Module 9 Flashcards
How are bones classified
Long, short, flat, irregular
what is hematopoiesis
blood cell production
what are osteoprogenitor cells
stem cells that are mitotic
What are osteoblasts
bone-forming cells that produce bone matrix
What are osteocytes
Mature bone cells
What are osteoclasts
bone resorption cells that are not derived from the osteoprogenitor cell but from monocytes
2 types of bone tissue
compact and spongy (cancellous)
What is Synarthroses
completely immovable joints such as the sutures between the skull bones.
What is Amphiarthroses
slightly movable joints such as those found at the attachments of the ribs to the sternum.
What are Diarthroses (synovial joints)
freely movable joints such as the knee joint, elbow, and shoulder. This type of joint is the most common type in the human body
After an injury that destroys some skeletal muscle, by what process can a person regain much of the original size and strength of the muscle, considering that destroyed muscles cannot be replaced by mitosis?
Although the cells can’t divide and produce more in number to replace the lost cells, with the increased demands on the remaining cells as a result of exercise, the cells may undergo hypertrophy. The number of cells is the same but they increase in size.
What are the 5 stages of bone healing
hematoma, granulation tissue, procallus (fibrocartilage), bony callus, and remodeling.
What is subluxation
occurs when the bone is only partially displaced.
Sprain is a tear in what
ligament
Strain is a tear in what
tendon
Avulsion is what
when tendon or ligament is completely off the bone
Why do sprains and severe strains take so long to fully repair and allow full use of the site of damage?
If there is bleeding into a joint capsule, healing of the joint area may be delayed. The repair of a strain/sprain is a step-by-step process that involves the formation of granulation tissue and the deposit of collagen to form a link with the ends of the damaged ligaments/tendons. Fibrous tissue will then further develop and over time strengthen this reconnection, eventually allowing for normal joint function.
what are rickets/osteomalacia
characterized by deficits in mineralization of newly formed bone matrix caused by a deficit of vitamin D and phosphates.
What is Paget’s disease
is a progressive bone disease characterized by increased metabolic activity in bone and by abnormal and excessive bone remodeling involving both reabsorption and formation of new bone.
What is Chondrosarcomas
arise from cartilage cells. More common in adults over 30, these tumors develop more slowly but eventually metastasize to the lungs.
Metastatic Tumors
bone tumors that are usually secondary to malignant tumors in the breast, lung, or prostate.
What are some factors related to a person’s age that could increase his or her potential for developing osteoporosis?
As a person ages, he or she tends to be involved in less physical activity and become more sedentary. Eating habits change as a person ages and may result in certain vitamin, calcium, and protein deficiencies and hormone changes, particularly in postmenopausal women. All of these factors can contribute to the development of osteoporosis.
What is Duchenne (pseudohypertrophic) muscular dystrophy
most common type of muscular dystrophy
What is muscular dystrophy (MD) characterized by
Classification is based on age of onset, rate of progression, distribution of muscular involvement, and inheritance pattern.
Pathology of MD
A metabolic defect, a deficit of dystrophin (a muscle cell membrane protein), leads to degeneration and necrosis of the cell.
Skeletal muscle fibers are replaced by fat and fibrous connective tissue, which leads to the hypertrophic appearance of the muscle (as noted in the illustration).
Muscle function is gradually lost.
What is Primary fibromyalgia
is a chronic musculoskeletal disorder characterized by pain and stiffness affecting muscles, tendons, and surrounding soft tissues.
Why does Duchenne’s type muscular dystrophy predominantly affect male patients?
Duchenne’s muscular dystrophy is an X-linked recessive genetic disorder. Males possess the X chromosome; normal females do not.
Muscular Dystrophy: Pathophysiology
A metabolic defect, a deficit of dystrophin (a muscle cell membrane protein), leads to degeneration and necrosis of the cell.
Skeletal muscle fibers are replaced by fat and fibrous connective tissue, which leads to the hypertrophic appearance of the muscle (as noted in the illustration).
Muscle function is gradually lost.
Primary fibromyalgia symptoms
Specific tender or trigger points have been identified in tendons and ligaments in the neck, shoulder, trunk, and limbs. These points may be used in diagnosis.
No obvious signs of inflammation or tissue degeneration are present.
The cause is unknown but seems to be related to altered central neurotransmission.
The incidence is higher in women age 20 to 50, often with a history of prior trauma or osteoarthritis.
Aggravating factors include sleep deprivation, stress, and fatigue.
