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Clinical Medicine II > Bone Histology and Disease > Flashcards

Bone Histology and Disease Flashcards

1
Q

Describe bone

A
  • rigid & static for mechanical purposes
  • some elasticity
  • physiologically active Ca (bone stores 99% of the body’s calcium), P (phosphate), & hematopoeisis (makes blood cells/platelets)
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2
Q

Parathyroid function

A
  • secretes parathyroid hormone (PTH) which regulates calcium & phosphate levels & monitor & adjust blood levels accordingly
  • PTH affects bone, kidney, & GI metabolism (increased or decreased Ca)
  • usually 4 parathyroid glands
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3
Q

Describe bone biochemistry

A
  • bone tissue is composed of tiny crystals of (Ca & P) embedded in a collagen framework
  • calcium crystals give bones their compressional strength, harness, & rigidity
  • collagen fibers give them their relative capacity for flexibility & tensile strength
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4
Q

What are the 3 types of bone cells

A
  • Osteoblasts (build)
  • Osteocytes (line the interior surface of the bone)
  • Osteoclasts (break down)
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5
Q

Difference between cortical (compact) bone and trabecular (spongy) bone

A
  • Cortical/compact bone is solid & dense
  • Trabecular/spongy bone is more porous & looks like a honeycomb
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6
Q

Describe bone at the tissue level

A
  • all bones are composed of interior trabecular bone surrounded by cortical bone
  • vertebrae are mostly trabecular bone surrounded by a thin cortical shell
  • long bones have relatively more cortical bone with areas of trabecular bone concentrated toward their ends
  • skeletal mass is 80% cortical bone & 20% trabecular but volume-wise we have more trabecular bone
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7
Q

Functions of the bone

A
  • allow for mobility via joints
  • resist &/or transfers mechanical stresses
  • maintain Ca homeostasis
  • production & storage for blood/immune system components
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8
Q

Describe the structure of bone

A
  • long bones are comprised of diaphysis (long tubular shaft), epiphysis (articulating surface), & metaphysis (the area that flares out)
  • children have epiphyseal plates which are cartilaginous between epiphysis & metaphysis
  • bones deform with stress (young” modulus; stress/strain curve)
  • bones also remodel according to stress (Wolff’s law); high stress = bone gets reinforced & low stress = bone gets resorbed
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9
Q

Define hematopoiesis

A
  • the production of blood cells & platelets which occurs in the bone marrow
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10
Q

Difference between parathormone and calcitonin

A
  • Parathormone: release calcium from bone
  • Calcitonin: bone uptake calcium
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11
Q

Symptoms of bone & joint disease

A
  • pain
  • decreased mobility
  • deformity
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12
Q

Define osteoporosis

A
  • bone mineral density 2.5 standard deviations below normal for age 30
  • peak bone mass is at 30 years
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13
Q

Causes of osteoporosis

A
  • estrogen loss
  • corticosteroids
  • loss of weight bearing/bed rest
  • hyperparathyroidism
  • hyperthyroidism
  • chronic renal failure
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14
Q

Epidemiology for osteoporosis

A
  • most common metabolic bone disease
  • 10 million people in the US
  • risk factors include: females, thinner, & asian/caucasian
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15
Q

Pathogenesis for osteoporosis

A
  • combination of increased bone reabsorption & decreased bone formation
  • imbalance between osteoclastic & osteoblastic function
  • greatest effect on trabecular bone (vertebrae) & metaphysis of long bones
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16
Q

Relevant factors of osteoporosis

A
  • hormones
  • aging
  • nutrition
  • physical activity
  • ethnicity
  • heredity
  • low body weight
  • smoking
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17
Q

Primary osteoporosis

A
  • idiopathic (no known cause)
  • post-menopausal
  • senile
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18
Q

Secondary (caused by something else) osteoporosis

A
  • endocrine disorders
  • malabsorption syndromes
  • chronic renal failure
  • rheumatoid arthritis
  • loss of menses
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19
Q

Clinical features of osteoporosis

A
  • back pain
  • postural changes
  • loss of height
  • fractures
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20
Q

Management of osteoporosis

A
  • fall prevention & other risk reduction strategies
  • proper nutrition
  • functional loading as tolerable
  • screening high risk groups (BMD)
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21
Q

If you were asked to design a community exercise program for women at high risk for osteoporosis, what would you include?

