malabsorption, or liver and kidney disease.
    • Contributes to Rickets in children, characterized by weak bones, bowing of legs, and chest deformities
    • Can lead to Osteomalacia in adults, resulting in frequent fractures
    • Can be caused by genetic disorders
    • Results in reduced bone mineralization and an increased risk of fractures

    Vitamin D Toxicity

    • Excessive intake of Vitamin D causes Hypercalcemia (high levels of calcium in blood)
    • Soft tissue calcification
    • Can cause renal failure

    Calcitonin

    • Hormone produced by thyroid gland
    • Decreases calcium levels in the blood by inhibiting the activity of osteoclasts (cells that break down bone)

    Hypocalcemia

    • Low calcium levels in blood
    • Caused by low parathyroid hormone (hypoparathyroidism)
    • Can be caused by high parathyroid hormone due to secondary hyperparathyroidism (usually due to vitamin D deficiency)
    • Can occur due to:
      • Vitamin D deficiency, leading to low 25-hydroxyvitamin D levels
      • Renal insufficiency, leading to low 1,25-dihydroxyvitamin D levels
      • Parathyroidectomy, leading to low parathormone levels
    • Symptoms: tetany, cardiac arrhythmias, breathing problems

    Treatment of Hypocalcemia:

    • Calcium gluconate IV (immediate treatment)
    • Calcium supplements
    • Vitamin D

    Hypercalcemia

    • High calcium levels in the blood
    • Caused by:
      • High parathyroid hormone (hyperparathyroidism)
      • High levels of 1,25-dihydroxyvitamin D
    • Symptoms: weakness, constipation.

    Hyperphosphatemia

    • High phosphate levels in blood
    • Caused by:
      • Poor phosphate absorption due to vitamin D deficiency
      • High phosphate excretion due to excess parathyroid hormone

    Back Pain

    • Hyperkyphosis: Humpback (increased thoracic curvature)
    • Crush Fracture: Compression of vertebral body
    • Wedge Fracture: Small fractures around vertebral body
    • Spinal Canal Stenosis Syndrome: Hypertrophy of ligamentum flavum
    • Lateral Displaced Scapula: damage to dorsal scapular nerve or Rhomboid major/minor
    • Winged Scapula: Long Thoracic Nerve

    Spinal Cord and Back

    • Herpes Zoster: Located at dorsal root ganglion
    • Lumbar Puncture: Between L4-L5 (subarachnoid space)
      • Landmark for lumbar puncture: Highest point of iliac crests (Tuffe's Line)
    • Disc Herniation: Nucleus pulposus protrudes posterolaterally into the intervertebral foramen.
    • Spina Bifida: Different types:
      • Occulta: Tuft of hair and a small dimple
      • Meningocele: Protrusion of meninges through unfused vertebral arch
      • Myelomeningocoele: Protrusion of meninges and CNS tissue
      • Myeloschisis: Protrusion of the spinal cord, spinal nerves, and meninges
    • Spinal Cord Termination: L1/L2
    • Laminectomy: Involves removal of part of the vertebral arch and removal of the ligamentum flavum
    • Caudal Anesthetic: Injected into the sacral hiatus (epidural space)
    • Drooping Shoulder: Damage to spinal accessory nerve (CN XI) or trapezius
    • Compression of Dens/Odontoid Process: Rupture of transverse ligament
    • Fracture/Compression of Pedicles: Rupture of cruciform ligament
    • Hangman's Fracture: Fracture of the pars interarticularis of C2, causing anterior displacement of C2 (Spondylolisthesis)

    Vertebral Fractures:

    • Whiplash: Hyperextension Injury, tearing of anterior longitudinal ligament
    • Jefferson: Burst Fracture of C1/C2, damage to anterior and posterior arches.
    • Wedge/Compression Fracture: Loss of vertebral height
    • Chance Fracture: Transverse fracture with anterior compression of the vertebral body, usually at T12-L2, often caused by forward flexion (lap seatbelt injury)
    • Burst Fracture: Severe compression of vertebral body, forcing bone fragments in all directions
    • Spondylolysis: Fracture of the pars interarticularis, usually requiring a "dog collar" immobilizer
    • Spondylolisthesis: Vertebra slips anteriorly
    • Epidural Drainage: Internal vertebral plexus of Batson

    Muscles in Back

    • Dorsal Rami: Innervate deep intrinsic back muscles
    • Ventral Rami: Mixed spinal nerves to and from all parts of the body, excluding the back

    Anatomy of the Back

    • Triangle of Petit: Medial border - Latissimus dorsi, Lateral border - External abdominal oblique, Inferior border - Iliac crest, Floor - Internal abdominal oblique
    • Triangle of Auscultation: Latissimus dorsi, trapezius, scapula

    Hernia

    • Indirect Inguinal Hernia: Located at the inguinal canal
    • Direct Inguinal Hernia: Located at the Hesselbach's Triangle
    • Femoral Hernia: Located below the inguinal ligament

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    This quiz covers key concepts related to Vitamin D, its derivatives, and associated hormones like Parathyroid Hormone and Calcitonin. You'll also explore the effects of Vitamin D deficiency, including conditions like Rickets and Osteomalacia. Test your knowledge of these important topics in human physiology.

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