Musculoskeletal Pathology Flashcards
1
Q
Osteoporosis
A
- Increased porosity of the skeleton
- Reduced bone mass
2
Q
Primary osteoporosis
A
- Postmenopausal
- Senile
3
Q
Secondary osteoporosis
A
- Endocrine Disorders
- Neoplasia
- Gastrointestinal
- Rheumatologic disease
- Drugs
4
Q
Determinants of peak bone mass
A
- Genetic factors
- Physical activity
- Nutrition
5
Q
Menopause factors with osteoporosis
A
- Decreased estrogen
- Increased IL-1, IL-6, TNF
- Increased RANK, RANKL
- Increased osteoclast activity
6
Q
Aging factors with osteoporosis show decreased
A
- Replicative activity of osteoprogenitor cells
- Synthetic activity of osteoblasts
- Biologic activity of matrix-bound growth factors
- Physical activity
7
Q
Postmenopausal osteoporosis
A
- Hormone-dependent accelerated bone loss (decade after menopause)
- Decreased estrogen levels
8
Q
Decreased estrogen levels show increased secretion of
A
- IL-1
- IL-6
- TNF
9
Q
IL-1, IL-6, and TNF are all
A
- From blood monocytes and bone marrow cells
- Stimulators of osteoclast recruitment and activity
10
Q
Most affected in postmenopausal osteoporosis
A
- Cancellous compartment of vertebral bodies
- Trabeculae thinning
- Microfractures
- Vertebral collapse
11
Q
Trabecular bone effects in postmenopausal osteoporosis
A
- Loss of bone is most rapid
12
Q
Vertebral effects in postmenopausal osteoporosis
A
- Prominent trabecular component
- Fractures
13
Q
Postmenopausal osteoporosis vertebral fractures (clinical features)
A
- Back Pain
- Shortening of stature
- Dorsal kyphosis
- Cervical lordosis
14
Q
Senile osteoporosis features
A
- Decreased osteoblast response (reduced replication and biosynthetic potential)
- Decline in biologic potency of growth factors
- Thinning of Cortex
- Widened haversian systems
15
Q
General clinical course of postmenopausal and senile osteoporosis
A
- Painful thoracic and lumbar regions
- Other fracture sites include; femoral neck, pelvis
- Plain radiographs not helpful
16
Q
Postmenopausal and senile osteoporosis prevention and treatment
A
- Exercise
- Appropriate calcium and vitamin D intake
- Pharmacologic Agents (Bisphosphonates, Recombinant PTH)
17
Q
Rickets and Osteomalacia vitamin D involvement
A
- Maintains normal plasma Ca+2 and Phosphorus
- Maintains the correct concentration of ionized calcium
- Absorption of Ca+2 from GI tract
18
Q
Calcium is essential for
A
- Skeletal mineralization
- Blood coagulation
- Neural transmission
- Membrane preservation
- Skeletal and cardiac muscle
- Normal tone
- Excitability
19
Q
Phosphorous constituents
A
- Nucleic Acids
- Phospholipids
- ATP
- NADP
20
Q
Phosphorous is essential for
A
- Muscle Contraction
- Neural Function
- Electrolyte Transport
- O2 carrier for Hgb
21
Q
Vitamin D deficiency may result from
A
- Dietary deprivation
- Chronic renal failure
22
Q
Dietary deprivation vitamin D deficiency
A
- Fat malabsorption
- Prolonged lack of sunlight
23
Q
Chronic renal failure vitamin D deficiency
A
- Vitamin D conversion to active form hindered
24
Q
Vitamin D deficiency or phosphate depletion
A
- Rickets in Children
- Osteomalacia (soft bones) in adults
25
Rickets
- Children
- Deranged bone growth produces skeletal deformities
- Ends of long bones (epiphyseal plate ossification)
26
Osteomalacia (soft bones)
- Adults
| - Under-mineralized remodeled bone
27
Basic abnormality in Rickets and Osteomalacia (morphology)
- Defective mineralization of osteoid
- Increased unmineralized matrix
- Wide osteoid seams
- Decreased calcified bone
28
Rickets clinical features
- Pain
- Bone deformities
- Outward curvature of sternum (pigeon chest)
- Shortened and deformed limbs with bowing of arms and legs
- Frequent fractures
29
Bone deformities in Rickets
- Rachitic rosary (swollen costochondral junctions of ribs)
30
X-ray findings in Rickets
- Thickened, irregular and lobulated epiphyseal plate
31
Deranged bone growth in Rickets
- Bowing of Extremities
- Rachitic rosary
- Frontal bossing
32
Osteomalacia under-mineralized bone may be visualized histologically with
- Von Kossa stain
33
Clinical features of osteomalacia
- Osteopenic x-ray pattern
- Compression fractures
- Decrease in bone thickness
- Low serum calcium and phosphorus
34
Osteopenia
- Early manifestation of osteoporosis
35
Basic common abnormalities (Rickets and Osteomalacia)
- Vitamin D deficiency
- Low serum levels of Ca+2 and Phosphorus
- Secondary hyperparathyroidism
- Defective mineralization of osteoid
- Increased unmineralized matrix
36
Primary hyperparathyroidism of the parathyroid gland may result from
- Hyperplasia
- Adenoma
- Carcinoma
37
PTH secreting adenomas may cause
- Depression
- Seizures
- Nephrocalcinosis
- Nephrolithiasis
- Acute pancreatitis
- Gallstones
38
Morphology of primary hyperparathyroidism
- Dissecting osteitis
- Osteopenia
- Osteoblast activity increased
- Marrow space replaced by fibrovascular tissue
39
Secondary Hyperparathyroidism
- Compensatory hypersecretion of PTH
| - Osteoclast activity stimulation
40
Secondary Hyperparathyroidism may be caused my
- Prolonged states of hypocalcemia
41
Hyperparathyroidism is associated with
- Microfractures and secondary hemorrhages
- Brown Tumor
- Cystic Degeneration
42
Brown tumor
- Vascularity, hemorrhage, and hemosiderin deposition by macrophages
43
Cystic degeneration
- Severe hyperparathyroidism
| - Generalized Osteitis Fibrosa Cystica (Von Recklinghausen Disease of Bone )
44
Hyperparathyroididm pathology features
- Increased bone cell Activity
- Peritrabecular fibrosis
- Cystic Brown Tumors
45
Morphology of hyperparathyroidism
- Cortical bone = widened haversion canals
- Cancellous bone = dissecting osteitis
- Osteopenia
46
Renal osteodystrophy may result from chronic renal diseases such as
- End stage renal disease (ESRD)
| - Uremic osteodystrophy
47
Features of renal osteodystrophy
- Increased osteoclastic bone resorption
- Delayed matrix mineralization (osteomalacia)
- Osteosclerosis
- Growth Retardation
- Osteoporosis
48
Effects of chronic renal failure results in
- Hyperphosphatemia
- Hyperphosphatemia --> secondary hyperparathyroidism
- Hypocalcemia develops (damaged kidneys)
- PTH secretion --> at all levels of serum Ca+2
- PTH --> Increased osteoclast activity
- Metabolic Acidosis
49
Effects of Aluminum (Al 3+)
- Interferes with deposition of Ca+2 hydroxyapatite
| - Promotes Osteomalacia
50
Magnesium
- Modulates secretion of PTH
| - Cofactor for α-1-hydroxylase
