Chapter 26: bones and joints Flashcards
1
Q
skeletal tissue and structure
- give the body its ______ form
- protect ______
- promote efficient ______ despite the forces of gravity
- store ______ and other materials needed for ______
- produce ______
A
structural vital organs movement salts metabolism RBCs
2
Q
connective tissue that provides a smooth articulation surface for other bones
A
cartilage
3
Q
where bones interact
A
joint
4
Q
a form of dwarfism caused by impaired ______ in the growth plate; common cause of dwarfism; caused by mutation of the gene for the ______ (FGFR3). most mutations are sporadic and related to ______ paternal age. mental function, life span and fertility are ______ affected
A
achondroplasia (congenital and genetic bone diseases) cartilage proliferation fibroblast growth factor receptor gene 3 increased not
5
Q
- bones defect caused by mutations of the gene for collagen.
- clinical features:
a) multiple ______ of bone (can mimic child abuse, but ______ is absent), ______: thinning of scleral collagen reveals underlying veins, hearing loss due to middle ear bone easily fractured
A
osteogenesis imperfecta (congenital and genetic bone diseases)
fractures
bruising
blue sclera
6
Q
thick bones resulting from a defect in the function of ______. clinical features include bone fractures, ______, cranial nerve ______ etc. Treatment: ______
A
osteopetrosis (congenital and genetic bone diseases) osteoclasts anemia palsies bone marrow transplant
7
Q
- infection of marrow and bone (occurs in children)
- most commonly ______; arises via ______ spread (bacteria in the blood). bacterial infection (children) seeds ______. open wound bacteremia (adults) seeds ______.
- common agents: ______: (90% of cases), ______: sexually active young adults, ______: sickle cell disease, ______: diabetics or IV drug abusers, ______: involves vertebrae (Pott disease)
- clinical features: ______ pain with systemic signs of ______ (fever and leukocytosis), ______ focus (abscess) of bone on x-ray. diagnosis is made by ______ or bone ______.
- treatment: ______
A
osteomyelitis bacterial hematogenous metaphysis epiphysis staphylococcus aureus N. gonorrhoeae salmonella pseudomonas mycobacterium tuberculosis bone infection lytic blood culture aspiration antibiotic therapy
8
Q
- reduction in bone mass. results in ______ bone with an increased risk for ______
- risk of osteoporosis is based on peak ______ (in early adulthood) and afterwards
- factors may be involved: ______ (vitamin D receptor differences), diet, decreased ______ (menopause) and lack of exercise
- subdivided into two groups: primary and secondary
- clinical features: ______ pain and fractures in weight-bearing areas such as ______, hip, and distal ______. bone density is measured using a ______ scan. Lab tests: ______ normal (excludes osteomalacia)
- treatment: exercise, ______, and ______- limit bone loss
- ______: induce apoptosis of osteoclasts
- SERM (selective estrogen receptor modulator)
- ______ are contraindicated (worsen osteoporosis)
A
osteoporosis porous fracture bone mass genetic estrogen bone pain vertebrae radius DEXA PTH vitamin D calcium bisposphonates glucocorticoids
9
Q
- softening of bones as a result of inadequate ______ of the organic matrix (______)
- due to low levels of ______, which result in low serum ______ and ______ (lab findings for rickets and osteomalacia
- ______ is normally derived from the skin upon exposure to sunlight (______) and form the diet (______). activation requires ______ by the liver followed by ______ by the proximal tubule cells of the kidney.
- ______ is due to low vitamin D in children (less than ______ years old), resulting in abnormal bone ______. ______: soft leg bones can’t carry weight, ______: flawed teeth mineralization, pigeon-breast deformity
- ______: due to low vitamin D in adults. diffuse ______ pain, muscle weakness and increased risk of fracture
- treatment: ______ supplement and treating the underlying cause
A
rickets and osteomalacia mineralization osteoid vitamin D calcium phosphate vitamin D 85% 15% 25-hydroxyltion 1-alpha-hydroxylation rickets 10 mineralization bowlegs delayed dentition osteomalacia back vitamin D
10
Q
- imbalance between osteoclast and osteoblast function. usually seen in late adulthood (average age ______). idiopathic cause. three phases: ______, ______ and ______ phases
- clinical features: bone pain- due to ______, increasing hat size- ______ is commonly affected, ______ loss, ______ face and isolated elevated ______ (liver enzyme)
- treatment: ______ (inhibits osteoclast function) and ______ (induces apoptosis of osteoclasts)
A
page's disease of bones >60 years destructive, mixed, osteosclerotic micro-fractures skull hearing lion-like alkaline phosphatase calcitonin bisphosphonates
11
Q
- ______ describes increased pressure within a muscle compartment of the arm or leg. it is most often due to injury that causes ______ in a muscle, which then causes ______ in the muscle. this pressure increase causes ______ damage due to decreased ______.
