Musculoskelatal Flashcards
Skeleton turnovers __ per year
10%
Osteogenesis Imperfecta aka
Brittle bones
Osteogenesis imperfecata is a group of bone disorders with abnormal
Synthesis of type I collagen
Skeletal fragility
Osteo. Imperfecta moats are autosomal ___
Dominant
Osteo. Imperfecta teeth might look
Opalescent teeth
Dentinogensis very similar
Osteo. Imperfecta sclera
Blue
Prognosis of Osteo. Imperfecta depends on
Type and expression of the gene
Osteopetrosis aka
Marble bone disease
Osteopetrosis is a group of
Rare hereditary bone distorted with defective bone remodeling
Osteopetrosis is a dysfunction of
Osteolclast
Osteopetrosis affected bone
Is dense but structurally unsound and weake
Osteopetrosis prone to
Fractures and infections
Osteopetrosis can cause narrowing of
Cranial formanina
Leading to blindness deafness
Osteopetrosis can undergo bone marrow transplant which
Can repopulate functional osteoclasts
-derived from monocytes precursors
Osteoporosis is an increased
Porosity of the skeleton resulting from reduced bone mass
—> increased bone fragility
Osteoporosis affect
Postmeno females—-> reduced estrogen
______% of women sustain fractures by age 65
25%
___% females sustain fractures by 90
50%
Osteoporosis is an imbalance of
Favor is in osteoclasts
Reduced osteoblasts activity
Peak bone mass
Genetic factors
Physical activity
Nutrition
Menopause
Decreased estrogen
Increased IL1 IL6 TNF levels
Increased expression of RANK, RANKL
Increased osteoclast activity
Aging
Decreased replicative activity of osteoprogentior cells
Decreased synthetic activity of Ob
Decreased biologic activity of matrix bound growth factors
Reduced physical activity
Most common osteoporosis sites
Vertebral bodies
Pelvis
Femoral neck
Other weight bearing bones
Osteoporosis may lead to
Kyphoscoliosis and subsequent reduced respiratory function
Osteoporosis diagnosis
Dual X-ray absoprotometry
DEXA scan
Osteoporosis treatment
Diet and exercise Calcium and VIt D supplement Bisphosphonates Hormone therapy Monoclonal Ab
Pagets Disease of Bone abnormal
Dense bone formation whic is structurally weak and prone to fracture
Pagets Disease usually affects
Multiple bone (85% polyostotic)
Pagets Disease usually affects who
Adults> 40
Paramyxovirus infection suspected
Pagets Disease usually asymptomatic but
Bone enlargement Fractures Pain Cranial nerve compression Bowing of legs
Pagets Disease 3 Phases
Osteolytic Phase
Mixed Phase
Osteosclerotic Phase
Pagets Disease Treatment
Calcitonin, bisphosphonates
Analgesics for bone pain
Bone is Pagets Disease has a ______appearance
Mosaic
Very random placement of bone
Hyperparathyroidism inappropriate secretion of
PTH
Primary Hyperparathyroidism
Due to parathyroid hyperplasia adenoma or carcinoma more severe but less common
Secondary Hyperparathyroidism
Leads to poor calcium retention and lowered viatamine D metabolism common complication of end stage renal disease of vitamin deficiency
Which Hyperparathyroidism is less common and more severe
Primary Hyperparathyroidism
Actions of PTH
Osteoclastic activation
Increased Ca resorption by kidneys
Increased VIt D synthesis (kidney) promoting Ca absorption from gut
All actions of PTH work to
Increase serum Ca
Osteitis Fibrosa Cystica
Cyst like brown tumors of bone
Hyperparathyroidism Treatment for primary
Remove affected gland/tumor
Hyperparathyroidism Treatment for secondary
Renal transplant VIt D supplementation
Osteomyelitis
Infection of bone and marrow
Usually bacterial
Osteomyelitis colonize bone through 3 ways
Hematogenous spread
Contiguous i infraction
Implantation following fracture or surgery
Hematgoenous spread
Staph aureus
Contiguous infection
Odontogenic infection
Osteomyelitis assocaited with
