Chapter 2 Flashcards
1
Q
How many bones is the skeletal system composed of ?
A
206
2
Q
what is the skeletal system responsible for?
A
-body support
protection
-movement
-blood cell protection
3
Q
how much percentage does the skeletal system contain of the bodies total phosphorous
A
75 percent
4
Q
how much percentage does the skeletal system contain of the bodys total calcium
A
98 percent
5
Q
how many bones does the axial skeleton contain
A
80 bones
6
Q
how many bones does the appendicular skeleton contain
A
126 bones
7
Q
what is the axial skeleton contain of
A
head, neck, back, and chest
8
Q
what does the appendicular skeleton consist of
A
bones in the shoulders, pelvis, and limbs
9
Q
what bone marros is responsible for production of erythrocytes and leukocytes
A
red bone marrow
10
Q
where is red bone marrow typically found
A
found primarily in the bones of the trunk
11
Q
by what age is the red bone marrow replaced by the yellow bone marrow composed mainly of fat
A
20
12
Q
is specific to the cancellous bone with in the skull (spongy layer between the inner and outer compact layers of the flat bones of the skull
A
Diploe
13
Q
the spongy substance found within a bone, it gives a characteristic appearance to bony detail, it is the web-like bony structure visible on a x-ray
A
Trabeculae
14
Q
where is bone marrow located
A
is located within the medullary canal
15
Q
what type of tissue is bone
A
connective tissue
16
Q
what is bone classified as
A
compact (dense)
17
Q
what does cancellous mean
A
spongy
18
Q
what kind of bone is the outer portion
A
outer portion is composed of compact bone
19
Q
what kind of bone is in the inner portion,
A
The inner portion, the medullary canal is made of cancellous bone
20
Q
what type of cells form new bones
A
Osteoblast
21
Q
what cells dissolve old bones
A
osteoclasts
22
Q
Are bone forming cells that line the medullary canal and interspersed throughout the periosteum
A
osteoblast
23
Q
Cells which are associated with absorption and removal of bone
A
osteoclasts
24
Q
name some long bones
A
- humerus
-clavicle
-phalanges
-femur
25
the presence of extra digits
polydactyly
26
gives the appearance of web tows or fingers
syndactyly
27
*Occurs during fetal development
*Failure of toes/finger to separate
*Usually repaired surgically
Syndactyly
28
Hereditary disease with abnormal dense bone with common occurrence of fractures
OSTEOPETROSIS
29
*Abnormally heavy compact but brittle
*All bones are affected especially, long bones of extremities, vertebrae, pelvis, and base of skull
*Increase bone density with reduction of marrow space
OSTEOPETROSIS
30
Most common inherited disorder involving cartilage formation in the fetu
Achondroplasia
31
*Results in bone deformity and dwarfism
*There is an impairment to the longitudinal growth of the bone
*Affects cartilage in the epiphytes
*Adults usually are not more than 4 ft with lower extremities usually half the normal length
*Other manifestation – lumbar lordosis, bow legs, bulk forehead
Achondroplasia
32
*Starts years after birth
*Usually stops in adulthood
*Radiological evaluation will show multiple fractures in various stage of healing
*Bone cortex is thin and porous *Trabecula are thin, delicate, widely spread
Osteogenesis imperfecta tarda
33
*Present at birth
*Usually have multiple fractures at birth
*Results in limb deformities, dwarfism
*May lead to death
Osteogenesis imperfecta congenita
34
“Brittle Bone Disease”
Osteogenesis Imperfecta
35
*Bone mineral densitometry for the evaluation of osteoporosis
DEXA (double energy xray absorbtiometry)
36
It readily evaluates the bone mass of the distal radius, femoral neck, and lumbar spine
dexa
37
Then with the use of a combination lab test of blood and urine a determination of bone loss can be evaluated
dexa
38
*Advantage over CT and MRI in that you look at the entire body at one time in a conventional fashion
*It gives the ability to tell if it is a new or old problem by the activity uptake.
*It is the standard of care for examination of metastatic process, demonstrates metabolic reaction of bone to the disease process.
