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Pathoma LAH > MSK: 18.1: Skeletal System > Flashcards

MSK: 18.1: Skeletal System Flashcards

1
Q

What is teriparatide?

A
  • an osteoporosis tx drug
  • Causes increased bone growth compared to antiresorptive therapies (eg bisphosphonates)
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2
Q

How is osteomyelitis diagnosed?

A
  • blood culture
  • elevated CRP and ESR
  • x-ray and MRI
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3
Q

Why are the sclera blue in osteogenesis imperfecta?

A
  • sclera usually contain lots of Type I collagen
  • in O.I., the sclera are thin –> exposure of the choroidal veins
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4
Q

How do SERMs work to treat osteoporosis?

A

estrogen receptor agonist in bone

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5
Q

Dx?

  • imbalance btw osteoclast and osteoblast function (clasts get out of control and blasts try to compensate)
  • a localized process not involving the entire skeleton
A

Paget Disease of the Bone

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6
Q

Why do osteopetrosis pts get hydrocephalus?

A

narrowing of the foramen magnum

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7
Q

What causes Paget Disease of the Bone?

A

unknown- maybe viral

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8
Q

Why do pts with Paget Disease of the Bone get high output cardiac failure?

A

bone remodling = formation of AV shunts –> heart has to work harder to push against them

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9
Q

Dx?

  • defective mineralization of osteoid due to low levels of Vitamin D
A

osteomalacia/Rickets

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10
Q

Which SERM is a good tx for osteoporosis?

A

Raloxifene

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11
Q

Where does osteomyelitis seed in adults? Children?

A
  • adults = epiphysis
  • children = metaphysis
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12
Q

When is alkaline phosphatase (ALP) high?

A

when osteoblasts are activated

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13
Q

What is endochondral bone production and what bones does it make?

A
  • cartilage matrix is calcified and mineralized into bone
  • long bones
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14
Q

An ______ environment is necessary in order to lay down Ca++ and therefore calcify and build bone.

A

alkaline

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15
Q

What are the clinical features of osteoporosis?

A
  • bone pain and fractures in weight-bearing areas
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16
Q

What is osteoarthritis?

A

a wear and tear disease in which the joints are damaged

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17
Q

What is osteogenesis imperfecta?

A

congenital defect of bone formation, resulting in weak bones

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18
Q

Which drug gives these SEs?

  • Esophagitis (if taken orally, patients are advised to take with water and remain upright for 30 minutes)
  • osteonecrosis of jaw
  • atypical stress fractures
A
  • bisphosphonates
  • all end in -dronate
  • ex: Alendronate, ibandronate, risedronate, zoledronate
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19
Q

What are the SEs of bisphosphonates?

A
  • Esophagitis (if taken orally, patients are advised to take with water and remain upright for 30 minutes)
  • osteonecrosis of jaw
  • atypical stress fractures
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20
Q

What is Caisson disease?

A
  • nitrogen bubbles precipitate in ascending divers, causing air emboli
  • aka “the bends” or decompression sickness
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21
Q

Give the serum levels for osteomalacia/Rickets:

  • Ca++?
  • PO4?
  • Alk Phos (ALP)?
  • PTH?
A
  • Ca++ = decreased
  • PO4 = decreased
  • ALP = increased
  • PTH = increased
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22
Q

Bone formation is a balance btw the ______, which lay down bone, and the _____, which resorb bone.

A
  • osteoblasts = build
  • osteoclasts = crack
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23
Q

What is achondroplasia?

A

impaired cartilage prolif. in the growth plates

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24
Q

Dx?

  • carbonic anhydrase II mutation
A

osteopetrosis

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25
Q

Give the serum levels for osteoporosis:

  • Ca++?
  • PO4?
  • Alk Phos (ALP)?
  • PTH?
A
  • Ca++ = normal
  • PO4 = normal
  • ALP = normal
  • PTH = normal
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26
Q

Dx?

AD defect in collagen type I synthesis

A

osteogenesis imperfecta

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27
Q

Name the 2 most common forms of osteoporosis.

A
  1. senile (age-related)
  2. post-menopausal (estrogen loss)
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28
Q

What cells make cartilage?

A

chondrocytes

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29
Q

What are the complications of Paget Disease of the Bone?

