Musculoskeletal

Question 1

What is Osteoporosis?

Answer 1

Decreased bone density and in bone matrix
Osteoclastic activity > Osteoblastic activity
In menopause, loss of estrogen = loss of osteoclastic inhibition = loss of matrix
Check vitamin D levels

Question 2

What is Osteomalacia?

Answer 2

Decreased mineralization of bone
Bones become soft
Usually a vitamin D problem

Question 3

What is Osteopenia?

Answer 3

Decreased bone density
Loss of bone mass
Could be loss of matrix or mineralization
Combination of osteoporosis and osteomalacia

Question 4

What is Osteopetrosis?

Answer 4

Decreased osteoclastic activity resulting in too much bone density.
Bone can not be broken down properly
Marble bone disease
Loss of flexibility
Obliterated bone marrow
Spleenomegaly = spleen takes over erythropoiesis
Red cell destruction leads to tear drop cells

Question 5

What is Osteosclerosis?

Answer 5

Increased bone scarring

Can be due to any disease

Question 6

What is Osteitis Fibrosa Cystica?

Answer 6

Inflammation of the bone
Causes scarring and holes
Due to renal osteodystrophy
Permanent bone disease

Question 7

What is Osteitis Deformans?

Answer 7

Pagets Disease of Bone
Increased osteoclastic activity
Increased serum calcium and alkaline phosphate
Increased incidence of osteosarcoma
Disfigured remodeling
Hats and shoes do not fit anymore
Hearing loss from breakdown of petrous bone where CN VII and VIII run

*Paramyxovirus infection theory: stimulates osteoclastic activity to run wild, osteoblast increase activity to remodel but can not keep up.

Treatment: Alendronate (Fosamax)

Question 8

What is second line treatment for gouty arthritis?

• MOA
• Side effects

Answer 8

• Second line is colchicine
• Colchicine inhibits microtubular polymerization
• Binds tubulin protein that helps form microtubules, preventing their aggregation
• It also disrupts cytoskeletal dependent functions such as chemotaxis, phagocytosis and degranulation
• It also reduces formation of leukotriene B4
• Does not affect metabolism or urinary excretion of uric Side effects
• Nausea, abdominal pain and diarrhea
• Contraindicated in elderly or severe renal dysfunction

Question 9

What is first line treatment for acute gouty arthritis?

Answer 9

Indomethacin

Question 10

What are the 4 seronegative spondyloarthropathies?

Answer 10

• Ankylosing spondylitis
• Reactive arthritis
• Psoriatic arthritis
• Arthritis associated with inflammatory bowel disease