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21- Bone Disease Flashcards

1
Q

What is osteoporosis?

A

It is a representation of low bone density. It is osteoclast activity that is more robust that of osteoblast activity.

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2
Q

How does osteoporosis appear on radiographs?

A
  • Radiolucent
  • Poorly demarcated
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3
Q

What is osteopenia?

A

It is a less severe level of low bone density that is sometimes considered as a precursor to osteoporosis.

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4
Q

What does osteoporosis look histologically?

A

1.) Thin cortex
2.) Fewer and thinner trabeculae
3.) Widely spaced trabecule

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5
Q

What does osteoporosis look clinically?

A

Like fragile bones
Susceptibility to fracture

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6
Q

What are some mediators involved with osteoporosis?

A

1.) TNF (tumour necrosis factor)
2.) RANK ligand is blocked

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7
Q

What are the three types of osteoporosis?

A

1.) Postmenopausal osteoporosis
2.) Aging osteoporosis
3.) Idiopathic osteoporosis

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8
Q

What are the treatments of osteoporosis?

A

1.) Bisphosphonates
2.) Estrogen replacement therapy
3.) Calcitonin
4.) Calcium

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9
Q

What is osteopetrosis?

A

It is known as Albers-Schonber Syndrome and Marble Bone Disease.

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10
Q

What are the causes of osteopetrosis?

A

It is the inherited failure of normal osteoclast function. May occur due to AD or AR inheritance.

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11
Q

What are the demographics of osteopetrosis?

A
  • men = women
  • onset is usually infancy
  • affects all bones
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12
Q

What are the clinical features of osteopetrosis?

A

1.) Pathologic fracture
2.) Osteomyelitis
3.) Impingement of cranial nerves
4.) Delayed tooth eruption

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13
Q

What are the radiographic indications of osteopetrosis?

A
  • Generalized increase in bone density (really radiopaque)
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14
Q

What is the histology of osteopetrosis?

A

1.) Thick, lamellar bone
2.) Small marrow spaces
3.) May see inflammatory cells if there is concurrent osteomyelitis

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15
Q

What is the treatment of osteopetrosis?

A

1.) Manage osteomyelitis with antibiotics. This is critical to prevent dental infection in these patients

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16
Q

What is Vitamin D? And what is its responsibility?

A

It is a fat-soluble steroid hormone that helps directly maintain calcium levels and indirectly affects phosphorus levels.

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17
Q

What does a deficiency of vitamin D result into?

A

It leads to rickets in children or osteomalacia in adults.

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18
Q

What are the clinical signs and symptoms of Vitamin D deficiency?

A
  • Growth delay
  • Defects at costochondral junction (rachitic rosary)
  • Bowed legs
  • Osteoporosis
  • Cognitive problems
  • Diffuse bone pain
  • Increased risk of bone fracture
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19
Q

What are the head and neck signs and symptoms of Vitamin D?

A

Enamel Hypoplasia
Enamel hypocalcification
Frontal bossing

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20
Q

What is the treatment of Vitamin D deficiency?

A

Vitamin D and Calcium supplementation

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21
Q

What is hypoparathyroidism?

A

It is when there are low levels of parathyroid hormone due to:
- latrogenic damage to parathyroid gland
- autoimmune destruction of the gland

22
Q

What are the key roles of PTH? (parathyroid hormones)

A

1.) Regulates calcium levels
2.) Decrease calcium -> Increase PTH -> Increase calcium levels
3.) Increase calcium resorption in kidneys
4.) Increase calcium release from bone
5.) Increase phosphate excretion from kidneys
6.) Increase Vitamin D production -> increase calcium absorption in the intestine/GI system

23
Q

What are the clinical signs and symptoms of hypoparathyroidism?

A
  • Problems related to low calcium (hypocalcemia)
  • Tetany:
    Trousseau’s sign
    Chvostek’s sign
  • Tingling and numbness
  • Arrythmia
  • Seizures
24
Q

What is Chvostek’s sign in Hypoparathyroidism?

A

When there is twitching of the upper lip when the facial nerve is hit.

25
Q

What is hyperparathyroidism?

A

It is when there is an elevated level of PTH.

26
Q

What occurs if there is an elevated of PTH?

A
  • increase in calcium absorption
  • increase calcium resorption from kidneys
  • increase bone resorption
27
Q

What are the causes of elevated PTH?

