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Pathophysiology I > Metabolic and Rheatic Disorders > Flashcards

Metabolic and Rheatic Disorders Flashcards

1
Q

What shows up on the x-ray with osteopenia?

A

evidence of decreased bone mineral density

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2
Q

List the 4 causes of osteopenia

A

Osteoporosis
Osteomalacia
Malignancies (multiple myeloma)
Endocrine disorders

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3
Q

Describe what Osteoporosis is

A

it is a condition where the bone density and bone strength is decreased

  • matrix is weakened
  • mineralization is decreased
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4
Q

What is the cause of osteoporosis?

A

UKE, but occurs when bone resorption exceeds bone formation

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5
Q

What are the 7 things that osteoporosis is associated with (RF/causes)

A

GENDER:
postemenopausal osteoporosis
male hormone decline

GENETICS

ACTIVITY LEVEL

NUTRITION

BODY SIZE

RACE

AGE RELATED CHANGES

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6
Q

What are 2 examples of age related changes that contribute to osteoporosis?

A

dec osteoblast replication

dec activity levels

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7
Q

What are 4 types of endocrine disorders which can cause secondary osteoporosis

A

Hyper/hypothyroidism

Hyperparathyroidism

Cushing Syndrome

Diabetes Mellitus

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8
Q

what type of conditions regarding the GI can cause secondary osteoporosis?

A

malabsorption issues

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9
Q

Can alcoholism cause secondary osteoporosis?

A

yes

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10
Q

List the four medications that can cause secondary osteoporosis

A

Corticosteroids

Antacids with aluminum

Anticonvulsants

Antiretroviral therapy

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11
Q

Can prematurity cause secondary osteoporosis?

A

yes

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12
Q

Can cystic fibrosis cause secondary osteoporosis?

A

yes

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13
Q

Explain what the female athlete triad is.

A

It is a combination of eating disorders with excess exercise that results in weight fluctuations

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14
Q

Describe the three hormonal changes that result from Female Athlete Triad. What does this cause

A

dec……
Gonadotropin
LH and FSH
Estrogen

amenorrhea and osteoporosis/osteopenia

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15
Q

What is the most common complication of osteoporosis and what is the cause of this.

A

FRACTURES:

d/t loss of trabeculae from cancellous bone and thinning of cortex

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16
Q

Describe what occurs with postmenopausal osteoporosis and what this results in.

A

Increased osteoclast activity resulting in loss of trabeculae

Microfractures occur and bone compresses

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17
Q

What part of the bone is most affected by senile/age-related osteoporosis?

A

haversian system widens d/t loss of trabeculae

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18
Q

Is osteoporosis an obvious disorder?

A

no because the symptoms are subtle

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19
Q

List the 2 manifestations of osteoporosis. Is their pain associated with osteoporosis?

A

Sudden onset fracture

Wedging/collapse of vertebrae
(loss of height, kyphosis/dowager hump)

Pain is not present unless there is a fracture

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20
Q

Describe what osteomalacia is and what age group it occurs in

A

it is the softening of the bones d/t loss of mineralization

It is an adult condition

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21
Q

List the five manifestations of osteomalacia

A

1) Bone pain / tenderness
2) muscle wkness
3) fractures
4) delayed healing of fractures resulting in deformities
5) hyperparathyroidism

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22
Q

List 3 causes of osteomalacia

A

1) insufficient Ca2+ absorption from intestines
- poor intake or vit D def

2) Phosphate deficiency
- renal losses or poor absorption

3) Anticonvulsant use (long term)

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23
Q

Explain what Renal Rickets is.

A

Type of adult osteomalacia that occurs with CHRONIC RENAL FAILURE

Kidneys….
can’t activate vit D
excrete phosphate

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24
Q

Explain what Vitamin D resistant rickets is.

