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understanding human disease > chap 21 - disorders of the bones and joints > Flashcards

chap 21 - disorders of the bones and joints Flashcards

1
Q

skeletal system function

A

reservoir of minerals (calcium and phosphorus), protection, production of blood cells, movement, shape, rigid support

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2
Q

structure of skeletal system

A

bone is connective tissue, all bones have the same basic structure - cortex, trabeculae, and bone marrow

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3
Q

cortex

A

outlayer of compact bone

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4
Q

trabeculae

A

inner spongy layer of the bone

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5
Q

bone marrow

A

spaces between trabeculae consist of fat and blood-forming tissue

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6
Q

bone

A

dynamic living tissue, undergoing remodeling
- strength and thickness depend on activity

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7
Q

bone cells

A

osteoclasts, osteoclasts, osteocytes

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8
Q

bone growth

A

ossification
types: endochondral and intramembranous

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9
Q

endochondral ossification

A

lay down cartilage, laying down of bone, ossification at epiphyseal plate

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10
Q

intramembranous ossification

A

no cartilage phase occurs, typically occurs in flat bones

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11
Q

bone density

A
  • amount of mineral per cm/bone
  • indicator of fracture risk
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12
Q

factors influencing bone mineral density

A

diet(calcium, vitamin D, K+, magnesium,protein) , physical activity, hormones (calcitonin, parathyroid hormone, estrogen), age, sex

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13
Q

signs and symptoms

A

pain, decreased mobility, deformity

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14
Q

symptoms associated with arthritis

A

joint stiffness and decreased mobility

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15
Q

tests

A

diagnostic modalities
- radiography to visualize fractures and bony abnormalities

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16
Q

osteoblasts

A

secrete the matrix that will help build the bones
b = build

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17
Q

osteoclasts

A

ruffled membrane, causes bone resorption which is breaking down bone

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18
Q

osteocytes

A

cell of the bone, embedded in the matrix of the bone

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19
Q

osteoprogenitor

A

can become any bone cell

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20
Q

erythrocyte sedimentation rate

A

How long does it take for red blood cells to settle in a sample - shows systemic inflammation, increase in systemic inflammation causes the cells to be stickier and settle first, increase of erythrocyte settlement rate (could show arthritis because inflammation is one of the main manifestations of arthritis)

21
Q

achondroplasia

A
  • Plasia = division, chon = cartilage, chondrocytes, a=no → without chondrocyte dividing, important for bone formation, no laying down of cartilage, no laying down of bone
    Leading cause of dwarfism
    Causes mutation in fibroblast growth factor 3 (FGFR3)
  • Autosomal dominant
  • Majority de novo mutations, de novo = new
    • Most common risk is age of the father
      Result in Faulty bone formation
      Impaired growth of extremities and formation of skull bones
  • Can lead to stenosis on the spinal cord due to malformation of foramen magnum in occipital bone
    Causes dwarfism with disproportionately short limbs
22
Q

osteogenesis imperfecta

A

“Brittle Bone” Disease = Thin and delicate bones easily broken
“Imperfect bone formation”
Mutation in genes resulting in abnormal collagen formation
- Collagen is of normal quality but is produced in insufficient quantities
- Collagen is part of the cartilage that is laid down prior to the bone
Autosomal Dominant
Increase susceptibility to bone fractures
May be in utero
Eight Types
- I-VIII
- Different types of collagen
Malformation of fingers and toes
Spinal curvature
Brittle teeth
Blue Sclera - thin because it is a connective tissue disorder and the sclera is connective tissue, so the veins are showing through

23
Q

congenital clubfoot (talipes)

A

The most common congenital disorder of the legs
Not painful
Multifactorial inheritance - environment and genetic susceptibility
Treatment: manipulation and casts

24
Q

fractures

A

Any disruption in continuity of bone
Most often caused by
Trauma
Pathologic fracture
Underlying disease of bone
Pain resulting from tearing of periosteum (covering of the bone)
- types: simple, comminuted, compound, pathologic, and greenstick
in order for a fracture to heal
- broken fragments must be close to each other, also must be stabilized
healing process: involves proliferation of
- osteoblasts from fracture margins - lay down new matrix which will be mineralized to make new bone, vascular channels from periosteum
- immature bone and cartilage gradually remodel into mature bone

25
Q

osteomyelitis

A

Bacterial infection of bone and marrow
Organisms gain access to bone via
- Spread of infection from somewhere else
- Following trauma or surgery to bone itself
Manifestation
- Fever, local pain and tenderness
Diagnosis and treatment
- X-ray reveals changes in bone
- Antibiotics, possible surgery
Complications may include:
- Spread of infection
- Endocarditis, sepsis
Amputation

26
Q

osteoporosis

A

Multifactorial disease characterized by absolute reduction of total bone mass
- Porous bones
- Bone histology is usually normal but lacks structural integrity
Age related: One third of population >85 have it
Women > men; especially after menopause
- Men have a slower decline

27
Q

signs and symptoms of osteoporosis

A

Disease itself has no symptoms
Increased risk of fractures
- Mortality
- Loss of independent living
- Decreased Mobility