- pathogenesis: compartment syndrome develops when ______ or ______ occurs within a compartment. because the ______ does not stretch, this can cause increased pressure on the ______, ______, and ______ in the compartment
- blood flow to the muscle and nerve cell is disrupted. without a steady supply of ______ and ______, nerve and muscle cells can be damaged
A
compartment syndrome bleeding increased pressure nerve blood supply swelling bleeding fascia capillaries nerves muscles oxygen nutrients
12
Q
- occurs as a complication of an injury. often it is due to a fracture of the ______ or ______ in the forearm or the ______ and ______ in the lower leg that causes significant ______ in one or more of the compartments. bleeding can also be due to a badly ______ muscle. crush injury may cause both bleeding and swelling of muscles, common causes include:
- a person in an auto accident where their legs are trapped and compressed with heavy debris, which are subsequently freed from the debris after a period of time
- when a blood vessel is damaged and subsequently repaired through ______. the above conditions are due to the compartment swelling and may occur after the blood supply is re-establshed (______) to an area that has lost it for a period of time.
- compartment syndrome may be a complication of ______ or ______ that are applied too tightly
- symtoms: pain which is more ______ than what would be expected from the injury itself. using or stretching the involved muscles ______ the pain. there may also be ______ or ______ sensations in the skin. numbness or ______ are late signs of compartment syndrome. they usually indicate permanent tissue injury
- treatment: acute compartment syndrome is a ______. there is no effective nonsurgical treatment. ______ of the patient prior to surgery is via two large ______ with pain medication. your doctor will make an incision and cut open the skin and fascia covering the affected compartment. this procedure is called a ______.
- sometimes the swelling can be severe enough that the skin incision cannot be closed immediately. the incision is surgically repaired when swelling subsides. sometimes a ______ is used
A
acute compartment syndrome radius ulna tibia fibula bleeding bruised surgery reperfusion swelling bandages casts intense increases tingling burning paralysis surgical emergency stabilization bore IVs fasciotomy skin graft
13
Q
- causes pain or cramping during exercise. this pain subsides when activity ______. it most often occurs in the ______. symptoms may also include: ______, difficulty moving the ______ and visible muscle ______
- treatment: ______, orthotics (inserts for shoes), and ______ medicines are sometimes suggested. some athletes have symptoms that are worse on certain ______ (concrete vs. running track, or artificial turf vs. grass). symptoms may be relieved by switching surfaces.
- if conservative measures fail, ______ may be an option. similar to the surgery for acute compartment syndrome, the operation is designed to open the ______ so that there is more room for the muscles to ______. also, this surgery is typically an elective procedure, not an emergency.
A
chronic compartment syndrome stops legs numbness foot bulging physical therapy anti-inflammatory surfaces surgery fascia swell
14
Q
benign bone tumors
A
osteoma (associated with Gardner’s syndrome)
chondroma
giant cell tumor (benign in most cases but may recur)
15
Q
malignant bone tumors
A
osteosarcoma
chondrosarcoma
Ewing’s sarcoma
16
Q
tumors of the bone
- ______ bone tumors are unusual
- metastatic tumors from ______, ______, and other organs
A
primary malignant
prostate
breasts
17
Q
malignant tumor of cartilage. commonly found in ______. treatment: ______ survival with surgery. ______
A
chondrosarcoma
5 years
pelvis
chemotherapy
18
Q
malignant tumor from bone-forming cells (osteoblasts). frequent occurrence in age ______ to ______ years old men. older person with ______ disease may have an increase risk. 60% of the tumors in the ______ area. X-ray often shows an elevation of the periosteum known as ______ or ______. Treatment: ______ or ______
A
osteosarcoma 10 20 pagets knee conman triangle sunburst growth pattern chemo surgery
19
Q
childhood tumor. blue in color due to sheets of ______ cells which store large amount of ______. ages of patients less than ______ years
- tumors often invade the ______ bones and may mimic ______. imaging results show ______ tumor with ______ appearance
- treatment: ______, chemotherapy, and ______
A
ewing sarcoma primitive glycogen 20 long osteomyelitis lytic onion skin radiation surgery
20
Q
- most common joint disease (Arthritis) and known as wear and tear disease, disease of old age (60+) may increase with ______ and ______.
