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D&D Final > Disorders of the Skeletal System : Metabolic and Rhuematic Disorders > Flashcards

Disorders of the Skeletal System : Metabolic and Rhuematic Disorders Flashcards

1
Q

What is Osteoporosis?

A

a metabolic bone disorder

characterized by a decrease in bone mass and density, combined with loss of bone matrix and mineralization

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2
Q

What may be the first indicator of osteoporosis?

A

bone fracture

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3
Q

What is the patho behind Osteoporosis?

A

bone reabsorption exceeds bone formation

remaining bone is normal

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4
Q

Who is osteoporosis usually seen in?

A

post menopausal women (b/c lack of estrogen)

short women more than tall women
thinner women more than thicker women

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5
Q

Why don’t we just give estrogen to post menopausal women?

A

because estrogen has been linked to cancer

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6
Q

What are the predisposing factors for Osteoporosis?

A

smoking
calcium deficit
sedentary lifestyle
aging
Osteopenia
Hormonal Factors (Hyperparathyroidism or Cushing’s Syndrome)
Long Term intake of glucorticoids (steroids) such as Prednisone

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7
Q

What is osteopenia?

A

mineral bone density lower than normal but not osteoporosis

can contribute to the pathology of all metabolic bone diseases

mostly diagnosed after a bone fracture

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8
Q

When does bone density peak?

A

30 years old

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9
Q

Which race is at a higher risk of Osteoporosis?

A

European and Asian have higher risk

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10
Q

If your mother had osteoporosis are you at a greater risk to develop osteoporosis in your lifetime?

A

yes, at up to an 80% increase in likelihood

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11
Q

What are the modifiable risk factors for osteoporosis?

A

excessive alcohol, Vitamin D deficiency (calcium carrier), tobacco smoking, malnutrition, underweight, inactivity

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12
Q

How does tobacco increase the risk of osteoporosis?

A

tobacco smoking increases the breakdown of estrogen(look like a man)

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13
Q

What is Osteomalacia?

A

defective mineralization of bone WITHOUT the LOSS of bone matrix

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14
Q

What are the two causes of Osteomalacia?

A

inadequate calcium

inadequate phosphate

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15
Q

Osteomalacia is highly seen among…

A

the elderly

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16
Q

Can Osteomalacia be treated?

A

can be treated with diet if that is the cause

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17
Q

What is a matrix?

A

intracellular substance of tissue/s from which a structure develops

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18
Q

Children with what disease are at risk for Osteomalacia?

A

Rickets

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19
Q

What is Rickets?

A

Failure or delay in calcification of the growth plate

seen in children

several forms

may be nutritional: Vitamin D dependent or Vitamin D resistant

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20
Q

What is Rickets generally caused by?

A

Vitamin D deficiency

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21
Q

Premature Osteoporosis is being seen in who?

A

female athletes (they don’t menstruate)

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22
Q

What is Paget’s Disease?

A

Chronic

significant bone reabsorption followed by hectic bone reformation

bones are irregular and fracture easily
bones tend to bow or take abnormal shapes

Clinical features are going to vary depending on the extent of the disease

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23
Q

What are the commonly affected areas with Paget’s Disease?

A

pelvis, femur, lower lumbar vertebrae

*this differentiates this disease from osteoporosis

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24
Q

What is Rheumatoid Arthritis (RA)?

A

autoimmune disorder causing chronic systemic inflammatory disease

can effect tissue or organs but primarily flexible synovial joints

major cause of disability, can cause loss of function

Remissions and exacerbations

Severity varies from mild to severe, reflecting the number of joints involved (polyarticular)

often larger joints but can be in smaller joints

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25
Q

What does Polyarticular mean?

A

involving many joints

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26
Q

RA has a higher incidence in who?