Nuclear Medicine
39
*It is quicker, noninvasive
*It has the ability to define the presence and extent of the fracture or dislocation, joint abnormalities and spinal disorders
*MRI-has no signal for cortical bone, but CT can visualize bony detail
*Display bony margins and trabecula patterns, so you can assess both bony and soft tissue involvement of tumors
CT
40
*Useful in imaging of skeletal pathology particularly in soft tissue detail.
*There is superior contrast resolution
*Modality of choice for detection and staging of soft tissue tumors of the extremities.
*Useful in evaluation of the joints (knee, shoulder)
*Bone marrow imaging done with MRI is superior to older bone scan (especially for subtle abnormalities like edema
MRI
41
Image Considerations
-proper labeling
-film/screen technique
-motion
-Soft tissue is important in diagnosing –could demonstrate muscle wasting, soft tissue swelling, calcification, foreign bodies, air.
42
Congenital malformation of the foot
Club foot
43
another name for club foot
Talipes
44
*Prevents normal weight bearing
*Most commonly the foot is turned inward to the ankle
*Seen in males more often
*Casting. Splinting the foot in correct anatomic position
Club foot
45
*The acetabulum does not completely form
*The head of the femur displays superiorly and posteriorly
Congenital Dislocation of the hip
46
*Often the ligaments and tendons are affected for placement of the femoral head
*Most often treated with casting or splinting the affected hip
*Use of the Pavlic harness-it tightens ligaments and stimulates normal hip growth
Congenital dislocation of the hip
47
*More common in females
*Signs- different lengths of legs, uneven skin folds, less mobility or flexibility
*May not be noticeable at birth and may worsen as the child grows and becomes active
*Child may limp or have a duck-like gait
*Can develop osteoarthritis if not treated early
*Usually caught at newborn check-ups
Congenital Hip
48
Complications of scoliosis
cardiopulmonary, degenerative spinal arthritis, fatigue and joint dysfunction
49
is scoliosis more common in females or males
females
50
usually convex to the right in the thoracic region and left in the lumbar
scoliosis
51
abnormal lateral curvature of the spine
scoliosis
52
treatment for scoliosis
surgery or individual brace or body cast, depends on the site of deformity and severity
53
how do we typically view scoliosis
-initial evaluation AP/PA standing and lateral standing
-consistent quality is important to measure the curvature
54
if the patient is still growing, what would a 30 degree curvature indicate
30°-generally the use of a brace
55
if the patient is still growing, what would a 40 degree curvature indicate
40° or greater surgery is required
56
*Usually occurs at the major division of the spine
*Thoracic/lumbar- the 1st lumbar may have ribs articulating with the transverse process*
Also on c7, which is called a cervical rib
*Sometimes can cause pressure on the brachial nerve plexus or subclavian artery
Transitional Vertebra
57
Incomplete closure of the vertebral canal –failure of the two laminae to close
SPINA BIFIDA
58
*Usually in the lumbosacral area
*In severe cases the spinal cord and nerve root can be involved
*Results in varying degrees of paralysis
*Treatment depends on the severity
*Spina bifida occulta- only seen radilogically-covered with the skin
*Extensive-herniation of the spinal cord and meninges
SPINA BIFIDA
59
*Premature closure of any cranial suture
*It is a congenital anomaly
*It alters the shape of the head
*It can be corrected surgically
CRANIOSYNOSTOSES
60
*Detachment of the dura ( membrane covering the brain) should be widely detached from the involved area and a normal shape given to the deformed area
*During the first months of life, because of the infant’s increase tissue growth,
*Grafts fill in defects of the surgery
Craniosynostoes
61
*Congenital abnormality
*The brain and cranial vault do not form *It results in death shortly after birth
*Usually found with sonography
Anencephaly
62
*Is an infection of the bone and bone marrow
*Spread by the blood stream, infection from a contagious site, or direct introduction of the microorganism
Osteomyelitis
63
Spread by the blood
Hematogenous
64
Develops in the end of the long bones
osteomyelitis
65
true or false:
if the bone becomes necrotic for osteomyelitis simple antibiotic will not be effective against bacteria lurking in dead bone
true
66
Can occur from a infection{burns, sinus disease, skin ulcers}
osteomyelitis
67
dead devascularized bone, it appears very dense
sequestrum
68
is a new shell of bone formed around the sequestrum
involucrum
69
what modalities are more sensitive to detecting osteomyelitis
nuclear med and mri
70
how much percent of bone calcium must be lost to see radiographically
30 to 50 percent
71
Direct introduction- penetrating wounds, open fractures,
Early stages-no bone changes noticed on the film
Acute stages formation of an abscess, leading to an inflammatory reaction Bone necrosis can occur within 24 to 48 hours
It may take 10 to 14 days before it is noticed radiographically
Clinical evaluations is critical with treatment of antibodies or local drainage.
