Final: Musculoskeletal patho

Question 1

what does the musculoskeletal system provide for the body

Answer 1

form, stability, movement

Question 2

every how many years is the complete human skeleton replaced?

Answer 2

every 10-12 years a completely new skeleton is formed

Question 3

what is a group of hereditary bone diseases with abnormal synthesis of Type 1 collagen? aka? leads to what?

Answer 3

osteogenesis imperfecta which leads to skeletal fragility

aka brittle bone disease

Question 4

most osteogenesis imperfecta disorders are inherited how?
if severe enough what may happen at birth?
what are two facial features that may be seen with OI?

Answer 4

most OI= autosomal DOMINANT
if severe enough death may occur from passage thru birth canal
BLUE SCLERA and opalescent teeth (similar to dentinogenesis imperfect) may be seen

Question 5

whats the tx with OI?

whats the prognosis based on?

Answer 5

OI tx: minimize factors that causes fractures

prognosis: based on type of OI and expression of gene

Question 6

what is clinically indistinguishable between Dentinogenesis Imperfecta and Osteogenesis Imperfecta?

Answer 6

Opalescent teeth

Question 7

whats a group of rare hereditary disorders w defective bone remodeling (osteoclast dysfunction)?
what is the resulting bone in this disorder?
AKA?

Answer 7

osteopetrosis= dense bone that is structurally unsound and weak
Osteopetrosis aka marble bone disease

Question 8

PTs with osteopetrosis are predisposed to what?

Answer 8

Pts with osteopetrosis are prone to fractures and infections like osteomyelitis

Question 9

what is the only cure for osteopetrosis?
replacement of the marrow stem cells can lead to what?
what can occur in the head in PTs w osteopetrosis?

Answer 9

Osteopetrosis cure = bone marrow transplant
replacement of marrow stem cells can lead to anemia, thrombocytopenia, leukopenia
w osteopetrosis the cranial foramen can compress leading to blindness, deafness

Question 10

what is the most common acquired, metabolic bone disease ? what does this disease cause?

Answer 10

osteoporosis= INC porosity of skeleton resulting from reduced bone mass, INC bone fragility e

Question 11

who is at greatest risk for osteoporosis and what is this associated with? what percent sustain fractures by 65? by age 90?

Answer 11

postmenopausal women at greatest risk for osteoporosis associated with DEC estrogen
25% of women at age 65 have fractures bc of osteoporosis
50% of women at age 90 have fractures

Question 12

what is basically the problem in osteoporosis?

Answer 12

osteoporosis is an imbalance between INC osteoclastic activity and an DEC in osteoblastic activity

Question 13

what sites are most commonly affected by osteoporosis?

Answer 13

vertebral bodies, pelvis, femoral neck, other weight bearing bones

Question 14

what may osteoporosis lead to?

Answer 14

osteoporosis may lead to kyphoscoliosis and reduced respiratory function

Question 15

what affect more women osteoporosis fractures or the combo of heart attach + stroke + great cancer? how many people die within 1 year of sustaining a hip fracture bc of osteoporosis?

Answer 15

osteoporosis! 25% of people die within 1 year of hip fracture

Question 16

how do you diagnose osteoporosis?
tx?
prognosis?

Answer 16

osteoporosis gold standard of diagnosis= dual X ray absorptiometry (dexa scan)

tx: diet, exercise, calcium and vit D, biphosphonates, hormone therapy, monoclonal ABs
prognosis: guarded

Question 17

what disease usually affects adults older than 40 but has an unknown etiology that may be related to a paramyxovirus infection?

Answer 17

pagets disease of bone

Question 18

Pagets disease of bone causes what?

what percent are polyostotic: affects multiple bones?

Answer 18

pages disease of the bone causes abnormal, dense bone formation which is structuraly weak and prone to fracture
85% are polyostotic

Question 19

what are common signs of pagets disease that can be found on X-rays or blood tests even tho it may be asymptomatic

Answer 19

bone enlargement, fractures, pain, cranial nerve compression, bowing of leg bones

Question 20

what are the 3 phases of Pagets disease? what is a common description of the bone in Pagets disease?

Answer 20

1. osteolytic phase
2. mixed phase
3. osteosclerotic phase
   Mosaic bone

Question 21

Tx of Pagets?

Risks of Pagets outside of bone fractures?

Answer 21

Pagets tx: Calcitonin, bisphosphonates, analgesics for bone pain
slight 1% lifetime INC risk for sarcomas especially osteosarcoma

Question 22

what is primary hyperparathyroidism? tx of primary?

Answer 22

primary is due to parathyroid hyperplasia, adenoma, carcinoma more severe but less common
primary Tx: remove affected gland or tumor

Question 23

actions of PTH?

Answer 23

osteoclastic activation, INC Ca absorption by kidneys
INC Vit D synthesis by kidneys which promotes Ca absorption by gut
All these lead to INC serum Ca!!

Question 24

what can hyperparathyroidism causes?

what is more severe but less common primary or secondary

Answer 24

“painful bones, renal stones, abdominal groans and psychic moans”

primary is more severe but less common

Question 25

Hyperparathyroidism can causes osteitis fibrosa cystica, what is osteitis fibrosa cystica?

Answer 25

cyst like brown tumors of the bone

Question 26

what is secondary hyperparathyroidism?

tx of secondary?

Answer 26

secondary: leads to poor calcium retention and altered VIT D metabolism, common complication of end stage renal disease or VIT D deficiency
secondary tx: renal transplant, VIT D supplementation

Question 27

what is osteomyelitis? usually caused by what?

Answer 27

osteomyelitis is an infection of the bone and marrow

usually bacterial

Question 28

what are the 3 pathways of osteomyelitis?

Answer 28

1. hematogenous spread by Staph Aureus
2. continguous spread i.e. odontogenic infection
3. implantation following fracture or surgery

Question 29

what is osteomyelitis associated with?

Answer 29

pain tenderness, possible overlying erythema, or swelling

Question 30

describe the bone of chronic osteomyelitis

Answer 30

non vital bone sequestrum surrounded by rim of new bone involucrum

Question 31

tx of osteomyelitis?

Answer 31

drainage, ABs, surgical debridement