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RRPA Pathophysiology II > MSK System - Schoenwald (Exam 2) > Flashcards

MSK System - Schoenwald (Exam 2) Flashcards

1
Q

Osteoporosis is caused by (increased/decreased) bone (resorption/deposition).

A

Osteoporosis is caused by increased bone resorption.

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2
Q

What are the 2 types of primary osteoporosis?

For each type, what is the cause (increased osteoclastic activity vs decreased osteoblastic activity)?

A
  • Type 1: Postmenopausal (estrogen loss)
    • Increased osteoclastic activity
  • Type 2: Senile
    • ​Decreased osteoblastic activity
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3
Q

MC bones fractured in primary osteoporosis?

A
  • Hip
  • Compression fx of vertebrae
  • Distal radius (FOOSH)
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4
Q

What are some causes of secondary osteoporosis?

A
  • Endocrine: increased parathyroid hormone, DM, Addison’s dz
  • Gastrointestinal: malnutrition
  • Hematologic: blood cancers
  • Drugs: long term prednisone usage, heparin, someo chemo agents
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5
Q

Describe the typical osteoporosis pt

A

Thin, white, postmenopausal female with long-term hx of smoking.

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6
Q

What’s the difference between DEXA scan T score and Z score?

A
  • T score: Compares bone mass to healthy 30 yr old
  • Z score: Compares to what’s normally expected for same age, sex, weight, and ethnic or racial origin
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7
Q

How does the T-score rating system work for DEXA scan?

A
  • +1 to -1 = healthy bone density
  • -1 to -2.5 = osteopenia
  • -2.5 to -3.0 = osteoporosis
  • -3.0 and lower = severe osteoporosis
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8
Q

What is an abnormal Z score (DEXA scan)?

A

-2 or lower

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9
Q

Rickets and osteomalacia are due to deficiencies in ___________ and ___________.

A

Vitamin D and phosphate

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10
Q

T/F: osteomalacia and rickets are due to decreased mineralization of osteoid while bone mass stays normal, resulting in bowing of legs

A

Truth

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11
Q

Difference between rickets and osteomalacia?

A
  • Rickets: inadequate mineralization of osteoid matrix leads to overgrowth and distortion of epiphyseal cartilage
  • Osteomalacia: affects newly formed bone matrix in adults
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12
Q

MC pathogen in osteomyelitis?

A

Staph aureus

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13
Q

T/F: Osteomyelitis due to hematogenous spread is more common in adults, whereas contiguous spread is more common in children

A

False.

Hematogenous spread more common in children. Contiguous spread more common in adults (think of an adult with a diabetic ulcer that gets infected and spreads to the bone - probably doesn’t happen very often in kiddos).

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14
Q

T/F: fever can be present with osteomyelitis but is often absent

A

Truth

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15
Q

Describe the pathology of osteomyelitis

A
  1. Infection lifts periosteum of bone, impairs blood flow, results in ischemia of bone
  2. “Sequestrum” = dead bone fragment
  3. “Involucrum” = new bone growth around sequestrum
  4. Brodie abscess = residual abscess surrounded by bone growth
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16
Q

What is the most common degenerative joint disease in age >65?

A

Osteoarthritis - progressive loss of cartilage at the joint space

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17
Q

Describe the pathology of osteoarthritis

A
  • Microscopic findings: loss of proteoglycans and chondrocytes
  • Fibrillation & splitting of cartilage surface - allows for synovial fluid infiltration = inflammation
  • Granulation tissue and fibrosis replace cartilage = erosion of bony surface
  • Osteophyte formation - reactive new bone - limit ROM of joint
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18
Q

What are the 2 types of osteophytes associated with osteoarthritis?

A
  • Heberden node: DIP joint
  • Bouchard node: PIP joint

Wellsian pro tip: B comes before H in the alphabet, so Bouchard nodes are more proximal

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19
Q

T/F: With osteoarthritis, morning stiffness usually resolves 30 minutes after waking

A

True

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20
Q

Radiologic findings in osteoarthritis include….

