Adult Health Exam 4 (musculoskeletal & male reproductive disorders) Flashcards
how many bones in body
206
what are osteoblasts vs osteoclasts?
blast = builders clast = remodelers
osteocytes
mature bone
what are the 5 diff types of bones
Long bones, short bones, flat bones, irregular bones, sesamoid bones
what is compact bone vs spongy bone
Compact bone (cortical): dense and looks smooth
Spongy bone (cancellous): small lattice-like pieces called trabeculae
what are the 2 types of marrow and what do they contain
Red marrow consists mainly of hematopoietic tissue
Yellow marrow consists mostly of fat cells
how does estrogen affect bones?
Estrogen–induces chemical in osteoclasts that causes self destruction
Impact of menopause–decreases bone
How do calcitonin and TFH affect bone growth
Calcitonin & TSH = inhibit osteoclastic activity, stops remodeling process
-anterior pituitary promotes bone growth
how does parathyroid hormone affect bone growth
Parathyroid hormone = promotes activity for osteoblastic activity
how does GH affect bone growth
Growth hormone = facilitate bone growth until adult bone is reached
muscle strength is measured on what scale
0-5
what are lab studies associated with bone probs
- Calcium (norm: 8.8-10.3 mg/dL)
- Phosphorus (3-4.5 mg/dL) is inversely proportionate to Ca
- Vitamin D
- Calcitonin + Parathyroid
- Estrogen stimulates osteoblasts
what are imaging studies for bone issues?
XR, CT, MRI, arthrogram, DEXA (bone mineral density scan), bone scan, EMG, arthroscopic exam arthroscopy, arthrocentesis
What is a DEXA scan?
- Considered the “Gold Standard” for osteopenia/osteoporosis diagnosis
- No prep required
- Obtain height/weight
what happens to MSKL system with age
- Bone remodeling…
- Decrease in muscle fxn, mass & strength (sarcopenia)
- Decrease in motor neurons
- Decrease in joint/ligament/tendon flexibility and increase in stiffness
- Kyphotic posture
What are the ACCESS risk factors for osteoporosis
A: alcohol C: corticosteroids C: low calcium E: estrogen low S: smoking S: sedentary lifestyle
what is pathophys for osteoporosis and s/sx
Bone resorption activity is greater than bone rebuilding activity
Osteoclasts > osteoblasts
s/sx
“Silent” disease…
Dowager’s hump
Pathologic fracture
how to diagnose osteoporosis?
- Bone density tests: DEXA Scans
- –Osteopenia vs osteoporosis
- Quantitative computed tomography
prevention is key
what are nutritional changes for osteoporosis?
- -Calcium + vitamin D supplements (1st line PREVENTION!)
- -Recommended Calcium dosing for adults > 51: 1200mg/day
- -Recommended Vitamin D dosing: 800-1000iu
what meds for osteoporosis
Ca, vitD biphosphonates (fosamax), calcitonin, estrogen agonist/antagonist, parathyroid, dual acting bone agent, monoclonal
Calcium & vitamin D for osteoporosis
Ca dosing for adults >51 = 1200mg/day
Recommended Vitamin D dosing = 800-100 iu
Administration considerations = need together
Bisphosphonates for osteoporosis
Oral (Fosamax; risedronate; ibandronate)
- -Fosamax = take on empty stomach w full glass of water, sit up for 30 min afterwards, SE is destruction of jaw bone
- or monthly IV
Calcitonin for osteoporosis
made by thyroid, inhibits osteoclasts, can give as SQ injection, take vit d supp too
Estrogen agonist/antagonist for osteoporosis (evista)
preventative & treats osteoporosis, SE are risk for DVT
Parathyroid hormone for osteoporosis
protective factor against hormone regulated bone loss, SQ inj
Dual-acting bone agent for osteoporosis
decrease osteoclast, incr osteoblast activity, balance bone turnover
Monoclonal (denosumab/Prolia), Evenity for osteoporosis
inhibit osteoclastic activity, reducing bone reabsorption, last option med, SQ injection 2x/year, SE decrease serum calcium (do not give if low)
Evenity = new dual action monoclonal antibody, inhibits osteoclasts and increases osteoblast activity for severe osteoporosis —do not use if hx of MI/stroke
patient education for osteoporosis
Take medication as prescribed Weight reduction Adequate Calcium and vitamin D supplementation Exercise Avoid: alcohol, smoking
osteoarthritis
Progressive disease of articular cartilage (diarthrodial joints with synovial membrane)
risk factors for osteoarthritis
Risk factors =
Age
Female
Obesity (weight loss of 10% increases function of joint by 30%)
Occupation, manual labor
Poor diet = cartilage deteriorates from enzymes or nutrition
Articular Cartilage and involvement in osteoarthritis
-Chondrocytes make white smooth cartilage→ yellow & opaque with rough edges & softens. As it thins bones get closer
–causes central loss of cartilage, subchondral bone becomes more dense, osteophytes (bone spurs, classic sign*) develop
s/sx of osteoarthritis
- Localized joint s/sx = pain, swelling
- Asymmetrical
- Pain in AM, with weather changes, activity
- Eventually, pain all the time
- Loss of ROM (knee lock), cracking
- Bouchard’s nodules = at proximal, RED
- Heberden’s nodes = at distal osteophytes
what are bouchards nodules
proximal, red, osteoarthritis
what are heberdens nodes
at distal osteophytes, osteoarthritis
what is ESR for osteoarthritis indicative of
ESR (erythrocyte sedimentation rate) will be normal/elevated = indicates inflammation
what does increased CRP in osteoarthritis mean?