Primary Fibromyalgia treatment
No one regimen of medication has proved successful for the treatment of fibromyalgia. The following treatments are used:
Stress reduction
Regular exercise
Rest as needed
Local applications of heat or massage as needed
Low doses of antidepressants
Nonsteroidal anti-inflammatory drugs
New drugs (for example, Lyrica, which has been approved for fibromyalgia to mediate the pain pathway)
What is Myostosis
Myositis is a general term referring to severe inflammation and subsequent damage to the muscles
Includes: polymyositis, dermatomyositis, juvenile myositis, inclusion body myositis, and toxic myositis
Symptoms: muscle fatigue, chronic muscle pain/soreness, difficulty swallowing/breathing, elevations in muscle enzymes,
Diagnosis: blood tests, MRI, EMG, and muscle biopsy
Treatments: typically involve immunosuppressant medications
Osteoarthritis: Pathophysiology
The primary defect in osteoarthritis is the damage and eventual loss of articular cartilage.
The surface of the cartilage becomes rough and worn, interfering with the ease of joint movement.
Tissue damage releases enzymes from the cells, which accelerates the breakdown of cartilage. Eventually, the subchondral bone may be exposed and damaged, and cysts and osteophytes may develop.
Pieces of osteophytes and cartilage break off into the synovial cavity, causing further irritation.
The joint space becomes narrower (seen with x-ray).
Secondary inflammation may occur in response to altered movement and stress on the joint.
Osteoarthritis: Etiology
Two forms of osteoarthritis exist: primary and secondary.
Knees and hands are more commonly affected in women; hips are more commonly affected in men.
What is primary osteoarthritis
Primary osteoarthritis is the most common form. This disease:
Appears insidiously with age and without apparent initiating cause
Usually affects only a few joints
Usually develops because of injury or excessive wear and tear
What is secondary osteoarthritis
Secondary osteoarthritis occurs in fewer than 5% of the cases. This disease:
Occurs in youths
Typically follows some predisposing condition, such as a previous traumatic injury, developmental deformity, or underlying systemic disease
Often involves one or several predisposed joints
Osteoarthritis: Treatment
Undue stress on joint should be minimized and adequate rest and additional support provided to facilitate movement.
Ambulatory aids (canes, walkers) are helpful. Orthotic inserts in shoes may be recommended to reduce the risk for deformities.
Physiotherapy, massage therapy, and occupational therapy are common, recommended treatments.
Glucosamine-chondroitin compounds may be helpful to some individuals.
Injection of synthetic synovial fluid, glucocorticoids, analgesics, or NSAIDs are used for the treatment of pain.
Surgical joint replacement is performed in more severe cases, such as with a hip replacement (illustrated in the radiograph).
What is Rheumatoid arthritis (RA)
Rheumatoid arthritis (RA) is considered an autoimmune disorder that results in a chronic systemic inflammatory disease.
RA has a higher incidence in women than men.
Incidence increases in older individuals.
Chronic, symmetric inflammation of the joints is characteristic of this condition.
The extra-articular manifestations vary.
Rheumatoid Arthritis: Pathophysiology: Joints
The condition varies from mild to severe. Remissions and exacerbations lead to progressive damage to the joints. The progression of the condition is as follows:
The condition begins with synovitis. Inflammation recurs, and synovial cells proliferate.
Pannus forms; granulation tissue from the synovium spreads over articular cartilage.
Cartilage erosion, by enzymes from pannus, creates an unstable joint.
Fibrosis occurs. Pannus between bone ends becomes fibrotic; calcification follows, and joint space is destroyed.
Ankylosis (joint fixation) and deformity develop.
Rheumatoid Arthritis: Pathophysiology: Other Change
Acute inflammation results in disuse atrophy of muscles.
Bone alignment shifts depending on how much cartilage has been eroded.
Muscle spasm occurs because of inflammation and pain.
Contractures and deformity with subluxation develop.
Rheumatoid Arthritis: Systemic Effects
Systemic effects are believed to arise from the circulating immune factors resulting in:
Marked fatigue, depression, and malaise
Anorexia
Low-grade fever
Iron deficiency anemia with low serum iron levels that, if it results from rheumatoid arthritis, is resistant to iron therapy
Rheumatoid Arthritis: Etiology
Although rheumatoid arthritis is considered to be an autoimmune disorder, the exact nature of the condition has not been fully determined.
A genetic factor is present with a definite familial predisposition.
There seems to be a link to several viral infections.
Rheumatoid factor (RF) is not present in all patients with RA.
RA is more common in women than in men.
Incidence increases with age.
Rheumatoid Arthritis: Signs and Symptoms
Rheumatoid arthritis is subtle at onset, often just showing mild general aching and stiffness. Inflammation may be first apparent in the fingers or wrist, eventually involving more and more joints.
Joints appear red and swollen, often sensitive to touch and very painful.
Joint stiffness occurs following rest and eases with mild activity.
Joint movement eventually is impaired by swelling and pain. Daily activities become difficult.
The joint eventually becomes fixed and deformed.
Systemic effects result, as discussed on an earlier screen.