OSTEOMYELITIS
72
*It is a chronic inflammatory disease
*Commonly affects hip, knee and spine
*Radiographically appears at long ends of the bone {“worm-eaten” appearance}
TUBERCULOSIS
73
is also called Pott’s Disease, it can cause softening and eventual collapse of the vertebrae
Tuberculosis of the spine
74
Slowly destroys the epiphyses and spreads into articular cartilage it may infect the joint space
Tuberculosis
75
Spinal Tuberculosis
Potts disease
76
*Destroys the spine by softening and collapsing the vertebrae
*Results in an abscess and puts pressure on the spinal cord
Potts disease
77
pathologic changes begin in the articular cartilage of joints
degenerative
78
joint inflammation
arthritis
79
Pathologic begin in the synovial membrane of the joints
inflammatory
80
Called “pyogenic arthritis”
Acute Arthritis
81
*Generally enters by an open wound and responses well to antibiotic therapy
*Radiographic –increase joint space, bony destruction and joint dislocation
*During the healing stages, radiographically you may see decalcification, sclerosis (hardening) often resulting in joint ankylosis
Acute Arthritis
82
*Symptoms-pain, redness, swelling of joint, fever
*Factors- streptococci, staphylococci, gonococc
acute arthritis
83
develops slowly as synovial tissue increases it progressively destroys the cartilage, bone and supporting structures
Rheumatoid Arthritis
84
*A chronic autoimmune disease
*Chronic inflammation and overgrowth of synovial tissues (most often in extremities)
Rheumatoid Arthritis
85
*Treatment depends on the primary disease
*Radiation therapy in combination with either chemotherapy or hormone therapy is commonly used.
*Bone scans are used to follow the progress of therapy
*The reduction in uptake on serial scans is a positive sign
Treatment of Metastasis Bone Disease
86
synovium excision, joint reconstruction, joint replacements.
Surgical treatment for RA
87
bone and cartilage destruction and subluxation or dislocation of involved joint
LAte stage of RA
88
joints become unstable and leads to deformity cause by displacement of the bones
severe damage of RA
89
cortical erosion with narrowing of the joint spaces because of overgrowth of synovial tissue into the articular space
progression of RA
90
soft tissue swelling and osteoporosis
early stages of RA
91
*Affects children under 16 years of age*Generally less fibrosis and proliferation than adult form
*Fewer than 20% having progressive destructive disease with long periods of remission
JUVENILE RA
92
A form of RA affecting the spine eventually fusing the spine
Ankylosing spondylitis
93
what age in men is usally affected by Ankylosing spondylitis
Tends to affect men ages 20 to 40
94
*Radiographically it starts as fuzziness in SI joints and eventually it progress up the spine, articular cartilage is destroy and fibrous adhesion develop (nickname “bamboo spine”)
*Treatment: medications, exercises
Ankylosing spondylitis
95
Early symptoms- fever, fatigue weight loss, and anemia
Ankylosing spondylitis
96
Noninflammatory degenerative joint disease , deterioration of the joint cartilage occurring with normal wear and tear.
OSTEOARTHRITIS
97
*Signs – narrowing joint space, marginal spurs, sclerotic borders, cystic-like changes.