A

a type of osteomalacia caused by a GENETIC TUBULAR DEFECT

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25
Describe what rickets is. What age group does it occur in?
It is Ca2+ deficiency that occurs in children Results in.... Failure/delayed calcification of cartilaginous growth plate -> overgrowth and bowed legs Metaphyseal regions of long bones widen/deform as they are unmineralized
26
List the 5 causes of rickets
1) Nutritional deficits 2) Kidney failure 3) Malabsorption syndromes / GI loss 4) meds (anticonvulsants, Al antacids) 5) genetic
27
List the 3 RF for rickets
1) Breast fed only (need a vit D supplement) 2) Dark-skinned 3) Limited sunlight
28
list the 8 manifestations of Rickets
1) Enlarged skull 2) Delayed fontanel closure 3) Enlarged joints 4) Slow tooth growth 5) abnormal shaped thorax 6) bowed legs 7) difficult ambulation 8) stunted growth
29
Describe what rheumatoid arthritis is.
It is an autoimmune systemic disease that is polyarticular
30
What does polyarticular mean?
that involves more than one joint surface
31
What is Paget disease?
abnormal bone modelling as a result of: focal areas of excessive osteoclast mediated bone resorption followed by disorganized osteoblast repair
32
Describe the possible causes of paget disease
unclear, may be genetic, environmental or viral
33
List the 3 RF for Paget Disease
1) mid adulthood (progression) 2) men slightly more than women (pretty =) 3) Northern European heritage
34
What are the four manifestations of Paget Disease?
1) Lesions (isolated or widespread) 2) Long bone bowing and fractures 3) Large joint osteoarthritis 4) Cement lines
35
What is a cement line?
an area of new bone growth over the old
36
what are the common locations of Paget Disease?
``` skull spine pelvis femur tibia ```
37
Describe what osteoarthritis is.
It is an autoimmune systemic disease that is polyarticular
38
What does polyarticular mean?
that it affects multiple joint surfaces
39
List 3 RF / causes of Rheumatoid Arthritis
Genetic predisposition Woman > men Peak incidence 40-50
40
Describe the pathophysiology of Rheumatoid Arthritis
It is a T-cell mediated response to trigger - inflammatory mediators released - antibodies form against autoantigens results in synovial inflammation and joint destruction - fluid accumulates - Neovascularization in synovial membrane (Pannus forms)
41
What is the antibody that can be used to diagnose Rheumatoid Arthritis and in what percent of patients is it present in.
Rheumatoid Factor (RF) 70-80 percent
42
What is a pannus?
it is vascular granulation tissue specific to RA that results in inflammatory erosion of cartilage/bone
43
Describe the characteristics of which joints are affected by RA
Symmetrical Polyarticular Diarthrodial/synovial types
44
List the manifestations of RA
Joint pain Swelling Limited joint movement Wrist and finger common: pain when turning doorknob, opening jars, buttoning shirts FEET: pain on ball off foot when rising in the morning or widening of forefoot d/t inflamm ANKLES, KNEES, ELBOWS, SHOULDERS, SPINE: subluxation joint instability
45
What does the thickening of synovium that stretches joint capsule and ligaments cause?
Deformities Muscle imbalances Swan neck deformities of hand
46
Describe the five extra articular manifestations of RA?
``` Fatigue Wkness Anorexia Wt loss Inc ESR and C-reactive protein Rheumatoid nodules ```
47
What is a rheumatoid nodule?
it is a granulomatous lesion with central necrotic core may be.... tender moveable small or large
48
Describe the diagnosis criteria for RA
four or more of.... 1) morning stiffness of >1 hr x six wks 2) 3 or more joint swelling x six wks 3) swelling of rist or finger joints x six wks 4) symmetric joint swelling x six wks 5) rheumatoid nodules 6) serum RF 7) radiographic evidence
49
Describe what Systemic Lupus Erythematosis (SLE) is
it is a chronic inflammatory disease affecting entire body a type III hypersensitivity response
50
Describe the causes of SLE
unknown young women African, Hispanic, Asian dscent familial genetic
51
What is SLE often referred to as?
the great imitator b/c it affects the whole body with many subtle symptoms that imitate/mimic other disorders
52
List the six common complaints of SLE
1) arthralgia 2) myalgia 3) fever 4) malaise 5) fatigue 6) temp loss of cognitive abilities
53
List 4 triggers for SLE (systemic lupus erythematosis)
UV light Chemicals Food Infectious agents
54
Describe the characteristics of SLE manifestations
Acute or insidious exacerbations and remissions
55
What are the 6 groups of manifestations for SLE?
Skeletal Renal Pulmonary Cardiac Intergument CNS
56
Describe the skeletal manifestations of systemic lupus erythematosis
``` Arthralgia/arthritis (common early sign) Avascular necrosis (femoral head) Contractures Tendon rupture Subluxation ```
57
Is there articular destruction in systemic lupus erythematosis?
no, it is not like other arthritis'
58
Describe the integument manifestations of systemic lupus erythematosis
``` butterfly rash on nose/cheeks fingertip lesions hair loss mucous membrane lesions sunlight sensitivity ```
59
What are the 2 renal manifestations of systemic lupus erythematosis (SLE)?
glomerulonephritis | interstitial nephritis
60
What are the 2 pulmonary manifestations of systemic lupus erythematosis (SLE)?
pleural effusion | pleuritis
61
What are the 4 cardiac manifestations of systemic lupus erythematosis (SLE)?
pericarditis heart block HTN Ischemic heart disease (when chronic)
62
What are the 5 CNS manifestations of systemic lupus erythematosis?
Photosensitivity Hemorrhage (stroke) Thrombus Seizures (esp with renal disease) psychotic symptoms (depression, euphoria, confusion)
63
Describe what systemic sclerosis/scleroderma is
Autoimmune disease of the CT resulting in widespread fibrosis results thickened skin and organ involvement. Cause is poorly understood. Women > Men, but men have more serious progression
64
What are the two types of manifestations for systemic sclerosis / scleroderma? which is the most common?
Limited (most common) Diffuse
65
What areas of the body are commonly affected in limited scleroderma?
fingers, forearms, face
66
List the 6 manifestations of limited scleroderma
CREST ACRONYM CALCIUM DEPOSITS of skin/soft tissue resulting in spotty discoloration REYNAUD PHENOMENON ESOPHAGEAL DISMOTILITY SCLERODACTILY (disformity of fingers) TELANGIESTASIAS (spider like veins) and pulm HTN
67
Describe the characteristics of diffuse scleroderma.
Widespread, rapidly progressive fibrosis of skin with early movement to organs (kidneys, esophagus, heart, lungs)
68
List the manifestations of diffuse scleroderma
``` Stone face Hair loss Telangiestasis on face, chest, hands Reynaud phenomenon Arthralgia, myalgia malabsorption pulm fibrosis malignant HTN Pericarditis, heart blocks, myocardial fibrosis ```
69
What is ankylosing spondylitis?
chronic systemic inflammatory disease of the joints late adolescence/early adult Men > women genetic immune response destroys joints and FUSES adjacent bones
70
Where does ankylosing spondylitis begin?
sacroiliac joint then moves up spine

Pathophysiology I (16 decks)

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