A
  • an increase secretion from pituitary
  • primary hyperparathyroidism
  • renal disease
28
Q

What are the main clinical signs and features of hyperparathyroidism?

A

Stones, bones, abdominal groans, thrones and psychiatric overtones

29
Q

What are head and neck findings of hyperparathyroidism?

A

1.) Ground glass bone
2.) Loss of lamina dura
3.) Cyst like radiolucencies

30
Q

What are the treatment methods for hyperparathyroidism?

A

1.) Remove pituitary tumor
2.) Assess and treat kidney disease
3.) Remove parathyroid glands

31
Q

What is Paget’s disease?

A

It is known as Osteitis Deformans, which is an increase in bone breakdown and formation. This occurs when the remodeling is disorganized, when there is more osteoblastic activity than osteoclastic.

32
Q

What are the clinical signs and symptoms of paget’s disease?

A

1.) Weak, misshapen bones
2.) Increase in bones/joints
3.) Increase risk of osteosarcoma

33
Q

What are the 3 distinct phases of Paget’s disease?

A

1.) Osteolytic phase (Bone breakdown)
2.) Mixed Phase (both bone breakdown and bone formation)
3.) Osteosclerotic phase (bone formation)

34
Q

What are the clinical features of Paget’s Disease?

A

1.) Asymptomatic bone enlargement
2.) Bowing of legs
3.) Elevated alkaline phosphatase levels
4.) Normal calcium and phosphate levels
5.) Vision loss
6.) Anemia
7.) Increased infection risk

35
Q

What is the radiographic presentation of Paget’s disease?

A

-Classic wool presentation of “Cotton wool”
- has a ressemblance to cemento-osseous dysplasia

36
Q

What are the treatment methods of paget’s disease?

A

1.) Mild cases require no treatment
2.) Bisphosphonates
3.) Surgical reduction
4.) Be aware of risk of osteosarcoma

37
Q

What is Fibrous dysplasia?

A

A developmental development of bone. Abnormality in the development of bone.

38
Q

What is the cause of Fibrous Dysplasia?

A
  • A mutation in the GNAS1 gene
39
Q

Where does Fibrous Dysplasia typically present itself?

A

First present in children
In the posterior maxilla is the most common head and neck location.

40
Q

What are the clinical features of Fibrous Dysplasia?

A

1.) Painless bone expansion
2.) Cortical expansion
3.) Ground glass radiopacity
4.) Poorly demarcated: blend with normal bone
5.) Lamina dura disrupted
6.) Teeth may become separate

41
Q

What is the difference between the Monostotic fibrous dysplasia vs. Polyostotic Fibrous dysplasia?

A

Monostotic fibrous dysplasia (craniofacial fibrous dysplasia) involves one bone while the polyostotic fibrous dysplasia involves multiple bones.

42
Q

What are the 2 major variants of Polyostotic Fibrous Dysplasia?

A

1.) Jaffe- Lichtenstein Syndrome
2.) McCune-Albright Syndrome

43
Q

What are the feature of Jaffe-Lichenstein Syndrome?

A
  • Cafe au lait spots
  • Polyostotic fibrous dysplasia
44
Q

What are the features of McCune-Albright Syndrome?

A
  • Cafe au lait spots
  • Polystotic fibrous dysplasia
  • Endocrrinepathies: sexual precocity, hyperthyroidism, pituitary adenoma
45
Q

What are the treatment and prognosis of Fibrous dysplasia?

A

1.) usually burns out and stops
2.) Tissue does not generally return to normal
3.) Bisphosphonates are often provided
4.) Surgical recontouring may be required

46
Q

What is osteosarcoma?

A

It is a malignancy of osteoblasts, it is also known as the most common primary bone cancer.

47
Q

What are the demographics of osteosarcoma?

A

Found in the second decade of life
Affects patients around the age of 10 years old than osteosarcoma of long bones

48
Q

What are the 3 distinct histologic variants of osteosarcoma?

A

1.) Osteoblastic
2.) Fibroblastic
3.) Chondroblastic

49
Q

What are the clinical and radiographic features of osteosarcoma?

A

1.) Aggressive growth
2.) Moth-eaten radiolucency
3.) Mixed radiolucency/radiopacity
4.) Sun-burst pattern
5.) Widened PDL space
6.) Painful
7.) Can metastasize

50
Q

What is the treatment for osteosarcoma?

A

Radical surgery required
Adjunctive chemotherapy and radiation therapy
poor long term survival

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