A
  • Joint space narrowing
  • Subchondral sclerosis and cysts
    • synovial fluid leaks into defects in cartilage
  • Osteophytes
21
Q

What are some common bugs that cause infectious arthritis?

A
  • Staph
  • Neisseria gonorrhea
  • Chlamydia - reactive arthritis (Reiter’s syndrome)
    • affects joints, eyes, and urethra
  • Strep pneumoniae
22
Q

Which statement is false regarding rheumatoid arthritis?

a. Morning stiffness for <30 minutes
b. 3 or more affected joints
c. constitutional sx of fever, wt loss, and fatigue may be present
d. all of the above are true

A

a.

Morning stiffness lasts >1 hour

23
Q

Swan neck deformity, dupuytren’s contracture, and boutonniere deformity are all associated with which type of arthritis?

A

Rheumatoid arthritis

24
Q

There is a triad for RA and it has a specific name. What is it?

A

Felty syndrome:

  • RA
  • Leukopenia
  • Splenomegaly
25
Q

Swan neck deformity = (flexion/extension) of PIP and (flexion/extension) of DIP

A

Swan neck deformity = _hyperextension_PIP and _flexion_ DIP

26
Q

Boutonniere deformity = (flexed/extended) PIP and (flexed/extended) DIP

A

Boutonniere deformity = flexed PIP and extended DIP

27
Q

Common joints affected by RA?

A

MCP, PIP, feet, ankles, knees, wrists, elbows

28
Q

Common joints affected by OA?

A

Hips and knees, PIP and DIP

29
Q

Morning stiffness lasts how long in OA?

A

<30 mins

30
Q

Morning stiffness lasts how long in RA?

A

>1 hr

31
Q

OA pain is (better/worse) with inactivity, whereas RA pain is (better/worse) with inactivity

A

OA pain is better with inactivity, whereas RA pain is worse with inactivity

32
Q

90% of pts with ankylosing spondylitis are positive for ________

A

HLA B27

33
Q

Ankylosing spondylitis preferentially involves which joints?

A

Vertebral column and SI joints

34
Q

Gout is a form of arthritis due to _________ deposition in joint space

A

uric acid crystal

35
Q

Risk factors for gout?

A

Alcohol, obesity, thiazide diuretics

36
Q

In gout, urate crystals precipitate in the synovium and are a chemotactic for __________. They also activate ___________.

A

neutrophils and complement

37
Q

What are tophi?

A

Aggregates of urates rimmed with macrophages, lymphocytes, and giant cells

  • Found in joints and ligaments
  • Can cause a chronic tophaceous arthritis
38
Q

50% of first gout attacks occurat which joint?

A

1st MTP (aka Podagra)

39
Q

Pseudogout is caused by what kind of crystals?

A

Calcium pyrophosphate crystals - rhomboid

40
Q

Paget disease, aka ___________

A

osteitis deformans

41
Q

Pathology of paget disease?

A

Excessive osteoblastic bone formation with abnormal structure and impaired stability

42
Q

Clinical findings of paget disease?

A
  • Enlargment of head bones
  • HA
  • Deafness
  • Visual disturbances
  • Deformation/tenderness of long bones
43
Q

What would labs and imaging look like in Paget disease?

A
  • Chalk stick fx = pathologic fx (cross fx of long bones)
  • Thick coarse cortex of bone
  • Elevated serum alk phos
44
Q

What is the most common malignant bone tumor?

A

Osteosarcoma

45
Q

XR with lytic lesions and codman triange = _________

A

osteosarcoma

46
Q

Ewing sarcoma is often misdiagnosed as osteomyelitis because it often presents with ________and _______

A

fever and pain

47
Q

XR shows bulky osteodestructive lesion with characteristic pattern of calcification-popcorn: __________

A

chondrosarcoma

48
Q

Malignant fibrous histiocytoma is the most common sarcoma, affecting ____________, _____________, and ____________________________.

A

Deep fascia, skeletal muscle, and retroperitoneal space

49
Q

Why did the bicycle go to bed early?

A

Because it was two tired

RRPA Pathophysiology II (16 decks)

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