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DPT 682 - Pathophysiology > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

Two types of mature bones = ?

MSK

A

Two types of mature bones:

(1) Compact (cortical):

  • 80% of skeleton
  • Forms the outer surface of the bone, protective shell.
  • Densely packed calcified intercellular matrix making it rigid.

(2) Cancellous (spongy)

  • Trabeculae, lattice like patterns
  • Light but considerable tensile strength and weight bearing properties.
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2
Q

Long bones have

  1. = ?
  2. = ?
  3. = ?

MSK

A

Bones are classified by shape as long, short, flat or irregular.

Long bones:

  • Diaphysis/shaft
  • Epiphysis
  • Metaphysis
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3
Q

?

green

MSK

A

Epiphysis:

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4
Q

?

green

MSK

A

Metaphysis

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5
Q

?

green

MSK

A

Diaphysis/shaft

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6
Q

Strong mature form of bone that is highly organized, somposed of cylindrical units called osteons = ?

MSK

A

Lamellar Bone:

  • Strong mature form of bone that is highly organized.
  • Composed of cylindrical units called osteons/
  • Haversian systems: Concentric lamina of bone matrix surrounding a central canal called as Harversian canal that contains blood and nerve supply.
  • Osteocytes: mature bone cells, maintain cell matrix.
  • Lacuna: space filled with extracellular fluid.
  • Woven Bone: low tensile strength, found in developing fetus, areas surrounding tumors, part of healing fracture.
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7
Q

Occupies the medullary cavities of the long bones throughout the skeleton = ?

MSK

A

Bone Marrow:

  • Occupies the medullary cavities of the long bones throughout the skeleton and cavities of the cancellous bone in the vertebrae, ribs, sternum and flat bones of the pelvis.
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8
Q

Two types stem cells in bone = ?

MSK

A

Bone Marrow

(a) Bone contains stem cells:

(a.1) Hematopoietic stem cells:

  • RBCs
  • WBCs
  • platelets

(a.2) Stromal cells:

  • Adipose tissue
  • Cartilage
  • Bone
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9
Q

Bone Marrow:

  • Red bone marrow = ?
  • Yellow bone marrow = ?

MSK

A

Bone Marrow:

(1) Red bone marrow:

  • Contains developing red blood cells.

(2) Yellow bone marrow:

  • Composed of adipose tissue.

Note:

  • At birth, all bone marrow is red; with age red is gradually replaced by yellow.
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10
Q

Bone tissue is composed of = ?

MSK

A

Bone Tissue:

  • Bone is a connective tissue impregnated with inorganic calcium salts so that it has great tensile and compressive strength but is light enough to be moved by coordinated muscle contraction.

(a) Organic matter:

  • Type 1 collagen - 88%
  • Proteins - 10%
  • Lipids and glycosaminoglycans - 1-2%

(b) Inorganic salts:

  • Hydroxyapatite (calcium phosphate salts).
  • Calcium carbonate
  • Calcium fluoride
  • Bone cells
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11
Q

Osteoprogenitor cells are found in = ?

MSK

A

Osteoprogenitor cells:

  • Found in periosteum, endosteum and epiphyseal plate.
  • They differentiate into osteoblasts, active during normal growth, healing of fractures/injuries.
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12
Q

Four types of bone cells = ?

MSK

A

Bone Cells:

(1) Osteoprogenitor cells:

  • Differentiate into osteoblasts

(2) Osteoblasts:

  • Formation of bone matrix.
  • Forms osteoid/prebone and calcifies it.

(3) Osteocytes:

  • Maintains bony matrix

(4) Osteoclasts:

  • Large phagocyte cells, bone resorption.
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13
Q

Role of osteoblasts = ?

MSK

A

Osteoblasts:

(a) Bone building cells, form bone matrix.

  • Make a protein mixture called osteoid, which mineralizes to form bone.
  • Osteoid primarily consist of type-1 collagen.
  • Osteoblast puts up collagen fibers, then deposit calcium and phosphate which is hardened by inorganic salts.
  • Release alkaline phosphatase, helps precipitation of calcium and phosphorous.
    • Increase serum levels of AP after bone injury and fractures, other bone diseases like Paget’s disease and osteomalacia.
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14
Q

Osteocytes = ?