A
  • high output cardiac failure
  • osteosarcoma
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30
Q

What does PTH bind to when released? What does this do?

A

osteoblasts –> tells osteoclasts to resorb bone (osteoblasts control osteoclasts)

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31
Q

Osteosarcoma is a malignant tumor of _______.

A

osteoblasts

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32
Q

What organism causes osteomyelitis most often in pts with prosthetic joints?

A
  • Staph aureus
  • S epidermidis
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33
Q

What diagnoses osteoporosis?

A
  • DEXA scan T-score of less than 2.5
  • fragility fracture of hip or vertebra
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34
Q

What is intramembranous bone production and what bones does it make?

A
  • produce bone from a CT matrix
  • makes skull, chest, wrist- **flat bones
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35
Q

Name a hormone that is protective for maintaining bone mass.

A

estrogen

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36
Q

What are the clinical features of achondroplasia?

A
  • short extremities
  • normal-sized head and chest
  • normal cognition, life span, and fertility
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37
Q

What causes avascular (aseptic) necrosis?

A
  • lack of blood flow to the bone from:
    • Corticosteroids
    • Alcoholism
    • Sickle cell (dactylitis of bones of hands and feet)
    • Trauma/fracture
    • “the Bends” aka caisson disease (gas emboli in the bone)
    • LEgg-Calvé-Perthe disease
    • Gaucher disease
    • Slipped capital femoral epiphysis
    • ***“CAST Bent LEGS”
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38
Q

What causes osteomyelitis?

A

bacterial infection –> hematogenous spread

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39
Q

What is denosumab? How does it work?

A
  • a monoclonal Ab against RANKL
  • tx for osteoporosis
  • inhibits osteoclast maturation
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40
Q

What is avascular (aseptic) necrosis?

A

painful focal, ischemic necrosis of the bone and marrow

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41
Q

What organism causes osteomyelitis most often overall?

A

Staph. aureus

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42
Q

What is the function of vitamin D? Where does it do this?

A
  • allows absorption of Ca++ and PO4- (maintain their levels in the blood)
  • in the kidney, intestine, and bones
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43
Q

What causes osteomalacia/Rickets?

A

defective mineralization of osteoid due to low levels of Vitamin D

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44
Q

What drug is contraindicated in osteoporosis? Why?

A
  • glucocorticoids
  • increase the risk of osteoporosis
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45
Q

An acidic environment is necessary in order to ______ and therefore _____ bone.

A

remove Ca++ –> resorb bone

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46
Q

What are the SEs of teriparatide?

A

Transient hypercalcemia

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47
Q

How do bisphosphonates work?

A
  • they are pyrophosphate analogs
  • bind hydroxyapatite in bone –> inhibit osteoclast activity
48
Q

What is the most common site of avascular (aseptic) necrosis? Why?

A
  • the femoral head
  • insufficiency of medial circumflex artery
49
Q

______ is a malignant tumor of osteoblasts.

A

Osteosarcoma

50
Q

How is osteogenesis imperfecta inherited?

A

AD

51
Q

What organism causes osteomyelitis after a dog or cat bite or scratch?

A

Pasteurella multocida

52
Q

Dx?

  • x-ray showing a lytic focus (liquefactive necrosis) surrounded by sclerosis
A

osteomyelitis

53
Q

Why do osteogenesis imperfecta pts have hearing loss?

A

bc the ossicles fracture, too

54
Q

What are SERMs? Name 2 of them.

A
  • Selective Estrogen Receptor Modulators
  • tx for osteoporosis, breast CA
  • ex: Tamoxifen and Raloxifene
55
Q

How is achondroplasia inherited?

A

it’s auto dominant, but most mutations are sporadic

56
Q

What genetic defect causes osteopetrosis?

A
  • there are multiple variants
  • ex: carbonic anhydrase II mutation –> lack of acidic environment req’d for absorption of bone
57
Q

Where is Type I collagen found?

A
  • bone
  • “bONE has ONE in it”
58
Q

What determines the risk of osteoporosis?

A
  • peak bone mass
  • the rate of bone loss thereafter
59
Q

Why do pts with Paget Disease of the Bone get osteosarcoma?

