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**Old DOOS > Disorders of Bone > Flashcards

Disorders of Bone Flashcards

1
Q

is bone loss normal

A

Yes, but it can be lost to a level where is causes problems

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2
Q

when do you lose bone

A

before pubertal growth spurt

after menopause

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3
Q

what are the two types of primary osteoporosis

A 
postmenopausal
senile (age related)- if you live long enough bone will suck
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4
Q

bone loss secondary to diseases (malignancy, corticosteroid use, GI disorders, endocrine)

A

Secondary osteoporosis

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5
Q

when is the highest risk of falls?

A

age 80 or greater

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6
Q

what type fracture is a collapse of a spinal vertebral bone?

A

compression fracture

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7
Q

are most compression fractures noticed?

A

No, 2/3 are silent

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8
Q

what is a physical sign of a compression fracture?

A

loss of height

kyphosis

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9
Q

what grade of compression fracture is 20-25% reduction in vertebral height

A

grade 1

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10
Q

what grade of compression fracture is >40% reduction in vertebral height

A

Grade 3

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11
Q

what grade of compression fracture is 2 normal vertebral height

A

Grade 0

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12
Q

what grade of compression fracture is 25-40% reduction in vertebral height

A

Grade 2

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13
Q

what grade of vertebral compression fracture needs spinal surgery

A 
Grade 2 (sometimes, if painful)
Grade 3
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14
Q

what disorders are associated with stress/ insufficiency fractures

A 
osteoporosis
RA
osteomalacia
Paget's Dz
Radiotherapy
Glucocorticoids
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15
Q

what meds can cause stress/ insufficiency fractures

A

methotrexate
sodium fluoride
etidronate

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16
Q

what causes bone loss

A 
smoking
excess alcohol consumption
low calcium intake or urinary losses
renal problems 
inadequate Vit D and sunshine
low levels physical activity
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17
Q

what type activity do people w/ osteoporosis

A

weight bearing activity

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18
Q

once bone loss has occurred, can you reverse the loss?

A

No, once the bone is lost it is gone Vit D and calcium can’t reverse it

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19
Q

what drugs can reverse or stop significant bone loss

A

Rx meds

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20
Q

what lab test do you want for the Vit D level?

A

25-hydroxy Vitamin D

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21
Q

when is the best time to take calcium

A

with meals

body can only absorb 500-600 mg at once

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22
Q

what is the best type of Vit D to take

A

D3 (cholecalciferol)

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23
Q

what is the only prescription dose of Vit D?

A

D2

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24
Q

what is the most useful test for osteoporosis

A

called a Dual X-ray Absorptiometry or DXA.

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25
Q

what is is the reduction in bone density compared to what the person would have had as a young adult.

A

T score

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26
Q

reduction in bone density compared to what other adults of the same age would have

A

Z-score

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27
Q

A T-score of -1.0 to -2.4 indicates what?

A

Osteopenia

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28
Q

A T-score of -2.5 or less indicates …….

A

osteoporosis

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29
Q

A Z-score of -1.0 indicates a __ times normal risk of fracture.

A

2

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30
Q

A Z-score of -2.0 indicates a __ times normal risk of fracture.

A

4

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31
Q

A Z-score of -3.0 indicates an __ times normal risk of fracture.

A

8

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32
Q

what is an IVA or VFA

A

Intervertebral Assessment of Vertebral Fracture Assessment

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33
Q

What is VFA used for?

A

physician to see whole spine & identify Compression Fractures that may be silent or may have progressed

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34
Q

who gets a DXA scan?

A

65 and above for females
70 and older for males
women over 50 w/ risk factors

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35
Q

what are some other factors that indicate you need a DXA scan?

A 
10 pack/ year 
persons on seizure meds, steroids, DepoP
liver/ kidney dz
body weight <127
RA or immboility
cancers that destroy bone
family hx, early menopause
loss of height/ kyphosis
hyperthyroidism or fragility fracture
organ transplant
anorexia/ malabsorption
excessive alcohol
cancer/ spinal cord injury
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36
Q

if someone shows up w/ no risk factors and has osteoporosis what do you need to rule out

A 
hypertyroidism
hyperparathyroidism
cushing's
hematologic disorders
malignancy
vitamin D deficiency
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37
Q

what is the first line of treatment for osteoporosis

A

bisphosphonates

38
Q

what is a big risk with SERMs

A

DVT

39
Q

how long can you use teriparatide for?

A

no more than 2 years

40
Q

ROA of calcitonin

A

nasal spray or SubQ

41
Q

what is an osteoporosis med that is an IV infusion

A

zoledronic acid

42
Q

Softening of the bones due to impaired mineralization (with excess accumulation of osteoid), resulting from Vitamin D deficiency

A

osteomalacia

43
Q

is the organic matrix of bone or is young bone that has not yet undergone calcification

A

osteoid

44
Q

what type “fracture” does osteomalacia cause?

A

pseudofractures

45
Q

what happens to the bone in osteomalacia

A

bowing

46
Q

what are red flags associated w/ hypocalcemia

A

pancreatitis

osteoblastic metastasis

47
Q

what are some signs of hypocalcemia

A 
paresthesias
tetany (cramping) 
HPOTN
seizures
bradycardia
prolongation of QT interval 
Chvostek's sign (tap facial muscle) 
Trousseau's signs (hand held flexed after BP cuff on form 3 min at above systolic)
48
Q

what other labs should you test if you suspect hyper/ hypocalcemia

A

serum creatinine, phos, mag, and (PTH) and Pregnancy (!)

