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Systems Screening II > Bones > Flashcards

Bones Flashcards

1
Q

A genetic defect of endochondral ossification in the long bones; Defect is an inherited autosomal trait, NOT sex linked gene

A

Achondroplastic Dwarfism: presents with short arms and legs (torso unaffected bc they don’t ossify by endochondral ossification)

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2
Q

Where does long bone growth occur after birth?

A

Epiphyseal plate

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3
Q

A genetic defect that results in a mutation of the gene that codes for Type I collagen, the principle protein of the osteoid; The trait causes defective bone or osteoid formation; Results in defects of any tissue that consists of mostly Type I collagen

A

Osteogenesis Imperfecta

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4
Q

What occurs in the most severe forms of osteogenesis imperfecta?

A

infants born with many fractures; children have growth problems and are hospitalized for surgical repair and bony deformities

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5
Q

What are the types of defects in tissues are presented in patients with osteogenesis imperfecta?

A
  1. Thin skin
  2. Thin dental enamel
  3. Defective heart valves, e.g., floppy mitral valve
  4. Bluish hue to the normally white sclera of the eye
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6
Q

Inflammation of the bone caused by an infectious organism; Most common cause is bacteria, staphylococcus aureus but can be caused by fungi, parasites, and viruses

A

Osteomyelitis

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7
Q

Spread from preexisting infections from other body sites by the blood; more common in children than adults

A

Hematogenous osteomyelitis

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8
Q

Invasion of bone by infectious organism from outside the body

A

Exogenous osteomyelitis

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9
Q

Where is osteomyelitis more common in children?

A

Long bones (bones are still growing)

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10
Q

Adolescents and adults in addition to other sites, commonly occurs in ______

A

Vertebrae (back pain may be only symptom)

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11
Q

Chronic forms of osteomyelitis are more common in ______ and ________

A

Older adults; immunocompromised person

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12
Q

Where are the most common sites for osteomyelitis?

A
  1. Hands
  2. Humerus
  3. Femur
  4. Tibia
  5. Fibula
  6. Feet
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13
Q

Trauma or infections in other body areas, Drug addicts, Patients with sickle cell anemia,
Patients with tuberculosis who develop Pott’s disease, Patient with syphilis, and Screws and external fixators for Fx care ARE ALL RISK factors for:

A

Osteomyelitis

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14
Q

Where does the infection in osteomyelitis usually originate? why does it originate here?

A

In the metaphysis; it is the most vascularized part of the bone

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15
Q

Describe the pathology of osteomyelitis

A
  1. Initial infection takes place; neutrophils phagocytize bacteria
  2. Neutrophils die and create pus
  3. pus elevates periosteum, blocks blood circulation, causing bone to die creating sequestra; Involucrum is formed
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16
Q

Pus-filled/dead bone cavities

A

Sequestra

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17
Q

Weak reactive bone formed by osteoblasts from periosteum; predisposes the bone to fractures, and have poor healing potential as long is pus is present

A

Involucrum

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18
Q

What are the most frequent manifestations of osteomyelitis?

A

fever, pain and reluctance to use affected extremities

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19
Q

With osteomyelitis, what does local swelling and redness indicate?

A

The infection has spread out of the metaphysics into the subperiosteal space

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20
Q

How do you treat osteomyelitis?

A

Antibiotics and Surgery

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21
Q

What is the common origin of acute osteomyelitis? Age group commonly effected? Common therapeutic interventions?

A

Hematogenous; Children; Good response to antibiotics and Limited surgery may be necessary

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22
Q

What is the common origin of chronic osteomyelitis? Age group commonly effected? Common therapeutic interventions?

A

Post-traumatic; Adults; Minimal response to antibiotics and Aggressive surgery often necessary

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23
Q

What are PT implications for pts with osteomyelitis?

A
  1. drainage from surgical wound, pain during limb movement, and low-grade fever, swelling or redness should be noted
  2. WB and compressive forces should be controlled when infection is in articular cartilage
  3. WB restricted in affected extremities
  4. Do not touch skin around pins and wires (both PT and pt)
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24
Q

What is contraindicated in pts with osteomyelitis?