A
  • osteoblasts = lots of bone production
  • If they get mutated –> osteosarcoma
60
Q

What are the x-ray findings for Rickets?

A
  • osteopenia
  • “Looser zones”- pseudofractures
  • epiphyseal widening
  • metaphyseal cupping/fraying
61
Q

What are the clinical features of osteomyelitis?

A
  • bone pain
  • fever (infection)
  • leukocytosis (infection)
62
Q

What organism causes osteomyelitis most often in sexually active pts?

A

Neisseria gonorrhoea (this is rare)

63
Q

What are the clinical features of osteopetrosis?

A
  • bone fractures
  • anemia/thrombocytopenia/leukopenia (pancytopenia) with extramedullary hematopoesis
  • vision and hearing impairment
  • hydrocephalus
  • renal tubular acidosis
64
Q

Name and describe the 2 ways by which bone can be formed.

A
  1. intramembranous (produce bone from a CT matrix- makes skull, chest, wrist- flat bones)
  2. endochondral (cartilage matrix is calcified and mineralized into bone- long bones)
65
Q

An alkaline environment is necessary in order to _____ and therefore _______.

A

lay down Ca++ –> calcify and build bone

66
Q

Dx?

  • a wear and tear disease in which the joints are damaged
A

osteoarthritis

67
Q

What are the clinical features of Paget Disease of the Bone?

A
  • bone pain (microfractures of the bone)
  • increasing hat size (thick skull bones)
  • hearing loss (cranial nerve impingement)
  • lion-like faces (thickened facial bones)
  • isolated elevated Alk phosphatase (bc of blast activity)
68
Q

What is the end result of Paget Disease of the Bone?

A

thick, sclerotic bone that fractures easily

69
Q

What is osteoid? Where does it come from?

A
  • the unmineralized, organic portion of the bone matrix that forms prior to the maturation of bone
  • from osteoblasts
70
Q

What is Paget Disease of the Bone?

A
  • imbalance btw osteoclast and osteoblast function (clasts get out of control and blasts try to compensate)
  • a localized process not involving the entire skeleton
71
Q

What is the tx for osteopetrosis?

A

bone marrow transplant

72
Q

What do bisphosphonates end in?

A
  • -dronate
  • ex: Alendronate, ibandronate, risedronate, zoledronate
73
Q

Dx?

  • activating mutation in FGFR3
A

achondroplasia

74
Q

What is osteopetrosis?

A

an inherited defect of bone resorption (osteoclasts) –> abnormally thick, heavy bone that fractures easily

75
Q

What do osteoblasts produce?

A

osteoid

76
Q

Osteoclasts are derived from ______ cells.

A

monocytes

77
Q

What organism causes osteomyelitis most often in sickle cell pts?

A

Salmonella

78
Q

Dx?

  • painful, focal, ischemic necrosis of the bone and marrow
A

avascular (aseptic) necrosis

79
Q

What cell controls osteoclasts?

A

osteoblasts

80
Q

What is a fracture of the distal radius called?

A

Colles fracture

81
Q

What is vitamin D deficiency in children called?

A

Rickets

82
Q

What causes osteogenesis imperfecta?

A

defect in collagen type I synthesis

83
Q

Name the drug class and give an example:

  • they are pyrophosphate analogs
  • bind hydroxyapatite in bone, inhibiting osteoclast activity
A
  • bisphosphonates
  • all end in -dronate
  • ex: Alendronate, ibandronate, risedronate, zoledronate
84
Q

What has to happen to osteoid in order to make true bone?

A

it has to be mineralized with Ca++ and PO4-

85
Q

What are the x-ray findings of osteomyelitis?

A

lytic focus (liquefactive necrosis) surrounded by sclerosis

86
Q

Why do osteopetrosis pts get renal tubular acidosis?

A

Lack of carbonic anhydrase –> decreased tubular reabsorption of bicarb and no elimination of acid –> metabolic acidosis

87
Q

What are the clinical features of osteogenesis imperfecta?

A
  • blue sclera
  • multiple fractures of bone
  • hearing loss
88
Q

What are the SEs for SERMs?

A
  • both = increased risk of thromboembolic events
  • Tamoxifen = increased risk of endometrial CA, hot flashes
89
Q

An ______ environment is necessary in order to remove Ca++ and therefore resorb bone.