Rheumatoid Arthritis: Evaluation and Treatment
Evaluation of RA is by physical examination, x-ray, and serologic tests for RF and circulating immune complexes. Treatment varies from conservative to surgical.
Treatment involves a balance between rest and moderate activity.
Physical and occupational therapy are an important part of the treatment regimen.
For pain control, high doses of anti-inflammatory agents may be required. In severe cases, glucocorticoids may be prescribed.
Other drugs such as gold compounds and immunosuppressants are used in more resistant cases.
The use of cold and heat can be effective; splints and assistive devices may be required in acute episodes.
Surgical intervention may be needed to remove pannus, replace damaged tendons, reduce contractions, or replace joints.
What is Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) differs from the adult form. The onset is more acute and the systemic effects are more marked, but rheumatoid nodules are absent. JRA occurs in several forms:
The first form, or Still’s disease (systemic form), results in fever, rash, lymphadenopathy, hepatomegaly, and joint involvement.
The second form causes polyarticular inflammation similar to the adult form.
The third form involves four or fewer joints but causes uveitis of the eye.
What is infectious (septic) arthritis
Infectious (septic) arthritis develops in a single joint. Blood-borne bacteria such as gonococcus or staphylococcus are usually the source of the infection; however, anaerobic organisms can be the source as well.
The joint is red, swollen, and painful, with decreased range of movement.
In some cases, there is a history of trauma, surgery, or spread from a nearby infection.
Immediate, aggressive antimicrobial treatment is necessary to prevent excessive cartilage destruction and fibrosis of the joint.
Lyme disease (manifestation shown in illustration) is characterized by a migratory arthritis. The knee and other large joints are most often involved.
What is Gout (Gouty Arthritis)
Gouty arthritis is a form of joint disease that results from uric acid and urate crystals in the joints, causing an acute inflammatory response. The condition is common in men older than 40 years.
Sudden increases in serum uric acid levels usually cause a gout attack (hyperuricemia).
Gout often affects a single joint such as the big toe.
The inflammation causes redness, swelling, and severe pain.
Treatment consists of reducing serum uric acid levels by drugs and dietary changes, depending on the underlying cause.
Ankylosing Spondylitis (AS): Overview
Ankylosing spondylitis is a chronic progressive inflammatory joint disease characterized by stiffening and fusion of the spine (as noted in the radiograph of the lumbar spine) and sacroiliac joints.
The disease usually develops in persons between ages 20 and 30.
Symptoms vary in severity.
Remissions and exacerbations are common.
The cause is not fully determined.
Ankylosing spondylitis seems to be an autoimmune disorder with a genetic basis.
Ankylosing Spondylitis: Pathophysiology
The vertebral joints first become inflamed, followed by fibrosis and calcification of fusion of the joints. The result is fixation of the joints and loss of mobility.
Inflammation begins in the lower back at the sacroiliac joints and progresses up the spine.
Kyphosis develops as a result of postural changes necessitated by rigidity (as demonstrated in illustration).
Osteoporosis is common.
Lung expansion may be limited at this stage because the calcification of the costovertebral joints reduces rib movement.
Ankylosing Spondylitis: Signs and Symptoms
The most common signs and symptoms of early AS are low back pain and stiffness.
Pain is often more marked when lying down and may radiate to the legs, similar to sciatic pain. Discomfort is relieved by walking or mild exercise.
Some individuals develop systemic signs such as fatigue, fever, weight loss, or uveitis.
Treatment focuses on pain relief and maintenance of mobility via pain-relieving drugs, daily exercise, and sleeping in a supine position.
Other Inflammatory Joint Disorders
Bursitis—inflammation of the bursae associated with bones, muscles, tendons, and ligaments of various joints. Most common causes of this inflammation are repetitive motions or positions. Treatments include cold compresses, pain relievers, anti-inflammatory drugs, physical therapy, antibiotics in cases of infections.
Synovitis—inflammation of the synovial membrane lining the joint. Causes include infection or uric crystals indicating gout. Treatment includes use of anti-inflammatory drugs and treatment for underlying causes such as in cases of infection.
Tendinitis—irritation or inflammation of the tendon. Can be caused by a single, sudden trauma, it is more likely the result of repetitive motions/actions. Treatments include rest, application of ice and pain relievers, anti-inflammatory drugs, physical therapy.
What characteristic do rheumatoid arthritis, juvenile arthritis, and ankylosing spondylitis have in common that often requires aggressive treatments?
These joint disorders all have systemic effects. Rheumatoid arthritis causes fever, fatigue, and anorexia. Juvenile arthritis forms cause uveitis, fever, rash, lymphadenopathy, hepatomegaly, and joint involvement. Ankylosing spondylitis can cause osteoporosis and restrict lung expansion.
