MSK System - Schoenwald (Exam 2) Flashcards by Cody Prentice

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

Osteoporosis is caused by increased bone resorption.

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What are the 2 types of primary osteoporosis?

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

Type 1: Postmenopausal (estrogen loss)
- Increased osteoclastic activity
Type 2: Senile
- Decreased osteoblastic activity

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MC bones fractured in primary osteoporosis?

Hip
Compression fx of vertebrae
Distal radius (FOOSH)

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What are some causes of secondary osteoporosis?

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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Describe the typical osteoporosis pt

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

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

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

+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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What is an abnormal Z score (DEXA scan)?

-2 or lower

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

Vitamin D and phosphate

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

Truth

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Difference between rickets and osteomalacia?

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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MC pathogen in osteomyelitis?

Staph aureus

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

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

Truth

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Describe the pathology of osteomyelitis

Infection lifts periosteum of bone, impairs blood flow, results in ischemia of bone
“Sequestrum” = dead bone fragment
“Involucrum” = new bone growth around sequestrum
Brodie abscess = residual abscess surrounded by bone growth

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

Osteoarthritis - progressive loss of cartilage at the joint space

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Describe the pathology of osteoarthritis

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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What are the 2 types of osteophytes associated with osteoarthritis?

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

True

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Radiologic findings in osteoarthritis include….

Joint space narrowing
Subchondral sclerosis and cysts
- synovial fluid leaks into defects in cartilage
Osteophytes

What are some common bugs that cause infectious arthritis?

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

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

Morning stiffness lasts >1 hour

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

Rheumatoid arthritis

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

Felty syndrome:

RA
Leukopenia
Splenomegaly

Swan neck deformity = (_flexion/extension_) of PIP and (_flexion/extension)_ of DIP

Swan neck deformity = **_hyperextension**_PIP and _**flexion_** DIP

Boutonniere deformity = (_flexed/extended_) PIP and (_flexed/extended_) DIP

Boutonniere deformity = **_flexed_** PIP and **_extended_** DIP

Common joints affected by RA?

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

Common joints affected by OA?

Hips and knees, PIP and DIP

Morning stiffness lasts how long in OA?

\<30 mins

Morning stiffness lasts how long in RA?

\>1 hr

OA pain is (_better/worse_) with inactivity, whereas RA pain is (_better/worse_) with inactivity

OA pain is **_better_** with inactivity, whereas RA pain is **_worse_** with inactivity

90% of pts with ankylosing spondylitis are positive for \_\_\_\_\_\_\_\_

HLA B27

Ankylosing spondylitis preferentially involves which joints?

Vertebral column and SI joints

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

uric acid crystal

Risk factors for gout?

Alcohol, obesity, thiazide diuretics

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

neutrophils and complement

What are tophi?

Aggregates of urates rimmed with macrophages, lymphocytes, and giant cells * Found in joints and ligaments * Can cause a chronic tophaceous arthritis

50% of first gout attacks occurat which joint?

1st MTP (aka Podagra)

Pseudogout is caused by what kind of crystals?

Calcium pyrophosphate crystals - rhomboid

Paget disease, aka \_\_\_\_\_\_\_\_\_\_\_

osteitis deformans

Pathology of paget disease?

Excessive osteoblastic bone formation with abnormal structure and impaired stability

Clinical findings of paget disease?

* Enlargment of head bones * HA * Deafness * Visual disturbances * Deformation/tenderness of long bones

What would labs and imaging look like in Paget disease?

* Chalk stick fx = pathologic fx (cross fx of long bones) * Thick coarse cortex of bone * Elevated serum alk phos

What is the most common malignant bone tumor?

Osteosarcoma

XR with lytic lesions and codman triange = \_\_\_\_\_\_\_\_\_

osteosarcoma

Ewing sarcoma is often misdiagnosed as osteomyelitis because it often presents with \_\_\_\_\_\_\_\_and \_\_\_\_\_\_\_

fever and pain

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

chondrosarcoma

Malignant fibrous histiocytoma is the most common sarcoma, affecting \_\_\_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Deep fascia, skeletal muscle, and retroperitoneal space

Why did the bicycle go to bed early?

Because it was two tired