A

Massage or mechanical stimulation that may spread the infection

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25
Q

Death of bone caused by bacteria

A

Septic Necrosis of bone

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26
Q

Death of bone NOT caused by bacteria

A

Aseptic necrosis of bone

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27
Q

The most common cause of aseptic necrosis of bone

A

Avascular necrosis of bone

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28
Q

The most common site of Avascular Necrosis of Bone

A

Femoral head in the hip joint

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29
Q

Results from bony tissue ischemia; Minimum of 2-hours of complete ischemia and anoxia is needed for permanent loss of bone tissue; Bony ischemia may be caused by injury disrupting the arterial supply or a thrombus disrupting the microcirculation to the bone

A

Osteonecrosis

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30
Q

Disease that results in flattening of the femoral head caused by ischemic necrosis** (temporary loss of blood flow); condition lasts 2-5 years where pt must limit use and rely on braces to prevent flattening of femoral head; usually presents in ages 4-8 years

A

Legg-Calve’-Perthes Disease AKA coxa plana

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31
Q

What are the clinical features of Legg-calve’-perthes disease?

A
  1. Gradual or insidious onset of initial intermittent limping with hip pain described as aching or soreness with stiffness
  2. Pain may occur in the groin region and along the entire length of the thigh to the knee
  3. Severe reduction in hip ROM
  4. Pain relieved by rest
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32
Q

How would a PT treat legs-calve’-perthes disease?

A

Goal would be to maintain full ROM and prevent degenerative changes; Initially 1-2 weeks of bedrest Rx to reduce inflammation followed by gradual weight bearing

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33
Q

Avascular necrosis of the navicular bone (in the foot): Fx secondary to avascular necrosis in children

A

Kohler’s disease

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34
Q

Avascular necrosis of the lunate bone (in the wrist)

A

Kienbock’s disease

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35
Q

Avascular necrosis of the vertebrae: seen as kyphoscoliosis in adolescents 12-16 years of age

A

Scheuermann’s disease

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36
Q

Characterized by an absolute reduction of the total bone mass/bony matrix, or a demineralization of bone

A

Osteoporosis; most common bone disease

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37
Q

A softening of bone without a loss of the bony matrix, but a loss in the mineralization of the bone by calcium and/or phosphate

A

Osteomalacia

38
Q

Osteoporosis that includes the type of which there is no known cause, idiopathic; or the kind that effects children and young adults with normal gonadal function; Postmenopausal Osteoporosis which is associated with the aging process which is a disease of the elderly

A

Primary osteoporosis

39
Q

What causes secondary osteoporosis?

A
  1. Hormonal Disturbances (diabetes)
  2. Dietary Insufficiency of calcium, Vitamin C or a malabsorption of nutrients (intestinal disease or liver disease)
  3. Immobilization during a chronic disease or following trauma
  4. Drugs such as anticonvulsants for the treatment of epilepsy or anticoagulants (heparin)
  5. Tumors to endocrine glands or metastases that destroy bone directly
40
Q

What endocrine disorders contribute to secondary osteoporosis?

A
  1. Hyperthyroidism
  2. Hyperparathyroidism
  3. Type II diabetes
  4. Cushing Syndrome
  5. Hypogonadism
41
Q

At what age does the rate of bone resorption begin to exceed bone formation?

A

30 years

42
Q

The loss of _____ at menopause is related to a 3 to 5 fold acceleration in bone loss from 1% to 3% in postmenopausal women; This accelerated bone loss occurs over a period of 8 to 10 years

A

Estrogen

43
Q

Why do athletic individuals tend take a longer time to develop osteoporosis?

A

They tend to have greater bone densities

44
Q

What are the clinical features of osteoporosis?

A
  1. Vertebral fx causing backpain and/or kyphosis of the spine
  2. Reduction of the pt’s height of about 10%
  3. Fx’s of long bones
  4. Ca, Ph, and alkaline phosphate levels are normal in the blood
  5. X-rays diagnosis when 30-50% of bone mass is reduced
45
Q

What is osteomalacia caused by?

A

problems with VitD or phosphate metabolism

46
Q

The noncalcified matrix of young or prebone

A

Osteiod

47
Q

Osteomalacia of long bones

A

Rickets

48
Q

What is VitD deficiency in osteomalacia caused by?

A
  1. Inadequate intake
  2. Inadequate exposure to sunlight
  3. Abnormal intestinal absorption: biliary, pancreatic, and intestinal diseases or diseases that effect fat absorption, vitamin D is fat soluble
  4. Kidney tubular defects can reduce phosphorus absorption
49
Q

What are clinical features of osteomalacia

A
  1. An asymptomatic condition in adults or it may cause nonspecific bone pain in adults
  2. Muscle weakness and a condition in which skeletal abnormalities develop slowly and are not prominent.
  3. Rickets produces typical deformities of the legs, ribs, and head
  4. Varus tibia (legs) in the growing child
50
Q

What hormone can be elevated in the blood with osteomalacia?