A

acidic

90
Q

Dx?

  • an inherited defect of bone resorption (osteoclasts)resulting in abnormally thick, heavy bone that fractures easily
A

osteopetrosis

91
Q

How old is a pt that gets Paget Disease of the Bone?

A

late adult (usu around 60yo)

92
Q

What organism causes osteomyelitis most often in diabetic pts?

A

Pseudomonas

93
Q

What drugs can cause osteoporosis?

A
  • steroids
  • alcohol
  • anticonvulsants
  • anticoagulants
  • thyroid replacement therapy
94
Q

H2O + CO2 –> H2CO3 via what enzyme?

A

carbonic anhydrase

95
Q

What will Paget Disease of the Bone look like on histology?

A

thick bone with “cement lines” (looks like puzzle pieces- Mosaic pattern of woven and lamellar bone)

96
Q

Name 2 complications of avascular (aseptic) necrosis.

A
  1. osteoarthritis
  2. fractures
97
Q

Dx?

  • loss of trabecular bone mass –> porous bones easily fracture
A

osteoporosis

98
Q

What causes vitamin D deficiency?

A
  • low sun exposure
  • poor diet
  • malabsorption
  • liver/renal failure
99
Q

What x-ray findings will be seen in osteopetrosis?

A

thickened, completely white bone (no dark space of the medulla)

100
Q

Give the serum levels for Pagets Disease of the Bone:

  • Ca++?
  • PO4?
  • Alk Phos (ALP)?
  • PTH?
A
  • Ca++ = normal
  • PO4 = normal
  • ALP = increased
  • PTH = normal
101
Q

What medical conditions can cause osteoporosis?

A
  • hyperparathyroidism
  • hyperthyroidism
  • multiple myeloma
  • malabsorption syndromes
102
Q

Name some treatments for osteoporosis.

A
  • bisphosphonates
  • teriparatide
  • SERMs
  • rarely calcitonin
  • denosumab
103
Q

Who most often gets osteomyelitis?

A

children

104
Q

What is vitamin D deficiency in adults called?

A

osteomalacia

105
Q

What causes achondroplasia?

A

activating mutation in FGFR3

106
Q

What does Calcitonin do?

A

inhibits osteoclasts from resorbing bone

107
Q

Name the 4 phases of Paget Disease of the Bone and their features.

A
  1. Lytic = osteoclasts
  2. Mixed = clasts + blasts
  3. Sclerotic = blasts
  4. Quiescent = minimal clast/blast activity
108
Q

What organism causes osteomyelitis in the vertebra?

A
  • Staph aureus
  • Mycobacterium tuberculosis (Pott disease)
109
Q

What is a myelophthisic process?

A
  • replacement of the bone medulla with bone
  • “bone in bone” or “stone bone” appearance on x-ray
110
Q

What is osteomyelitis?

A

infection of the bone marrow space and bones

111
Q

How does Rickets present clinically?

A
  • pigeon breast deformity (inward bending of the ribs with an anterior protrusion of the sternum)
  • frontal bossing (deposition of osteoid in skull)
  • rachitic rosary (desposition of osteoid at the costochondral junction- feels “bead-like”)
  • bowing of legs
112
Q

Give the serum levels for osteopetrosis:

  • Ca++?
  • PO4?
  • Alk Phos (ALP)?
  • PTH?
A
  • Ca++ = normal/decreased
  • PO4 = normal
  • ALP = normal
  • PTH = normal
113
Q

What organism causes osteomyelitis most often in IV drug abusers?

A
  • Pseudomonas
  • Candida
  • Staph. aureus
114
Q

Why do osteopetrosis pts get hearing and vision loss?

A

impingement on cranial nerves as they exit the skull

115
Q

How does teriparatide work?

A
  • Recombinant PTH analog given subcutaneously daily
  • Increases osteoblastic activity
  • Causes increased bone growth compared to antiresorptive therapies (eg bisphosphonates).
116
Q

What is osteoporosis?

A

loss of trabecular bone mass –> porous bones easily fracture

117
Q

What is the tx for Paget Disease of the Bone?

A
  • calcitonin
  • bisphosphonates (all end in -dronate ex: Alendronate, ibandronate, risedronate, zoledronate)

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