A
  • resistance training (loading of the axial skeleton)
  • postural training
  • fall prevention
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22
Q

Describe osteomalacia

A
  • softening of bone
  • in children it’s called Rickets
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23
Q

Pathogenesis of osteomalacia

A
  • inadequate mineralization of newly formed bone
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24
Q

Risk factors for osteomalacia

A
  • diet: little variety or certain dietary practices, low in milk products, low in phosphate, & low in vitamin D
  • anti-seizure medications
  • cancers
  • environment (limited sunlight, smog)
  • family Hx of vitamin D metabolism disorders
  • renal/hepatic pathology
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25
Q

Clinical manifestations of osteomalacia

A
  • diffuse aching
  • fatigue
  • weight loss
  • proximal muscle weakness
  • postural deformities
  • bowing of tibia & femur
  • osteopenia
  • fractures
  • neuropathies
26
Q

What might you observe in a child being evaluated in physical therapy with the concurrent diagnosis of Rickets?

A
  • long bone deformities
  • complaints of pain
  • possible Hx of fractures
  • if asked about diet they may be malnourished
27
Q

Describe a hemangioma of vertebrae

A
  • most common benign spinal neoplasm
  • women between 40-50
  • thoracic & lumbar spine
28
Q

Symptoms of hemangioma

A
  • back pain
  • radicular pain
  • spinal cord compression
  • compression fracture
29
Q

Describe avascular necrosis

A
  • death of bone tissue due to a lack of blood supply
  • most often occurs at hip
30
Q

Symptoms of avascular necrosis

A
  • pain
  • decreased ROM
  • for femoral head, pain may radiate into groin
31
Q

Risk factors for avascular necrosis

A
  • trauma or dislocation
  • long term steroid use
  • alcohol
  • chemotherapy
  • kidney disease with dialysis
  • sickle cell disease
32
Q

Describe osteomyelitis

A
  • infection of the bone (eg. staphylococcus)
33
Q

Causes of osteomyelitis

A
  • open injury to the bone (“exogenous osteomyelitis”)
  • bacteremia, sepsis, pre-existing infection (“hematogenous osteomyelitis)
  • chronic open wound or soft tissue infection
34
Q

Risk factors for osteomyelitis

A
  • diabetes
  • hemodialysis
  • immunosuppression
  • sickle cell disease
  • intravenous drug abuse
  • elderly
  • renal/hepatic failure
  • alcohol abuse
35
Q

Symptoms for osteomyelitis

A
  • pain/tenderness in the infected area (may be a late sign; no pain fibers in cancellous bone)
  • swelling & erythema in the infected area
  • fever
  • nausea, secondarily from being ill with infection
  • drainage of pus through the skin
36
Q

Management of osteomyelitis

A
  • prevention of infections
  • screening
  • diagnosis (often late due to lack of signs/symptoms &/or being mistaken for something else; need imaging & need to ID specific pathogen)
  • treatment (immediate & aggressive treatment; high-dose antibiotics, possibly surgery)
37
Q

Which direction does thoracic scoliosis and lumbar scoliosis commonly curve

A
  • Thoracic: commonly curves to the right
  • Lumbar: commonly curves to the left
38
Q

Frontal/transverse coupled motion general rules

A
  • Cervical spine (C2-T2): ipsilateral
  • Thoracic spine (T3-T7): contralateral
  • Lumbar spine (T8-S1) flexion: ipsilateral
  • Lumbar spine (T8-S1) extension: contralateral
39
Q

Describe scoliosis

A
  • lateral curves in excess of 10 degrees or greater (from the Cobb angle)
  • 60% idiopathic
  • curvature usually reaches its max progression during the adolescent growth spurt
40
Q

What are the 5 different types of scoliosis

A
  • Congenital: they were born with it
  • Idiopathic: occurs with no cause
  • Neuromuscular: commonly in children with cerebral palsy
  • Postural: functional, may be caused by pain, spasm, herniation, & can become structural over time
  • Syndromic: marfan
41
Q

Idiopathic scoliosis classification

A

James classification: patient’s age when the scoliosis was first identified
- Infantile: <3 years
- Juvenile: 3-10 years
- Adolescent: 10-20 years (4% of children 9-14 year)
- Adult: 20+ years

42
Q

Problems associated with severe scoliosis in the thoracic and lumbar spine

A
  • Thoracic: volume of the chest can be reduced especially if curve is >60 degrees
  • Lumbar: may push the contents of the abdomen against the chest & interfere indirectly with heart & lung function and alter sitting balance & posture
43
Q

