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Biomedicine I > 2. Skeletal System - Pathologies > Flashcards

2. Skeletal System - Pathologies Flashcards

1
Q

Fractures

A

Any break in a bone

Causes include trauma, low bone density (osteoporosis), vitamin D deficiency

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2
Q

Types of Fractures

A

Complete - bone is broken in two of more fragments
Incomplete - not in fragments
Avulsion - tendon or ligament pulls off a piece of bone

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3
Q

Fracture repair

A
  1. Haematoma (& inflammation): Blood vessels at fracture line are broken and blood leaks into site. Causes death of local cells and swelling.
  2. Fibrocartilaginous callus formation: Phagocytes clean up the debris. Fibroblasts invade & lay down collagen forming a ‘soft callus’ (2-3 weeks).
  3. Bony callus formation: Osteoblasts replace cart with new bone(<3 months).
  4. Bone remodelling:The callus is mineralised & compact bone laid down. Then Osteoclasts reshape the new bone. Remodelling occurs over months to years.
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4
Q

Sprains

A

Involve a trauma that fores a joint beyond its normal range, over-straining / tearing ligaments

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5
Q

Subluxation

A

Incomplete or partial joint dislocation

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6
Q

Dislocation

A

Complete separation of the two bones at a joint

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7
Q

Kyphosis

A

Rounding of the upper back.

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8
Q

Lordosis

A

Increased concavity in the lumbar and cervical spine

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9
Q

Scoliosis

A

A lateral S-shaped curve in the spine

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10
Q

Osteoporosis

A

Chronic, progressive thinning of the bone (porous bone).
Characterised by decreased bone mineral density leading to bone fragility & and an increased risk of fracture
Diagnosed by ‘Dual X-Ray Absorptiometry’

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11
Q

Osteoporosis: Risk Factors

A 
Increasing age -> over 30
Female and post-menopausal
Poor diet
Drugs -> long term corticosteroid therapy
GIT diseases
Genetics
Sedentary lifestyle
Endrocrine pathologies (Cushings, hyperparathyroidism)
Low body weight
High alcohol consumption and smoking
Toxins (heavy metals)
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12
Q

Osteoporosis: Signs & Symptoms

A

Fractures with minor trauma
Focal pain and kyphotic posture with loss of height
Pain is aggravated by prolongued sitting, standing or bending, relieved by lying on side with hips & knees flexed

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13
Q

Osteorporosis: Treatment

A

Bisphosphonates (AledronicAcid)

HRT

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14
Q

Osteomalacia and Rickets

A

Inadequate mineralisation of the bone matrix in spongy and compact bone.
Softening of bone
Rickets - prior to epiphyseal plate closure >18yo
Osteomalacia - as adult or adolescent

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15
Q

Osteomalacia and Rickets: Causes

A

Vitamin D deficiency, possibly due to:
• Insufficient sunlight.
• Insufficient dietary vitamin D.
• Secondary deficiency: malabsorption disorders.
•Reduced receptor sites for vitamin D in tissues

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16
Q

Osteomalacia and Rickets: Signs and Symptoms

A
  • Deformed bones (bowed legs) & possible fractures.
  • Severe back pain & muscle weakness.
  • In Rickets:Delayed closure of fontanelles and skull softening.
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17
Q

Osteomyelitis

A

A bacterial infection of the bone marrow, resulting in necrosis and hence bone weakness.
Diagnosed by
• Bloods: Elevated inflammatory markers(ESR/CRP) & WBC’s.
• X-ray, MRI.

18
Q

Osteomyelitis: Causes

A
  • Bacterial infection(staphylococcus aureus) through the blood supply or post-fracture.
  • Immunosuppression, diabetes, IV drug users.
19
Q

Osteomyelitis: Signs and Symptoms

A

Presents as severe bone pain (often worse at night), with swelling, redness and warmth.

20
Q

Osteoarthritis

A

A degenerative wear & tear arthritis of the articular cartilage, typically affecting weight bearing (larger) joints in individuals typically over 50 years of age.

21
Q

Osteoarthritis: Causes

A

• Primary:A ssociated with aging. 80% of 65 year old’s have radiological signs of OA.
• Secondary: Associated with predisposing factors:
Congenital ill-development.
Trauma –e.g. fractures, surgery, meniscal injury, obesity.