A

PTH; Ca will be low in the blood with this

51
Q

With osteomalacia, when PTH is normal in blood, what electrolyte will be low?

A

Phosphate

52
Q

A disease of unknown etiology that is characterized by about a 20 time increase in the remodeling rate (breakdown and build-up) of bony tissue. Results in a disorganized and excessive amount of bony tissue

A

Paget’s disease

53
Q

Paget’s disease is characterized by 3 phases. What are those phases?

A
  1. The Destructive Phase – is marked by bone resorption ( osteoclastic activity)
  2. The Mixed Phase – balances the destructive phase with new bone formation
  3. The Osteosclerotic Phase – is marked by a thickened trabeculae and by abnormal compact bone which is wide and sclerotic dense bone. The bones in this phase take on the histological appearance of a mosaic pattern
54
Q

What are clinical features of Paget’s disease

A
  1. Asymptomatic patients or patients with only minor skeletal pain
  2. The most commonly affected sites are the cranium and the long bones of the lower extremities
  3. Headaches, hearing loss, or dizziness secondary to compression of the cranial nerves by thickened cranium
  4. The tibia and fibula are thickened and deformed or “bow-legs”
  5. Osteosarcoma or cancer can develop as a late complication in some patients
  6. Diagnosis is based on X-Ray in which films show “Honeycomb” or “Cotton-wool”
    appearance from the thickened bone and irregular bone structures
55
Q

A disruption of bone continuity caused by mechanical stress (usually trauma); can occur in bones that have been weakened by pathology

A

Fracture of bone

56
Q

Fx where bone is broke all the way through; Transverse, oblique, spiral, comminuted, and segmental

A

complete fracture

57
Q

Fx where bone is damaged but still in one piece; butterfly and greenstick

A

incomplete fracture

58
Q

Fx is wedged or squeezed together on one side of the bone; Often occurs in osteoporosis

A

Compression fracture

59
Q

Growth plate fracture; children and adolescents at risk before growth plate closes; Type I-V: increase in number represents an increase of involved tissue, involve joint surfaces as well as growth plate, high complication rate (I & II don’t involve joint)

A

Salter fractures

60
Q

Name the stages in bone healing

A
  1. Hematoma Formed: Bleeding from broken bone ends (48-72 hrs)
  2. Fibrous Network Formed: Fibrous lattice-platelets
  3. Osteoblasts - Cell Proliferation and Formation of Soft Callus (2-3 wks post injury)
  4. Hard Callus Formation: new bone starts to bridge fracture (4-8 wks)- new bone has filled Fx (8-12 wks).
  5. Remodeling (radiologic healing): reabsorbed excess callus; trabecular bone laid down
61
Q

What encourages hard callus formation? What stage is this and what is it known as? how long does this stage last?

A

Mineralization is encouraged by gradual weight bearing; this stage (IV) is known as the stage of clinical healing**; 4-12 weeks

62
Q

How long do fractures typically take to completely heal in children? in adolescents? in adults?

A

4-6 weeks; 6-8 weeks; 10-18 weeks

63
Q

Edema around the Fx applies pressure to regional blood vessels causing loss of blood supply to muscle and muscle death – leading to severe disability; this is a medical emergency and if not taken care of can result in loss of limb

A

Compartment Syndrome

64
Q

Fracture problem where there is damage to arteries and nerves around the injury site

A

Neuromuscular injury

65
Q

Fracture problem due to post traumatic Arthritis

A

Intracapsular fracture

66
Q

Fracture problem that causes growth abnormalities with premature partial or complete closure of the physis can stop bone growth, short-leg or short arm etc

A

Open Physis (growth plate fx)

67
Q

Fx takes longer to heal in bony regions with low blood supply, e.g. distal tibia & navicular or scaphoid bone

A

Delayed union of fx

68
Q

The bony Fx defect is replaced with a fibrous scar instead of mineralized bone

A

Fibrous nonunion

69
Q

Movement occurring between 2; bony fragments attached through a fibrous nonunion

A

Pseudoarthrosis

70
Q

What two fracture problems can happen by inappropriate care (too aggressive)?

A

Fibrous nonunion and psudoarthrosis

71
Q

A fracture that is healed in the wrong position

A

Malunion

72
Q

Decreased motor function, diminished reflexes, pain, burning, and paresthesia (tingling) are signs and symptoms of?