A

women than men

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27
Q

Discuss the development of RA

A

1) ABNORMAL IMMUNE RESPONSE, causing inflammation of the synovial membrane with vasodilation, increase permeability, and formation of exudates, causing the typical red, swollen, and painful joint
2) Rheumatoid Factor (antibody against immunoglobin G) is present in the majority of patients with RA
3) After the FIRST period of acute inflammation (in capsule around joints in the synovium), the joint MAY RECOVER COMPLETELY….. but….
* During subsequent EXACERBATIONS the process will CONTINUE into……….

  • Synovitis
  • Pannus Formation
  • Cartilage Erosion
  • Fibrosis
  • Ankylosis
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28
Q

Define Pannus

A

fibrous tissue in synovium

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29
Q

Define Fusion

A

when you cant move a joint

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30
Q

What is Ankylosis?

A

fusion

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31
Q

Define exacerbations?

A

flare ups

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32
Q

Synovitis

A

inflammation of the synovial membrane

33
Q

Pannus formation

A

unique to RA. (HALLMARK)

Not seen in other inflammatory arthritis

34
Q

Cartilage Erosion

A

abnormal layer of fibrovascular tissue or granulation tissue

35
Q

Ankylosis

A

Stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint

36
Q

What are the complications of RA?

A
  • atrophy of muscles
  • alignment shifts
  • inflammation/pain
  • contractures/deformities
  • mobility impaired
  • systemic effects
37
Q

What are some nonpharmalogical things we can suggest for RA patients?

A

Physical Therapy
Occupational Therapy
Nutritional Therapy

38
Q

What are some Pharmalogical treatments of RA?

A

Analgesics (pain killers)

Steroids (to decrease autoimmune response)

39
Q

What is Systemic Lupus Erythematosus (SLE)?

A

Chronic Inflammatory Condition-NO CURE
Unknown etiology

UNPREDICTABLE- each person with SLE may experience different manifestations
Harms heart, joints, skin, lungs, nervous system tissues

can be FATAL, esp. due to cardiovascular disease

40
Q

What is the patho behind Systemic Lupus Erythematosus ?

A

for some unknown reason patients with SLE develop AUTOANTIBODIES that damage different tissues around the body.

some SLE patients produce antibodies against RBC

41
Q

What are the Clinical Manifestations of SLE?

A

can affect many systems: musculoskeletal, skin, cardiovascular, lungs, kidneys, CNS

Onset could be Acute or Insidious (creeps up like an old pair of undies)

Exacerbations and Remissions

Arthralgia and Arthritis (early) [joint pain is a common early symptom]

Skin (Butterfly Rash) - don’t always have this

Wide range of S/S so diagnosis can be elusive

42
Q

Butterfly Rash is a hallmark of which disorder?

A

SLE

Systematic Lupus Erythematosus

43
Q

What is the difference between Arthralgia and Arthritis?

A

Arthralgia is non-inflammatory and Arthritis is Inflammatory

44
Q

What is SLE often called? Why?

A

The Great Imitator

b/c it mimics so many diseases with the wide range of S/S

45
Q

What is Scleroderma?

A

Autoimmune disorder characterized by fibrosis (or hardening “sclero”), vascular alterations and autoantibodies

Effects the CONNECTIVE TISSUE, primarily skin

46
Q

What is the Classic Characteristic of Scleroderma?

A

Fibrosis

47
Q

Who is Scleroderma most often seen in?

A

women

48
Q

Is there treatment for Scleroderma?

A

no

49
Q

Limited Vs. Diffuse Systemic Sclerosis (scleroderma)

A
  1. Limited Cutaneous = skin only (forearms, fingers and face)
    • “CREST”
  2. Diffuse is progressive skin involvement and other organs
50
Q

What does the acronym CREST stand for?

A

Clinical Manifestations of LIMITED scleroderma

Calcinosis
Raynaud's
Esophageal Dysfunction
Sclerodactyly
Telangiectasias
51
Q

Calcinosis (in LIMITED SLE)

A

deposits of calcium nodules in skin

52
Q

Raynaud’s (in LIMITED SLE)

A

exaggerated vasoconstriction in hands

53
Q

Sclerodactyly (in LIMITED SLE)

A

skin thickens on fingers

54
Q

Telangiectasias (in LIMITED SLE)

A

dilated capillaries on the face, hands, and mucus membranes

55
Q

What is Ankylosing Spondylitis ? (and what does it effect?)