Pain/tenderness, possible overlying erythema or swelling
Chronic Osteomyelitis
Non-vital bone
Surround by rim of new bone (involucrum)
Osteomyelitis treatment
Drainage, antibiotics, +/- surgical debridement
Fibrous Dysplasia is replacement
Of normal bone by fibrous CT and abnormal bony trabeculae
Fibrous Dysplasia usually affects
Adolescents young adults
Fibrous Dysplasia can be _____ or ______
Monostotic
Polystotic
Fibrous Dysplasia polyostotic Disease often associated with ____ and ____
Cafe-au-Liat spots
Endocrine disorders
Jaffa-lichenstein syndrome
Cafe-au-Lait
McCune-Albright Syndrome
Cafe-au-Lait and endocrine disorders
Fibrous Dysplasia can have a ____appearance
Ground glass
Ill defined radiolucency
Fibrous Dysplasia Treatment
Observation
Anti-restorative therapy
Surgical reduction
Fibrous Dysplasia after puberty
Usually arrests once plates close
Should wait if before puberty because growth can still continue
Osteosarcoma _____malignancy that produces ________ and _____
Mesenchymal
Osteoid
Bone
Osteosarcoma is the most common
PRIMARY malignant bone tumor
Osteosarcoma usually affects
Patients under 20; average 18
Osteosarcoma patients will have
Pain and swelling of affected bone
Osteosarcoma lesions are
Mixed
Will be calcified
Codmans triangle
Often seen on long bones partly tumor partly reaction of periosteum to tumor
Starburst
Radiating trabecular enlarging size of bone. Late stage and very painful
Osteosarcoma diagnosis
Histology evidence of direct production of steroid by malignant mesenchymal cells
Osteosarcoma treatment
Surgery and chemotherapy
Osteosarcoma prognosis
60-70% 5 year
Osteoarthritis aka
Degenerative joint disease
Osteoarthritis age related
Over 50
Osteoarthritis stems from
degeneration of articular cartilage
-bone changes are secondary
Osteoarthritis _____ play a major role
Mechanical stresses
Rheumatoid arthritis
Autoimmune disease
Affects women more than men
Osteoarthritis symptoms
After 50
Creptius & joint stiffness
Deep, aching pain
Pain, deformity and limitation of motion develop late
Osteoarthritis Treatment
NSAIDs Intrajoint hyualruonic acid Cortisone shots Physical therapy Joint replacement
Gout accumulation
Uric acid accumulation
Gout results in
Episodic acute arthritis
Tophus formation
Kidney damage
Gout usually affects
Adult males, great toe (90%)
Tophi
Sodium urate deposits
Gout food that has a lot of
Pyrines
Meat seafood etc
Gout Treatment
Diet modification (no beer reduce red meat)
NSAIDs, corticosteroids, colchicine, allopurinol
Muscular Dystrophy a heterogenous group of
Heritable diseases with spontaneous progressive degeneration of muscle fibers
Duchenne MD
X-linked condition
Duchenne MD absence of
Dystrophin, key structural protein in skeletal and cardiac muscle
Muscular Dystrophy symptoms usually begin by
Ages 3-5
Muscular dystrophy weakness of
Pelvic and shoulder areas, progressive atrophy and deterioration of muscle
Muscular dystrophy Treatment
None
Most patients in wheelchair by early teens and die before age 30 of diseases related complication
Myasthenia gravis is an acquired
Autoimmune disease
Myasthenia gravis autoAb production to
AChR
—> leads to muscle weakness/fatiguability
Myasthenia gravis usually affects
Females; any age; onset often insidious
Myasthenia gravis problems with
Eye muscles and muscles of mastication Amy be initial presentation
Myasthenia gravis weakness worsens
With repeated contractions, symptoms worse later in day
Myasthenia gravis Treatment
Cholinesterase inhibitors (improves transmission)
Immunosuppressive
Thymectomy may induce remission
Spontaneous remission in some cases
Myasthenia gravis prognosis
Good
Respiratory compromise was a past major cause of death
5 year 95% survival