22
Q

Osteoarthritis: Signs and Symptoms

A
  • Onset is gradual, pain increasing (months –years).
  • Joint pain and stiffness.
  • Not associated with systemic symptoms.
23
Q

Osteoarthritis: Pathophysiology

A
  1. Articular cartilage wears away; underlying bone is exposed.
  2. Subchondral bone becomes hard and glossy (‘eburnation’).
  3. Remodelling of underlying bone (i.e. thickening) occurs.
  4. Compensatory bone overgrowth in an attempt to stabilise joint = Osteophytes(spurs).
24
Q

Rheumatoid Arthritis

A

Autoimmune inflammation of the synovium, potentially affecting ALL organs except the brain (systemic inflammation).
• Affects 1% of people worldwide, ↑ in women.
• Peak occurrence between 30–50 years of age

25
Q

Rheumatoid Arthritis: Causes

A
  • Geneticmarkers (HLA-DR4 & DR1).
  • Infectious agents e.g. EBV, rubella.
  • Abnormal intestinal permeability, Small Intestinal Bacterial Overgrowth (SIBO), smoking.
26
Q

Rheumatoid Arthritis: Signs and Symptoms

A
  • Symmetrical/bilateral arthritis of small joints (hands and feet mostly).
  • Gradually spreads through more proximal structures.
  • Progressive morning stiffness (>1 hour).
  • Deformity of jointse.g. swan neck, ulnar deviation.
  • General malaise and fatigue.
  • Subcutaneous nodules (around fingers and elbows).
  • C1/2 subluxation & compression of the spinal cord leading to paralysis neurological complications.
  • Kidney problems.
27
Q

Rheumatoid Arthritis: Treatment

A
  • Anti-inflammatories and immunosuppressants

* Surgery.

28
Q

Ankylosing Spondylitis (AS)

A

• AS is a systemic autoimmune disease associated with chronic inflammation of the spine & sacroilliacjoints, often leading to spinal fusion (‘ankylosis’) & stiffness.

29
Q

Ankylosing Spondylitis (AS): Causes

A
  • Age of onset is typically between 15-30 years of age, more commonly affecting males.
  • Strong genetic association with HLA-B27 (present in 95% of AS patients).
  • Links with inflammatory bowel diseases (& leaky gut), as well as uro-genital or intestinal infectionssuch as Salmonella & Shigella cross-reacting with HLA-B27.
30
Q

Ankylosing Spondylitis (AS): Signs and Symptoms

A

• Typically begins with sacroiliac and low lumbar
spine pain, before progressing up the spine. Associated with worsening morning stiffness.
• Lower back symptoms often improve with activity.
• The lumber lordosis flattens & patients often
become kyphotic.
• Hip and heel (Achilles) pain are common.
• 20% suffer acute iritis –(HLA-B27diseases)
• Systemic symptoms: fever, fatigue & malaise.

31
Q

Ankylosing Spondylitis (AS): Diagnosis

A

• Elevated blood inflammatory markers
(ESR/CRP), HLA-B27 positive.
• X-Ray/MRI – identifies characteristic
‘bamboo spine’.

32
Q

Ankylosing Spondylitis (AS): Treatment

A

Surgery, anti-inflammatories (including non-steroidal and steroids).

33
Q

Gout

A

Gout is a type of monoarthritis, characterised by uric acid crystal deposition in synovial joints.
• One of the most common forms of arthritis in men (10:1 women), over 40 years of age.
• Excess uric acid forms solid crystals (monosodium urate) on cartilage surfaces.
• This causes white blood cells to infiltrate activating an acute inflammatory response.
• ‘Hyperuricaemia’= elevated blood uric acid levels due to overproduction or underexcretion.
• Uric acid is derived from the breakdown of ‘purines’.

34
Q

Gout: Causes

A

• Increased intake of purine rich foods (red
meat, organ meats, shellfish etc).
• Dehydration, kidney disease, obesity, excessive alcohol consumption (competes with uric acid for elimination by the kidney & accelerates purine breakdown), hypertension, type II diabetes.

35
Q

Gout: Diagnosis

A
  • Blood serum for uric acid (not definitive fluctuates) but can be useful to monitor treatment.
  • Analysis of synovial fluid (needle aspiration).
36
Q

Gout: Signs and Symptoms

A
  • Most often affects the big toe. Can affect the mid-feet, ankles, knees, elbows, hands.
  • Usually monoarticular (one joint).
  • Sudden onset of intensely painful, red, hot & swollen joints, often lasting 12-24 hours. Shiny skin over joint.
  • Urate crystals can deposit under the skin and produce ‘tophi’.
37
Q

Gout: Treatment

A
  • ‘Allopurinol’ to prevent episodes (hepatotoxic).
  • Corticosteroid injection(Side effects:Indigestion, rapid heartbeat, nausea, insomnia, mood changes, diabetes, glaucoma, mood changes).
38
Q

Disc Herniation

A
  • The nucleus pulposus of the intervertebral disc leaks out through the annulus fibrosis.
  • This tends to affect discs with the highest fluid content (30-40 yearsof age). Most commonly lumbar spine (L5/S1), then cervical spine.
  • The classic injury mechanism is combined lumbar spine flexion (bending) and rotation.
  • A herniated disc cancompress spinal nerves.
39
Q

Disc Herniation - Treatment

A

Manual therapy & exercise
Steroid injection
Surgery

40
Q

Bursitis

A

Inflammation of the bursae

41
Q

Bursitis: Causes

A 
Repetitive use (overhead painting)
Sudden trauma, infection, wear and tear

Biomedicine I (18 decks)

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