A

Autoimmune disease
Chronic
Progressive
Inflammatory

Effects….

  1. Sacroiliac joints
  2. intervertebral spaces
  3. Costovertebral joints of the axial skeleton
56
Q

Discuss the progressive process of Ankylosing Spondylitis?

A

Vertebral joints become inflamed

Fibrosis and calcifications or fusion of joints

Inflammation begins and progresses up spine

Kyphosis

Osteoporosis

Lung expansion may be limited

57
Q

How does inflammation present in Ankylosing Spondylitis?

A

progresses up the spine

58
Q

Why does Kyphosis develop in Ankylosing Spondylitis patients?

A

kyphosis develops as result of rigidity and loss of normal curvature

59
Q

Why is Osteoporosis common in Ankylosing Spondylitis patients?

A

because of pathological compression fractures

60
Q

What is Bamboo Spine?

A

complete fusion and rigidity of spine from Ankylosing Spondylitis

61
Q

In what autoimmune disease to the patients become plasticized?

A

Scleroderma

62
Q

Can Scleroderma be fatal?

A

Yes because they can develop organ system complications that can be fatal ( Diffuse Systemic Sclerosis)

63
Q

What is Osteoarthritis ?

A

Degenerative “non-inflammatory” joint disease

64
Q

Osteoarthritis is often seen in which joints?

A

frequently occurs in weight bearing joints

65
Q

Discuss the mechanisms and patho behind Osteoarthritis?

A

Articular cartilage of joints is lost through erosion from excessive mechanical stress. Surface becomes rough and worn interfering with easy joint movement.

Tissue damage appears to cause release of enzymes from the cells that accelerates degeneration of the cartilage.

Subchondral bone may be exposed and damaged, leading to bone spurs developing. Pieces of bone spurs break off in the joint, causing further irritation

joint space becomes narrow
(evidenced by crepitus and grinding)

66
Q

What are the S/S of OA (osteoarthritis)?

A

joint pain (can be debilitating), crepitus, stiffness

*no systemic S/S with OA which is how it is differentiated from RA

67
Q

What is the treatment for OA?

A

exercise
Analgesics (pain killers)
Nutrition

68
Q

OA can lead to bone spurs… why?

A

Because of the degeneration of the cartilage Subchondral bone may be exposed and damaged which leads to the development of bone spurs.

69
Q

What is a complication of bone spurs with OA?

A

Pieces of bone spurs could break off in the joint causing further irritation

70
Q

T/F The risk of Osteoarthritis does not increase with age.

A

FALSE

Osteoarthritis is associated with increased risk with age

71
Q

Discuss the Evolution of Osteoarthritis. (in what order are things effected?)

A
  1. Bone
  2. Cartilage
  3. Thinning of Cartilage
  4. Cartilage Remnants
  5. Destruction of Cartilage
72
Q

What is Gout/Gouty Arthritis?

A

deposits of URIC ACID/urate crystals in joints. Cause an acute inflammatory response.

affects a single joint

73
Q

What are the S/S of Gout?

A

affects a single joint

redness/swelling of joint pain with severe pain

74
Q

What is a common site for Gout to be seen?

A

the Big Toe

75
Q

What could precipitate and attack of gout?

A

a sudden increase in serum uric acid levels

76
Q

How do we diagnose Gout?

A

attain a sample of the fluid

77
Q

What is Gout sometimes called?

A

“The King’s Disease” because it is associated with a diet that a rich person would have (red wines, Red Meats)

78
Q

Who is Gout commonly seen in?

A

men over 40

79
Q

How do we treat Gout?

A

diet modifications (less uric acid) and medications

D&D Final (6 decks)

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