MEDICAL FACTS AND MCQ'S

Pulsating Tumors of the Bone

*Primary tumors that may present as pulsating lesions :
- Telengiectatic Osteogenic sarcoma
- Angioendothelioma/Angiosarcoma of bone
- Aneurysmal bone cyst
- Giant cell tumor (rarely)

*Secondaries/Metastases that may present as pulsating lesions :
- Metastasis from Renal cell carcinoma
- Metastasis from Thyroid carcinoma

Markers of Bone formation and Bone resorption

*MARKERS OF BONE FORMATION :
- Serum Bone specific Alkaline phosphatase
- Serum Osteocalcin
- Serum propeptide or type I procollagen

*MARKERS OF BONE RESORPTION :
- Urine and Serum N-telopeptide
- Urine and Serum C-telopeptide
- Urine total free deoxypyridinoline
- Urine Hydroxyproline
- Serum tartarate resistant Acid phosphatase
- Serum Bone Sialoprotein
- Urine hydroxylysine glycosides

Congenital Dislocation of Hip ( CDH or DDH)

*Synonyms: CDH, Developmental dysplasia of the hip, DDH, dysplasia of the hip

*Developmental dysplasia of the hip (DDH) was formerly referred to as congenital dislocation of hip. DDH is now the preferred term to reflect that DDH is an ongoing developmental process, which is variable in presentation and not always detectable at birth. Developmental dysplasia of the hip refers to a range of developmental hip disorders, from a hip that is mildly dysplastic, concentrically located, and stable, to one that is severely dysplastic and dislocated.

*There is a suggestion that the national screening programme in the UK, that has operated since 1969, has

Milestones of Prenatal development

1^st week of gestation : fertilization and implantation , beginning of embryonic period.

2^nd week of gestation : endoderm and ectoderm appear ( bilaminar embryo ).

3^rd week of gestation : first missed menstrual period, mesoderm appears ( trilaminar embryo ), somites begin to form.

4^th week of gestation : neural folds fuse, folding of embryo into human like shape, arm and leg buds appear , crown-rump length is 4 to 5 mm .

5^th week of gestation : lens placodes,primitive mouth,digital rays on hands.

6^th week of gestation : primitive nose , philtrum ,primary palate , crown-rump length 21 – 23 mm

7^th week of gestation : eyelids begin

8^th week of gestation : ovaries and testes distinguishable

9^th week of gestation : fetal period begins, crown-rump length is 5 cms, weight is 9 grams .

10^th week of gestation : external genitalia distinguishable

20^th week of gestation : usual lower limit of viability ,weight is 460 grams , length is 19 cms

28^th week of gestation : eyes open , fetus turns head down , weight is 1000 grams

38^th week of gestation : term.

Nadas criteria

The assessment of a child for the presence or absence of heart disease can be done with the help of some guidelines suggested by nadas and are called "nadas criteria" . the criteria are divided into major and minor criteria. Presence of one major and two minor criteria are essential for indicating the presence of heart disease.

The major criteria are :

1. systolic murmur grade 3 or more specially with a thrill
2. diastolic murmur
3. cyanosis
4. congestive cardiac failure

The minor criteria are :

1. systolic murmur less than grade 3 in intensity
2. abnormal second heart sound ( S2)
3. abnormal ECG
4. abnormal X-ray
5. abnormal blood pressure

Juvenile Myoclonic Epilepsy ( Janz syndrome )

Here are some important points about Juvenile Myoclonic Epilepsy :

1. Juvenile Myoclonic Epilepsy is otherwise called Janz syndrome .

2. It usually begins between the ages of 12 and 16 year .

3. It accounts for approximately 5 % of all the epilepsies .

4. Patients note frequent myoclonic jerks on awakening , making hair combing and tooth-brushing difficult .

5. As the myoclonus tends to abate later in the morning, most patients do not seek medical advice at this stage and some deny the episodes .

6. A few years later, early morning generalized tonic-clonic seizures develop in association with the myoclonus.

7. The EEG shows a 4-6/sec irregular spike and wave pattern, which is enhanced by photic stimulation .

8. The neurologic examination is normal.

9. Majority of the patients respond dramatically to valproate, which is required lifelong .

10. Discontinuance of the drug causes a high rate of recurrence of seizures .