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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
Q

Describe what rickets is. What age group does it occur in?

A

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

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26
Q

List the 5 causes of rickets

A

1) Nutritional deficits
2) Kidney failure
3) Malabsorption syndromes / GI loss
4) meds (anticonvulsants, Al antacids)
5) genetic

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27
Q

List the 3 RF for rickets

A

1) Breast fed only (need a vit D supplement)
2) Dark-skinned
3) Limited sunlight

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28
Q

list the 8 manifestations of Rickets

A

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

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29
Q

Describe what rheumatoid arthritis is.

A

It is an autoimmune systemic disease that is polyarticular

30
Q

What does polyarticular mean?

A

that involves more than one joint surface

31
Q

What is Paget disease?

A

abnormal bone modelling as a result of:

focal areas of excessive osteoclast mediated bone resorption followed by disorganized osteoblast repair

32
Q

Describe the possible causes of paget disease

A

unclear, may be genetic, environmental or viral

33
Q

List the 3 RF for Paget Disease

A

1) mid adulthood (progression)
2) men slightly more than women (pretty =)
3) Northern European heritage

34
Q

What are the four manifestations of Paget Disease?

A

1) Lesions (isolated or widespread)
2) Long bone bowing and fractures
3) Large joint osteoarthritis
4) Cement lines

35
Q

What is a cement line?

A

an area of new bone growth over the old

36
Q

what are the common locations of Paget Disease?

A 
skull
spine
pelvis
femur
tibia
37
Q

Describe what osteoarthritis is.

A

It is an autoimmune systemic disease that is polyarticular

38
Q

What does polyarticular mean?

A

that it affects multiple joint surfaces

39
Q

List 3 RF / causes of Rheumatoid Arthritis

A

Genetic predisposition
Woman > men
Peak incidence 40-50

40
Q

Describe the pathophysiology of Rheumatoid Arthritis

A

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
Q

What is the antibody that can be used to diagnose Rheumatoid Arthritis and in what percent of patients is it present in.

A

Rheumatoid Factor (RF)

70-80 percent

42
Q

What is a pannus?

A

it is vascular granulation tissue specific to RA that results in inflammatory erosion of cartilage/bone

43
Q

Describe the characteristics of which joints are affected by RA

A

Symmetrical
Polyarticular
Diarthrodial/synovial types

44
Q

List the manifestations of RA

A

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
Q

What does the thickening of synovium that stretches joint capsule and ligaments cause?

A

Deformities
Muscle imbalances
Swan neck deformities of hand

46
Q

Describe the five extra articular manifestations of RA?

A 
Fatigue
Wkness
Anorexia
Wt loss
Inc ESR and C-reactive protein
Rheumatoid nodules
47
Q

What is a rheumatoid nodule?

A

it is a granulomatous lesion with central necrotic core

may be….
tender
moveable
small or large

48
Q

Describe the diagnosis criteria for RA

A

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
Q

Describe what Systemic Lupus Erythematosis (SLE) is

A

it is a chronic inflammatory disease affecting entire body

a type III hypersensitivity response

50
Q

Describe the causes of SLE

A

unknown

young women
African, Hispanic, Asian dscent
familial
genetic

51
Q

What is SLE often referred to as?

A

the great imitator b/c it affects the whole body with many subtle symptoms that imitate/mimic other disorders

52
Q

List the six common complaints of SLE

A

1) arthralgia
2) myalgia
3) fever
4) malaise
5) fatigue
6) temp loss of cognitive abilities

53
Q

List 4 triggers for SLE (systemic lupus erythematosis)

A

UV light
Chemicals
Food
Infectious agents

54
Q

Describe the characteristics of SLE manifestations

A

Acute or insidious

exacerbations and remissions

55
Q

What are the 6 groups of manifestations for SLE?

A

Skeletal

Renal

Pulmonary

Cardiac

Intergument

CNS

56
Q

Describe the skeletal manifestations of systemic lupus erythematosis

A 
Arthralgia/arthritis (common early sign)
Avascular necrosis (femoral head)
Contractures
Tendon rupture
Subluxation
57
Q

Is there articular destruction in systemic lupus erythematosis?

A

no, it is not like other arthritis’

58
Q

Describe the integument manifestations of systemic lupus erythematosis

A 
butterfly rash on nose/cheeks
fingertip lesions
hair loss
mucous membrane lesions
sunlight sensitivity
59
Q

What are the 2 renal manifestations of systemic lupus erythematosis (SLE)?

A

glomerulonephritis

interstitial nephritis

60
Q

What are the 2 pulmonary manifestations of systemic lupus erythematosis (SLE)?

A

pleural effusion

pleuritis

61
Q

What are the 4 cardiac manifestations of systemic lupus erythematosis (SLE)?

A

pericarditis
heart block
HTN
Ischemic heart disease (when chronic)

62
Q

What are the 5 CNS manifestations of systemic lupus erythematosis?

A

Photosensitivity

Hemorrhage (stroke)

Thrombus

Seizures (esp with renal disease)

psychotic symptoms (depression, euphoria, confusion)

63
Q

Describe what systemic sclerosis/scleroderma is

A

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
Q

What are the two types of manifestations for systemic sclerosis / scleroderma? which is the most common?

A

Limited (most common)

Diffuse

65
Q

What areas of the body are commonly affected in limited scleroderma?

A

fingers, forearms, face

66
Q

List the 6 manifestations of limited scleroderma

A

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
Q

Describe the characteristics of diffuse scleroderma.

A

Widespread, rapidly progressive fibrosis of skin with early movement to organs (kidneys, esophagus, heart, lungs)

68
Q

List the manifestations of diffuse scleroderma

A 
Stone face
Hair loss
Telangiestasis on face, chest, hands
Reynaud phenomenon
Arthralgia, myalgia
malabsorption
pulm fibrosis
malignant HTN
Pericarditis, heart blocks, myocardial fibrosis
69
Q

What is ankylosing spondylitis?

A

chronic systemic inflammatory disease of the joints

late adolescence/early adult

Men > women

genetic

immune response destroys joints and FUSES adjacent bones

70
Q

Where does ankylosing spondylitis begin?

A

sacroiliac joint then moves up spine

Pathophysiology I (16 decks)

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