49
Q

with symptoms how do you treat hypocalcemia

A

IV calcium (not too fast)

50
Q

what disease can cause hypercalcemia

A 
paget's dz
malignancy
malignant lymphoma 
pheochromocytoma 
theophylline toxicity
51
Q

complications of hypercalcemia

A 
pancreatitis 
short Q-T interval
corneal calcifications 
muscle weakness
constipation 
nephrolithiasis
52
Q

Tx for hypercalcemia

A 
increase urinary Ca excretion (Lasix)
bisphosphonates 
steroids (if high Vit D) 
chelation therapy w/ EDTA or IV phos
dialysis
53
Q

Sx of excess parathyroid secretion

A 
symptoms of hypercalcemia
bone disease
nephrolithiasis, proximal renal tubular acidosis
anemia 
hyperuricemia and gout
54
Q

what does the parathyroid hormone affect

A

bone
kidney
intestine

55
Q

Meds for HyperPTH

A 
estrogen plus progestin
bisphosphonates
raloxifene
calcimemtic
Vit D
56
Q

bone infection usually due by s. aureus

A

osteomyelitis

57
Q

what are the 2 descriptions for duration of osteomyelitis

A

acute vs. chronic

58
Q

what are the descriptions for cause of osteomyelitis

A

hematogenous
exogenous
surgical
true continguous spread

59
Q

what must you describe w/ osteomyelitis

A 
duration
cause
site
extent (of defect)
type of patient (infant, child, immunocomprimised)
60
Q

what are patient with sickle cell anemia at risk for

A

salmonella osteomyelitis

61
Q

what causes exogenous osteomyelitis

A

open Fx. Or surgery

62
Q

Acute hematogenous osteomyelitis most commonly affects _____ bones of children

A

long

63
Q

Chronic is used when after the acute infection has had appropriate treatment viable colonies of bacteria harbored in necrotic and ischemic tissue cause a __________________

A

recurrence of infection

64
Q

clinical features of acute hematogenous osteomyelitis

A

pain
loss of motion
soft tissue swelling
drainage rare (no open wound)

65
Q

presentation of chronic hematgenous osteomyelitis

A

acute flare-ups of tender, warm, sometimes swollen area
patients complain of malaise, anorexia, fever, wt. loss, night sweats
pain and drainage from sinus tract (from bone out to skin)

66
Q

what do you order for osteomyelitis

A

WBC, CRP, ESR (normal possible)
ID organism ASAP (blood culture, bone biopsy)
aspirate joint if concerned of involvement

67
Q

are x-rays good for tracking osteomyelitis

A

sort of, but 7-10 days behind symptoms

68
Q

what is good for early detection of osteomyelitis

A

Ultrasound

69
Q

what shows bone changes before XR or bone scan?

A

MRI

70
Q

what is the gold standard for osteomyelitis imgaging

A

MRI (as it affects the tissue of the bone)

71
Q

Tx for acute osteomyelitis

A

antibiotics x 3-12 weeks IV then to PO drugs

72
Q

tx for chronic osteo

A 
4 week- 2 years of IV abx
and PO antibiotics depending on organism
surgical I and D may be indicated 
removal of adjacent orthopedic hardware 
multiple surgeries may be required
73
Q

_____ tumors of bone and soft tissue are more common than primary malignant tumors

A

benign

74
Q

what is the most common primary malignant bone tumor

A

multiple myeloma

75
Q

the most common bone tumor in adults is what?

A

metastatic (breast, lung, prostate, kidney, thyroid) most common location is spine

76
Q

where does lung CA often metastasize to?

A

distal phalanges (hand)

77
Q

what work up do you need to get for neoplasms

A 
XR
CBC
ESR
CRP
CMP
bone scan
CT
78
Q

Proliferation of a single cell line in bone marrow

A

multiple myeloma

79
Q

injection dye and take pictures at intervals, goes to increased areas of remodeling

A

bone scan

80
Q

diagnostic tool for multiple myeloma

A

urine electrophoresis

81
Q

presentation for multiple myeloma

A

sudden bone pain
fractures
ROS for constitutional sx
anemia

82
Q

who is multiple myeloma more common in?

A

Males

african americans

83
Q

Can be a single entity in bone, part of soft tissue mass, or metastatic
All age groups
Pain, soft tissue swelling

A

lymphoma of bone

84
Q

Constant bone pain – hallmark is night pain

Highest in teen yrs..”growing pains that don’t go away”

A

osteosarcoma

85
Q

What does an x-ray of a bone w/ osteosarcoma show?

A

periosteal stripping

86
Q

tx for osteosarcoma

A

chemo, surgery, chemo

87
Q

common in 5-25 year olds
pain, fever, elevated ESR/ WBC, anemia
small round blue cells on histology

A

Ewing’s sarcoma

88
Q

like a mole of the bone
benign
cortex of bone is completely undisturbed

A

enchondroma

89
Q

periostael stripping around destroyed cortex indicates what?

A

osteosarcoma

90
Q

who should manage a benign orthopedic tumors?

A

general orthopedics

if malignant tumors- refer to orthopedic oncologist

91
Q

tumor of fatty tissue, may grow slowly

A

lipoma

92
Q

outpouching of synovial sac and fills up with fluid. wrist most common

A

ganglion

**Old DOOS (11 decks)

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