*Affects weight bearing and joints of the hands
*Treatment: medication and surgery in advance cases
osteoarthritis
98
*The most common
*Also know as degenerative joint disease (DJD)
osteoarthritis
99
*Inherited metabolic disease
*Increase in uric acid production and deposit in the joints
*Acute inflammatory reaction
*Bony changes –erosion with over hanging edges
*Treatment: medication
Gouty arthritis
100
Thoracic /lumbar spine weaken and collapse anteriorly, kyphotic deformity known as
"dowagers hump"
101
*Metabolic disorder resulting in the demineralization of the bone
*Bone formation is normal but reabsorption rate is abnormal high *Results in thinning of the cortical bone and enlargement of the medullary canal
*Thoracic /lumbar spine weaken and collapse anteriorly, kyphotic deformity known as “dowager’s hump”
*30 to 50% loss before evident on x-rays DEXA has improve earlier detection
OSTEOPOROSIS
102
*About 10 million people in the US (post menopausal women)
*The most common metabolic bone disease
–Female, White, Asian
–Family history
–No children
–Scoliosis,
–Small frame
–Increase alcohol intake
–Inactivity
–Early or surgical menopause
–Steroid or anticonvulsant medications
–Increase protein intake
–Decrease calcium intake
–Space travel ( weightlessness)
Osteoporosis
103
*Softening of the bone due to lack of calcium and failure of bone tissue to calcify
*If it occurs before the closure of the growth plates it is called rickets
*Appears similar to osteoporosis expect for bands of radiolucency with the bone (pseudofractures or “looser's zones”)*
Diffuse skeletal pain, bone tenderness and muscular weakness
*Lab and biopsy determines a diagnosis
Osteomalacia
104
*The replace bone is very bulky, porous and very vascular
*Leads to stress induced fractures and deformities.
*No known cure/may be viral *Treatment: usually not necessary /sometime medication to decrease bone resorption
Pagets Disease
105
*Metabolic disorder
*Most common in pelvis spine, skull and long bones
*2 stages- undergoes continuous destruction (osteolytic stage) and simultaneous replacement with soft and poorly mineralized material (osteoblatic stage)
Pagets Disease
106
*Usually asymptomatic
*3% of adults over 40 have the disease
*Painful, warm extremities, bowing of the long bones, enlarged skull, nerve compression
*Increase serum alkaline phosphates
*Abnormal bone remodeling / poor organized*Complications- enlarged or deformed bones, pathological fractures, auditory or cardiac conditions
Pagets Disease
107
*Slowly progressive disease with enlargement of head, hands and feet
*Endocrine disorder –disturbance in the pituitary gland (pituitary adenoma)
*Radiographically- enlarge sella turcica and changes in the skull
*Patient presents with prominent forehead, jaw widened teeth, abnormally large spade like hands
Acromegaly
108
Occurs because of Forward slippage
Spondylolisthes
109
appears as a broken neck of the Scotty Dog
spondylosis
110
cleft or breakdown of the body of the vertebra between the superior and inferior articular process (pars interarticularis)
spondylosis
111
*A wall of fibrous tissue filled with fluid
*80% ages 3-14
*Twice as common in boys than girls
*Presents with pain, or pathologic fracture
Simple Bone cyst
112
*Starts in the medullary canal (starburst appearance)
*Extremely malignant
*Chemotherapy with 80% survival after 5 years
Ewings Sarcoma
113
Primary neoplasm occurring in ages of 5 to 15 and rarely after 30
Ewings sarcoma
114
*Can occur any age but 75% occur in patients younger than 20
*Sometimes seen in older patients with Paget’s or high levels of radiation exposure
*Lab and biopsy are used to determine diagnosis
Osteosarcoma
115
*Etiology is unknown-maybe genetic or environmental.
*Most frequently found in the metaphyses of long bones 50% affecting the knee
Osteosarcoma
116
*Virtually any type of cancer can metastasize to the bone
*Most common malignant tumor of the skeleton
*Usually presents with pain and pathologic fracture
*The bones that contain red bone marrow are affected more due to increase vascularization
*Radionuclide bone scans are the most accurate in detection because 3% to 5% bone destruction produces a “hot spot”
Metastases From Other Sites
