Exam 3 - alterations in musculoskeletal system Flashcards
1
Q
What kind of bone cells enable bone growth, repair, and change in shape?
A
bone cells
2
Q
What is the act called where bone cells continually synthesize new bone tissue and dissolve old tissue?
A
remodeling
3
Q
define osteoblasts; where do they come from?
A
bone-forming cells; from mesenchymal stem cells
4
Q
define osteoclasts; what do they contain?
A
bone-reabsorbing; contain lysosomes with hydrolytic enzymes
5
Q
define osteocytes; what osteocytes come from?
A
mature cells; once osteoblasts are finished with bone-forming, they become “imprisoned” in mineralized matrix and transform to osteocytes
6
Q
What are 2 types of bone tissue?
A
- compact
2. spongy
7
Q
What is compact bone tissue also called?
A
cortical
8
Q
What is spongy bone tissue also called?
A
cancellous, trabecular
9
Q
What is a break in the continuity of bone?
A
fracture
10
Q
What is a complete fracture?
A
bone broken all the way through
11
Q
What is an incomplete fracture?
A
damaged, but in 1 piece
12
Q
what is an open or compound fracture?
A
skin broken
13
Q
what is a closed fracture?
A
skin intact
14
Q
What is a comminuted fracture?
A
when it is broken in 2 or more fragments
15
Q
What is a linear fracture?
A
when the fracture is parallel to long axis of bones
16
Q
What is oblique fracture?
A
when the fracture is at a 45 degree angle to bone shaft
17
Q
What is a spiral fracture?
A
When the fracture encircles bone
18
Q
What is a transverse fracture?
A
When the fracture is straight across bone
19
Q
What kind of bones do children have?
A
flexible, growing bones
20
Q
What are 3 types of incomplete fractures that occur in children?
A
- greenstick
- torus
- bowing
21
Q
What is an incomplete fracture that perforates cortex and splinters spongy bone?
A
greenstick
22
Q
What is an incomplete fracture that is characterized by the cortex buckling, but it does not break?
A
torus
23
Q
What is an incomplete fracture that occurs from longitudinal force being applied to the bone? Hint: it involves paired radius-ulna or fibula-tibia with a complete fracture in one, while the other bends
A
bowing
24
Q
What is a pathologic fracture?
A
break at a pre-existing abnormality by a force that would not normally cause the bone to break
25
What are pathologic fractures associated with?
tumors, osteoporosis, infections, and metabolic bone disorders
26
When do stress fractures occur?
occurs in bone that is repeatedly subjected to stress
27
When are stress fractures seen most? (2 things)
1. seen in athletes
| 2. seen in bones without normal ability to deform and recover
28
What are fractures seen in athletes?
fatigue fracture
29
What are fractures seen in bones without normal ability to deform and recover?
insufficiency fracture
30
What is the healing process like after bone breakage?
1. Bleeding occurs in the broken ends and a hematoma forms
2. Hematoma organizes into a fibrous network
3. Invasion by osteoblasts, lengthening of collagen strands, and calcium deposition
4. A callus forms - new bone is built up as dead bone destroyed by osteoclasts
5. Remodeling occurs - excess callus resorbed and trabecular bone laid down
6. New bone tissue, not scar tissue, is formed during healing
31
What is rapid breakdown of muscle causing the release of intracellular components, including myoglobin into the extracellular space and bloodstream:
Rhabdomyolysis (Myoglobinuria)
32
What can rhabdomyolysis be a life-threatening complication of?
severe muscle trauma
33
What can rhabdomyolysis result in?
1. hyperkalemia
2. cardiac arrhythmia
3. acute renal failure
34
what are the 3 manifestations of rhabdomyolysis?
1. muscle pain
2. weakness
3. dark urine
35
what is excess myoglobin (an intracellular muscle protein) occurs in the urine due to muscle damage?
myoglobinuria
36
What is the most severe form of myoglobinuria?
crush syndrome
37
What is a less severe form of myoglobinuria?
compartment syndrome
38
What is a most recent problem involving myoglobinuria?
complication from cholesterol-lowering statins
39
what is myoglobinuria found after?
Found after viral infections, tetanus, heat stroke, strychnine poisoning, and fractures, excessive muscle activity in long distance runners, military recruits and after fraternity hazing
40
What is severe and fatal myoglibinuria associated with?
status epileptics and high-voltage shock
41
If myoglobinuria is caused by malignant hyperthermia, what can it lead to?
the severe muscle spasm and rhabdomyolysis can lead to RENAL FAILURE
42
What can myoglobinuria lead to?