Treatment for scoliosis

A
  • <25 degrees: no aggressive treatment
  • 25-40 degrees: braces often used to slow progression (TLSO/thoracic-lumbar-sacral-orthosis brace, Milwaukee brace, Boston brace, Charleston bending brace, & Providence brace)
  • Curves of 40 degrees or greater usually need surgery
44
Q

Describe infantile scoliosis

A
  • lateral curvature in the spine of >10 degrees
  • usually develops <6 months age
  • spine usually bends left
  • girls with right-bending curve have worse prognosis
  • likely have cardiopulmonary abnormalities
  • higher incidence of plagiocephaly (a slight flattening of one side of the head) and developmental dysplasia of the hip (ipsilateral to direction of spinal curvature)
45
Q

Casting for infantile scoliosis

A
  • infants with moderate & severe curves have a greater chance of progressing
  • serial casting up to 18 months
  • change cast/brace every 6-12 weeks
  • cast is made of plaster or fiberglass & is applied in the operating room under general anesthesia
46
Q

Complication of scoliosis

A
  • Thoracic insufficiency syndrome: inability of the chest to support normal breathing or lung growth
47
Q

Describe kyphoscoliosis

A
  • scoliosis + kyphosis
  • Juvenile kyphosis: posterior convexity that measures a Cobb angle greater than 5 in 3 adjacent thoracic vertebrae
  • Causes: trauma, tumor, infection (usually tuberculosis), osteoporosis, Scheuermann’s disease (seems to have a familial component), or a congenital or developmental process
48
Q

Describe scheuermann’s vertebral osteochondrosis

A
  • ossification & endochondral growth with pathologic changes to discs & vertebral body junctions
  • damage to the cartilage plates & ring epiphysis = Schmorl’s nodes
  • increased wedging of bodies & progressive kyphosis
49
Q

Describe Schmorl’s nodes

A
  • most commonly in the lower thoracic vertebrae
  • can result from herniation & associated pressure onto vertebral body surface -> necrosis
  • note the disc protrudes through the endplate
50
Q

Describe the clinical presentation of an adolescent with osteochondrosis

A
  • kyphosis
  • abnormal growth/lack of growth
  • wedging of vertebrae
51
Q

Difference between displaced/angulated and non-displaced fractures

A
  • Displaced/angulated: bone fragments have shifted out of position
  • Non-displaced: fragments maintain pre-injury anatomic shape & position
52
Q

Types of fractures

A
  • Stress: accumulated over time related to overuse
  • Pathological: the force it takes to break the bone in reduced by a disease
  • Traumatic
53
Q

Stages of healing for bone

A
  • the healing response of bone is the complete regeneration of original structures
  • healing of an acute fracture to long bone (compact) proceeds through the same phases of inflammation, repair, & remodeling
54
Q

Describe hematoma formation for bone

A
  • immediately after the injury, bleeding into the fracture site will form a hematoma
  • the inflammatory phase starts hours later (may last several weeks)
55
Q

Describe repair phase of bone

A
  • soft callus, then hard callus
  • cell proliferation: chondrocytes & osteoblasts deposit an organic matrix & hematoma is slowly absorbed
  • after 2-3 weeks, hematoma replaced by soft callus
  • fibrocartilage formation: pro callus differentiates into dense, fibrous, osteoid tissue & X rays show continued presence of rarefaction (thin or less dense bone)
  • as repair continues, size of soft callus gradually decreases, giving way to lamellar bone that forms a hard callus & joins the broken bone ends
  • union will normally occur 4-6 weeks (arm) or 8-12 weeks (leg) after fracture
56
Q

Describe the remodeling phase of bone

A
  • remodeling of the hard callus will return the fracture site to its original bony structure & appearance
  • bone callous will continue to shrink & shape into original bony structure
57
Q

Describe epiphyseal bone

A
  • growth plate in children & adolescents
  • is particularly susceptible to acute & chronic injuries
  • bone that forms as a result of injury to the epiphysis may alter or stop overall bone growth (can result in deformities)
58
Q

Factors that affect bone healing

A
  • immobilization
  • blood supply
  • position
  • location of fracture
  • type & severity of fracture
59
Q

Complications related to fractures

A
  • delayed union (takes excessively long), nonunion (fails to heal), malunion (heals in a bad position)
  • osteonecrosis
  • vascular injury
  • nerve injury
  • intra-articular & peri-articular adhesions
  • infection
60
Q

Describe soft tissue injury

A
  • concurrent injury
  • secondary dysfunction: disuse, adhesions (articular, periarticular, and/or capsulitis), and shortening

Clinical Medicine II (21 decks)

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