- affects weight-bearing big joints but also small joints of hands and feet. classic presentation is ______ in the morning that ______ during the day. imaging results show joint space ______ with ______ and floating cartilage known as ______
- classified as: primary and secondary
- treatment: ______, ______ inhibitors and surgery
A
osteoarthritis- degenerative going disease (DJD) trauma obesity joint stiffness worsens narrowing ostophytes joint mice NSIADS COX-2
21
Q
-chronic systemic disease of unknown etiology characterized by the symmetric inflammation of joints
-pathogenesis: with
1) chronic inflammation and thickening of ______ (synovitis) which leads to ______ (inflamed granulation tissue) formation
2)increasing degrees of inflammation destroys the ______ and ______ (fusion) of the joint.
3) autoimmune disease due presence of ______ (rheumatoid factor) in the blood. mainly affects women. associated ______ gene
-clinical symptoms: arthritis with morning ______ that improves with activity. involvement of ______ joints of the fingers (______), wrists (______), elbows, ankles, and knees are affected.
______ is usually spared (unlike osteoarthritis). Rheumatoid nodules (central zone of necrosis) are present
-diagnosis: Joint-space ______, loss of ______, and ______ are seen on x-ray.
-Lab findings: ______ autoantibody against Fc portion of IgG (rheumatoid factor), ______ and high protein in synovial fluid.
A
rheumatoid arthritis synovial membrane pannus cartilage ankylosis IgM HLA-DR4 stiffness PIP swan-neck deformity ulnar deviation DIP narrowing cartilage osteopenia IgM neutrophils
22
Q
- abnormal lateral curvature of the spine
- occurs in ______ of the population
- most cases are ______ (cause is unknown) in adolescent girls
- the spinal curvatures lead to an ______ of the ______, so one shoulder is ______ than the other, and the pelvis is ______
- large curvatures cause pronounced ______
A
scoliosis 4% idiopathic asymmetry trunk higher tilted disabilities
23
Q
- pathogenesis: deposit of ______ crystals (monosodium urate: MSU due to defective metabolic pathway of ______ metabolism. the uric acid crystal deposit on the small joints of the ______ and ______ causing ______
- two types: ______ gout is the most common form. idiopathic pathogenesis for ______
- secondary gout is seen with ______, Lesch-Nyhan syndrome (X-linked HGPRT enzyme) and presents with mental ______ and ______. renal insufficiency- decreased renal excretion of ______
- increase of ______ in diet or ______ can make gout worse.
- lab diagnosis: ______: drawing fluid from your affected joint. When examined under the microscope, your joint fluid may reveal ______ (needle shaped crystals with negative birefringence under polarized light).
- ______: to measure the ______ level in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood.
A
gout uric acid purine hands feet inflammation primary hyperuricemia leukemia retardation self-mutilaton uric acid protein (meat) alcohol joint fluid test urate crystals Blood test uric acid
24
Q
acute gout: treatment
- ______: non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs may control inflammation and pain in people with gout.
- ______: these medications, such as the drug ______, may control gout ______ and ______. corticosteroids may be administered in a pill form, or ______ into the joint. side effects of corticosteroids may include ______ bones, poor ______ and a decreased ability to fight ______
- medication that blocks ______ production. drugs called ______ inhibitors, including allopurinol (zyloprim, aloprim) and febuxostat (uloric), limit the amount of uric acid your body makes. this may lower your bloods ______ level and reduce your risk of gout
A
acute attack corticosteroids prednisone inflammation pain injected thinning wound healing infection uric acid xanthine oxidase uric acid
25
Q
chronic gout: treatment
- ______: A type of pain reliever that effectively reduces gout pain by prevent polymerization of ______ into microtubules and inhibits ______ and ______.
- ______ improves your kidneys’ ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is ______.
A
Colchicine tubulin leukocyte migration phagocytosis Probalan increased
26
Q
- it resembles gout clinically, but is due to the deposition of ______ (CPPD). common in elderly and affects large joints of ______, ______, and ______
- Analysis of synovial fluid shows ______-shaped crystals with weakly positive birefringence under ______ light after X-ray.
A
pseudogout calcium pyrophosphate dihydrate knee shoulder wrists rhomboid polarized