Can lead to cerebral edema, pulmonary edema, DIC, and hypovolemic shock
43
What are 3 metabolic bone diseases?
1. osteoporosis
2. osteomalacia
3. paget disease
44
What is 1 infectious bone disease
osteomyelitis
45
What occurs in osteoporosis with old bone and new bone?
1. old bone is resorbed faster than new bone is made
| 2. spongy bone exceeds loss of compact bone
46
What is the most common metabolic disease and medical problem for older women?
osteoporosis
47
What are potential causes of osteoporosis?
1. Endocrine dysfunction (PTH, cortisol, TH, GH)
2. Medications
3. Vitamin D deficiency
4. Underlying causes
5. Low physical activity
6. Abnormal BMI
48
What is a major complication of osteoporosis?
fracture
49
In pre-menopausal women, what is high? what does this inhibit?
estrogen; inhibits bone resorption
50
Post-menopausal osteoporosis is most likely due to what?
estrogen deficiency and secondary causes
51
What is RANKL?
cytokine receptor activator of nuclear factor kappa B ligand
52
What is RANK?
receptor of RANKLY
53
What is OPG?
decoy receptor of RANKL
54
What is the patho of osteoporosis?
1. RANKL, a member of TNF family, is expressed by osteoblasts and their precursors, and is needed for osteoclast development
2. RANKL activates RANK, which is on osteoclasts and their precursors, to suppress apoptosis and increase survival/activation of osteoclasts
- -> Increases bone resorption and bone loss
3. OPG blocks RANKL by acting as a decoy
4. Cytokines and hormones regulate RANKL and OPG balance
5. Dysregulation leads to osteoporosis and other problems
55
What increases RANKL expression?
1. IL-1, 11, 17
2. TNF alpha
3. PTH
4. glucorticoids
56
What decreases RANKL expression?
1. IL-4 and TGF beta
| 2. estradiol
57
What increases OPG production?
1. IL-1, -13, and –18
2. TNF alpha and TGF beta
3. Estradiol
4. Leptin
5. Mechanical strain
58
What decreases OPG production?
1. PTH and glucocorticoids
| 2. others
59
What is inadequate or delayed mineralization of bone?
osteomalacia
60
What proceeds normally in osteomalacia, and what does not occur?
1. remodeling cycle occurs normally
| 2. calcification does not occur
61
What is replaced bone like with osteomalacia?
soft instead of rigid
62
What does osteomalacia result from?
lack of vitamin D
63
True or false: osteomalacia is not like rickets
false; it is similar to rickets
64
What is the major difference between osteomalacia?
1. rickets occurs in growing bones of children
| 2. osteomalacia occurs in adults
65
What is the patho of osteomalacia?
1. Lack of vitamin D causes calcium ion concentration to fall
2. Low calcium stimulates PTH to raise calcium, but phosphate is lost in urine
3. When phosphate falls below a certain level, proper mineralization does not occur
66
What is a state of increased metabolic activity of bone?
paget disease
67
What does the excessive remodeling of bone in paget disease lead to?
leads to soft and enlarged bones
68
What is paget disease a chronic acceleration of and deposition of?
1. accelerated remodeling of spongy bone
| 2. deposition of disorganized bone
69
Does paget disease have symptoms?
no, it is often symptomless
70
What are 3 reasons why osteomyelitis is hard to treat?
1. Bone has many small channels that are impermeable to cells and biochemicals of the defense system
2. Capillaries of bone are sensitive to bacterial toxins--easily damaged; small clots lead to bone necrosis
3. Bone cells have a limited capacity to replace bone destroyed by infections
71
What are 3 inflammatory joint disorders?
1. rheumatoid arthritis
2. ankylosing spondylitis
3. gout
72
What is the most common joint disease?
osteoarthritis
73
What is there loss and damage of with osteoarthritis?
articular cartilage in synovial joints
74
What are 3 key features of osteoarthritis?
1. inflammation
2. mild synovitis
3. thickening of joint capsule
75
What is the secondary form of OA associated with?
associated with known risk factors
76
What is the idiopathic form of OA associated with?
associated with age
77
What are 4 risk factors for OA?
1. increased age
2. joint trauma
3. long-term mechanical stress
4. obesity
78
What are the symptoms of OA?