A

Compartment syndrome (acute or chronic)

73
Q

Signs and Symptoms: Initial Symptoms appear within 1 wk post injury. Subtle Behavior and orientation changes if cerebral circulation has emboli. Dyspnea and chest pain, diaphoresis, pallor, or cyanosis. A rash on the anterior chest wall, neck, axillae, & shoulder may develop.

A

Fat embolism (this is a medical emergency)

74
Q

Who is most at risk of fat embolism?

A

Fx of bones with most marrow (long bones and pelvis)

75
Q

What is the majority of bone cancer from?

A

Secondary (metastatic) - outnumber primary bone tumors by 10:1

76
Q

What age group have the highest incidence of bone tumors? which group has the lowest?

A

Adolescents (at age 60, rates become equal but they are metastatic tumors); Adults between 30 and 35

77
Q

What is the name given for a benign bone tumor? Malignant?

A

Benign - “-oma”; osteoma

Malignant - “-sarcoma”; osteosarcoma

78
Q

What prefix is given for a tumors originating from osteoblasts? chondroblasts? fibroblasts? Marrow blood cells?

A 
Osteoblasts = "Oseto-"; osteosarcoma
Chondroblasts = "chondro-"; chondrosarcoma
Fibroblasts = "Fibro-"; fibrosarcoma
Marrow = no real prefix; Giant cell tumor (malignant or benign), Ewing Sarcoma
79
Q

Are primary malignant bone tumors more common in males or females?

A

Males (osteosarcoma, chondrosarcoma, ewing’s sarcoma); Female = Giant Cell tumors

80
Q

What age group is osteosarcoma most prevalent in? chodrosarcoma? Ewing’s sarcoma? Giant cell tumor?

A
  1. Osteosarcoma: Tumor of young people – 10–25 years old
  2. Chondrosarcomas: Tumor of adults – 35–60 years old
  3. Ewing’s Sarcoma: Tumor of the very young – 5–20 years old
  4. Giant Cell Tumors: Tumor of adults – 20-40 years old
81
Q

What is the most common site of metaphysis (osteosarcoma)?

A

Long bones (90% osteosarcomas)

82
Q

What is the most common joint with osteosarcomas?

A

Knee joint

83
Q

What is the most common short bone where osteosarcomas occur?

A

Mandible

84
Q

Symptoms of this disease: Systemic symptoms are uncommon; Initially Slight intermittent pain and swelling; Over a short time pain increases in severity and duration; Pain becomes worse at night and requires medication; Coincidental history of trauma; Can develop as a result of preexisting Paget’s Disease usually in 50-60 y/o

A

Osteosarcoma

85
Q

Large malignant tumor that infiltrates trabeculae in spongy bone.
Occurs most often in the metaphysis or diaphysis of long bones, especially the femur, proximal humerus, also common in the pelvis, ribs, and vertebrae

A

Chondrosarcoma

86
Q

Symptoms of this disease: Insidious onset of local swelling and pain; Pain is intermittent at first, then becomes more intense and constant. The pain may awaken the individual at night; Surgical excision of the tumor or complete amputation is the treatment of choice. These tumors are insensitive to chemotherapy

A

Chondrosarcoma

87
Q

What are chondrosarcomas graded I-III based on?

A

Maturity level of cartilage cell differentiation; more differentiated = less severe (I)

88
Q

Tumors are intraosseous cysts usually located in the epiphysis of the femur, tibia, radius, or humerus; Has a low rate of metastasis to other organs or tissues; After surgical excision, the reoccurrence rate is high at ~ 80%

A

Giant Cell tumors

89
Q

Is a proliferation of immune cells called plasma cells; Tumors cause cortical & medullary bone damage and spread to the bone marrow; Pain in a single bone or the entire skeleton; initially aching, intermittent, and ’ed by weight bearing. As disease ’s pain becomes more severe and prolonged; Most located in low back, upper spine, pelvis, ribs, & sternum; General weakness, fatigue, weight loss, and anorexia is reported by the patient

A

Myeloma

90
Q

What is the treatment for myelomas?

A

Palliative care; poor prognosis; more recently, immunotherapy has been found to improve survival

91
Q

A malignant primary bone tumor composed of undifferentiated small cells, although mesencymal and bone marrow in nature, the exact origin (stem cell) of the tumor cells have not been determined, e.g. bone, cartilage; Arises from stem cells in the medullary cavity of bone and may be found in the shaft or diaphysis of the bone; Tumor invades the cortical bone, medullary cavity, and bone marrow. It can spread to the soft tissue of the extremities

A

Ewing’s sarcoma

92
Q

Any unexplained cellulitis in children should be considered a sign of

A

osteomyelitis

Systems Screening II (27 decks)

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