Increased CRP high sensitivity = indicates blood vessel injury, predictive test
what does osteoarthritis synovial fluid look like?
turbid, cloudy
how to determine RA vs osteoarthritis
Draw lab for rheumatoid factor to determine, negative = osteoarthritis; positive = RA
what is management for OA
- Conservative: phys therapy, NSAIDs, corticosteroid injections
- Prevent OA through exercise, weight bearing and wt loss
- GOAL = decrease pain, maintain mobility
what meds for OA
- -Tylenol, 4g/day max = Can also impact BG levels and cause fake low
- -NSAIDS = Considerations = careful with older, liver/renal insufficiency, higher risk for GI bleed (dark, tarry stools),
- -COX-2 inhibitors
- -Corticosteroid injections
- -Opioids–sparingly
- -Lidocaine patches
- -Glucosamine
what are different surgeries for OA
- -Debridement
- -Arthroplasty = resurface joint
- -Osteotomy = correct deformity by cutting bone, alter joint stress
- -Arthrodesis = fusion of joint
Sequence of progression of OA 6 steps
1 - Incongruity in joint surfaces leads to reduction in motion
2 - Osteophytes (bone spurs) form at joint margins
3 - Cartilage becomes softer and less elastic
4 - Erosion of articular surfaces
5 - Joint cartilage becomes yellow and granular
6 - Joint space narrows
joint replacement dx criteria
Dx = based on deformity, tissue destruction, loss of function
what are complications of hip, knee surgeries?
DVT, PE, Wound site infection, wound site infection, joint dislocation
pain meds pre/post arthroplasty
Pre op = nausea, stool softeners
Post op = pain meds, beta blockers, normal meds, antithrombotics
what are the 6 Ps for assessing for distal limb function/clot
polar, pallor, pain, pulselessness, paralysis, paresthesias
What is pagets disease
bone disease
risk factors for pagets disease
Risk factors =
Genetics measles as child Male Older than 50 Caucasian, european descent (dutch, british)
pathophys of pagets
accelerated bone remodeling
- Osteoblasts enlarged
- Osteoclasts overactive
where are the deformities of pagets usually
commonly skull, femur, tibia, pelvic bones, vertebrae
what does a radiographic exam for pagets look for
can for hot spots (weak spots)
what enzyme is elevated with pagets
Elevated ALP = enzyme made by bone cells, especially w overproducing bone cells
what meds for pagets
NSAIDs COX2 calcitonin bisphosphonates denosumab
what does calcitonin do for pagets
Calcitonin = first line, decreases osteoclast activity, helps with collagen breakdown SE = flushing :/
what are biphosphonates for pagets for
Bisphosphonates = helps with bone pain, decrease osteoclast activity
what does denosumab do for pagets
Denosumab = Monoclonal–inhibit osteoclastic activity, reducing bone reabsorption, last option med, SQ injection 2x/year, SE decrease serum calcium (do not give if low)
what are 2 surgical tx for pagets
Joint replacement
Spinal decompression
what is prognathism with pagets
Skeletal changes (deformities) → enlargement of mandible joint (prognathism)
what other body issues come with pagets
hearing loss, fractures, bone deformities
what is rheumatoid arthritis
- -Chronic systemic autoimmune disease of joints, has remissions and exacerbations
- -RA characterized by synovitis and joint deformity