1. Pain (worsens with activity)
2. Stiffness (diminishes with activity)
3. Enlargement of the joint
4. Tenderness, limited motion, muscle wasting
5. Partial dislocation, deformity
79
a. What loses its glistening appearance in OA?
| b. What does bone become (hint: dense and hard)
a. cartilage
| b. sclerotic
80
What is the patho of OA?
1. Cysts can develop in underlying bone and communicate with fissures in cartilage
2. Pressure build-up in the cysts causes rupture
- -> Cyst contents spill into synovial cavity
3. Cartilage-coated bone cells grow outward and form spur-like projections
4. Spurs break off and fall into synovial cavity
5. Broken spurs irritate the synovial membrane
81
What is an inflammatory autoimmune joint disease?
rheumatic arthritis
82
What is RA systemic automminue damage to?
connective tissue, primarily in the joints (synovial membrane)
83
What are the systemic symptoms of RA?
1. Inflammation
2. fever
3. fatigue
4. weakness
5. anorexia
6. weight loss
7. generalized aching and stiffness
84
What does RA result in? (hint: 3 things)
1. joint pain
2. deformity
3. loss of function
85
What is the cause of RA?
unknown
86
What are 3 different patho processes involved in RA?
1. Neutrophils and other cells in the synovial fluid become activated
2. Inflammatory cytokines:
- -> Tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-21 (IL-21), induce enzymatic breakdown of cartilage and bone
3. T cells also interact with synovial fibroblasts through TNF-α, converting synovium into a thick, abnormal layer of granulation tissue (pannus)
87
What are physical symptoms of RA?
painful, tender, stiff joints
88
What is a treatment option for RA?
DMARDS such as methotrexate
89
What is a chronic inflammatory joint disease of the spine or sacroiliac joints causing stiffness and fusion of the joints?
ankylosing spondylitis
90
What causes AS?
cause is unknown, but strong association with HLA-B27 antigen
91
What is the PATHO of AS?
1. Begins with the inflammation of fibrocartilage, mainly in vertebrae and sacroiliac joint
2. Inflammatory cells infiltrate and erode fibrocartilage
3. As repair begins, scar tissue ossifies and calcifies causing the joint to eventually fuse
92
What are some manifestations of AS?
1. low back pain in 20s; stiffness, pain, restricted motion
2. loss of lumbar curvature (lordosis)
3. increased concavity of upper spine (kyphosis)
93
How does AS differ from RA?
RA - synovial membranes are involved at the site; AS - enthesis is the main site involved.
94
How does the end result of AS differ from the end result of RA?
RA - end result is destruction and instability of synovial joints.
AS - end result is ossification and fusion of the joint
95
What are 2 treatments for AS?
1. physical therapy
| 2. NSAIDS
96
What is a syndrome caused by either overproduction or under excretion of uric acid?
gout
97
When uric acid crystals occur in synovial fluid, the inflammation is called what?
gouty arthritis
98
What are risk factors of gout?
1. male sex
2. increasing age
3. high intake of alcohol, red meat, and fructose
4. drugs
99
What are 5 manifestations of gout?
1. Increase in serum urate concentration (hyperuricemia)
2. Recurrent attacks of inflammation of a single joint
3. Deposits of tophi in and around joints
4. Renal disease
5. Formation of renal stones
100
What is gout linked to?
purine metabolism and renal function
101
What is the breakdown product of purine nucleotides?
uric acid
102
This with gout have sluggish what?
uric acid excretion
103
What are manifestations of acute gouty arthritis?
1. severe pain, especially at night
| 2. hot, red, tender joint pain
104
What are signs of systemic inflammation with acute gouty arthritis?
1. increased sedimentation rate
2. fever
3. leukocytosis
105
What is chronic widespread diffuse join pain, fatigue, and tender joints?
fibromyalgia
106
What are these symptoms characteristic of:
Increased sensitivity to touch
Absence of inflammation
Fatigue
Sleep disturbances/non-restorative sleep
Anxiety and depression
~80-90% of individuals affected are women (peak age 30-50)
Inflammation may play a role (autoimmune disorders often coexist)
Genetic factors
CNS dysfunction
fibromyalgia
107
What is 1 neuroimmunoendocrine disease?
chronic fatigue syndrome
108
What is chronic fatigue syndrome characterized by (4 things)?
1. Cognitive impairment
2. Severe postexertional fatigue
3. Unrefreshing sleep
4. Decreased physical activity that affects daily functioning
109
What is involved with chronic fatigue syndrome?
psychologic and physiologic involvement