28
Q

causes of osteoporosis

A

Primary
- Intrinsic to bone itself
- Age - age related bone loss (approx. 0.7%/yr) is a normal biological phenomenon
- Declining estrogen
Secondary
- Cortisol excess
- Cortisol breaks things down - stress hormone, so people who are under prolonged stress or take cortisol drugs
- Increase PTH
-Bone resorption

29
Q

risk factors for osteoporosis

A

Age
Ethnicity - caucasian and asian women are more at risk
Genetics
- Allele for the vitamin D receptor molecule
Skeletal frame size
- Smaller frame - less bones - increased risk
Decreased levels of estrogen and testosterone
Decreased activity level
Excess intake of phosphorous, alcohol, nicotine
Inadequate levels of vitamins D, calcium, K+, or Mg++

30
Q

clinical manifestations of osteoporosis

A

Vertebral fractures - vertebrae break down over time
Lumbar lordosis and kyphoscoliosis - excess curvature
Pulmonary embolism may result from overt fractures of the femoral neck, pelvis or spine
- Break the bone = bone marrow in the middle gets into the bloodstream and can travel and get lodged in pulmonary vein

31
Q

diagnosis of osteoporosis

A

Plain radiographs cannot detect osteoporosis until 30-40% of bone mass is loss; thus specialized radiographic imaging techniques needed
- Not a very sensitive test
Dual energy x-ray absorptiometry (DEXA)
- More sensitive, much better at looking at small changes in loss of density
Can be used for screening in populations that are at risk

32
Q

treatment of osteoporosis

A

irreversible
-Medication
Inhibition of osteoclasts(biphosphonate, boniva, fosamax), estrogen mimetic - don’t want to put women on hormone replacement therapy (evista), synthetic PTH (forteo)

33
Q

osteopenia

A

BMD is lower than normal
- precursor to osteoporosis

34
Q

osteomalacia and rickets

A

softening of bone
- poor mineralization
causes
- vitamin D deficiency
rickets in children and osteomalacia in adults
complications
- deformity - increased fracture risk

35
Q

scoliosis

A

abnormal lateral and rotational curvature of spine

36
Q

kyphosis

A

abnormal forward bending of upper spine
- produces hunched back

37
Q

potential causes of scoliosis and kyphosis

A

arthritis, congenital, osteoporosis, idiopathic

38
Q

complications of scoliosis and kyphosis

A

impairment of activity, breathing problems, back pain

39
Q

neoplasms of bone

A

most common = metastatic tumors from prostate, breasts, other organs
- hematopoietic (40%) - myeloma, leukemia
bone tumor groups (excluding hematopoietic)
- bone - cartilage -fibrous - miscellaneous
tumors of bone
- benign cysts and tumors: osteoma
- primary malignant: osteosarcoma

40
Q

osteoma

A

histology resembles normal bone
- generally slow-growing tumors of little clinical significance when they cause obstruction or produce cosmetic problems
- asymptomatic, often in facial bones
they do not undergo malignant change

41
Q

osteosarcoma

A

the most common malignant tumor of bone in children
- 70% in patients younger than 20 years
symptoms
- bone pain, progressive enlarging mass, pathologic fractures
- more common in males, ends of long bones, metastasis is common

42
Q

symptoms, signs, and tests of the joints

A

joint stiffness and decreased mobility, pain and inflammation
tests: arthroscopy to visualize joint space

43
Q

osteoarthritis

A

degenerative joint disease, most common
- “wear and tear” = disease of old age
- affects weight-bearing big joints, small joints of hands and feet
classification
- primary: cause unknown or multifactorial
- secondary: related to another disease

44
Q

etiology of osteoarthritis

A

cartilage becomes thin, bone surfaces rub against each other - produce bone cysts and osteophytes
- little inflammation until advanced stage

45
Q

risk factors of osteoarthritis

A

increased age, joint trauma, long-term mechanical stress, endocrine disorders, drugs, obesity

46
Q

rheumatoid arthritis

A

systemic autoimmune disease affecting connective tissues throughout the body, especially the joints
- produces chronic inflammation and thickening of synovial membrane
- often associated with rheumatoid factor
- autoantibody in blood and synovial tissues, produced by B lymphocytes directed against individuals own gamma globulin
- not age associated
- usually affects small joints of hands and feet

47
Q

clinical course of rheumatoid arthritis

A

extremely variable
- begins with malaise, fatigue and generalized musculoskeletal pain and then joint pain
- small points are usually affected first
- involved joints are swollen, warm, painful and stiff on arising or following inactivity

48
Q

arthritis: gout

A

disorders of purine metabolism
- disrupts the body’s control of uric acid production or excretion
- precipitation
gout manifests high levels of uric acid in the blood and other body fluids
- hyperuricemia
can also lead to uric acid kidney stones
crystals deposit in CT throughout the body
- 50% of the initial attacks occur in the metatarsophalangeal joint of the great toe
- heel, ankle, instep, knee, wrist or elbow
when these crystals occur in the synovial fluid, the inflammation is known as gouty arthritis

49
Q

contributing factors of arthritis

A

age, male sex, obesity, high intake of alcohol, red meat, genetic predisposition

understanding human disease (25 decks)

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