MSK

A

Osteocytes:

  • Mature bone cells.
  • Maintain bone matrix.
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15
Q

Osteoclasts = ?

MSK

A

Osteoclasts:

(a) Bone chewing cells, resorption of bone, removing the mineral content and inorganic matrix.

  • Phagocytic cells of monocyte/macrophage lineage.
  • Estrogen reduces the number and function of osteoclasts.
  • Decrease in estrogen levels at menopause causes increased resorption of bone.
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16
Q

Bone Remodeling:

  • Process of remodeling is to maintain strength and integrity of skeleton by = ?
  • Ideally, replaced bone = ?

MSK

A

Bone Remodeling:

  • Process of skeletal maintenance once skeletal growth is complete.
  • Process of remodeling is to maintain strength and integrity of skeleton by replacing fatigue damage older bone with new bone.
  • Consist of sequence of bone resorption by osteoclasts followed by new bone formation by osteoblasts.
  • Ideally, replaced bone = resorbed bone.
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17
Q

Phases of bone remodeling = ?

MSK

A

Phases of Bone Remodeling:

(1) Activation Phase:
(2) Resorption Phase:
(3) Reversal Phase:
(4) Formation Phase:

18
Q

Hormonal control of bone metabolism is influenced by = ?

MSK

A

Hormonal Control of Bone Metabolism:

(a) Bone formation and mineral metabolism involves interplay among the actions of:

  • PTH
  • Calcitonin
  • Vitamin D
19
Q

Parathyroid Hormone and Calcitonin

MSK

A
20
Q

Vitamin D

MSK

A
21
Q

Two types of metabolic bone disease = ?

MSK

A

Metabolic Bone Disease:

(1) Disorders of bone formation / resorption.

  • (1.a) Formation > Resorption:
  • (1.b) Resorption > Formation:
    • Osteopenia = decreased bone mass.
    • Osteoporosis = loss of mineralized bone mass.

(2) Disorders of Mineralization

  • (2.a) Reduced Mineralization:
    • Osteomalacia
    • Rickets
  • (2.b) Increased Mineralization:
    • Metabolic soft tissue mineralization
22
Q

Osteopenia:

  • Characterized by = ?
  • Causes = ?

MSK

A

Osteopenia:

(I) Characterized by reduction in bone mass greater than expected for age, race or sex due to:

  • Decrease in bone formation
  • Inadequate bone mineralization

(II) Causes:

  • Osteoporosis
  • Osteomalacia
  • Malignancy
  • Hyperparathyroidism
  • Hyperthyroidism (causes increased bone remodeling)

44 mil. people in US have osteopenia / osteoporosis

23
Q

Osteoporosis:

MSK

A

Osteoporosis:

  • Means porous bone
  • Combination of decreased bone mass and micro-damage to bony structure fracture.
  • Most common metabolic disease, affecting more than 10 million people living in the US.
  • Imbalance between bone resorption and bone formation.

Depending on underlying etiology:

  • Primary: most common
  • Postmenopausal/ estrogen deficient
  • Age related
  • Secondary: associated with medications like corticosteroids, other conditions/ diseases like malnutrition, alcoholism

  • Most common metabolic disease, affecting more than 10 million Americans.
24
Q

Two types of osteoporosis = ?

MSK

A

Osteoporosis:

*Depending on underlying etiology:

(a) Primary (Most common)

  • Postmenopausal,
  • Estrogen deficient,
  • Age related

(b) Secondary:

  • Associated with medications like corticosteroids,
  • Malnutrition,
  • Alcoholism
25
Q

Risk factors for osteoporosis = ?

* Big List / ACCESS = ?

MSK

A

Risk factors for osteoporosis:

(a) Personal characteristics:

  • Advanced age
  • Female
  • White
  • Small bone structure
  • Family history
    • (8 genes linked to reduced calcium levels)
  • High bone peak mass
    • (diet and bone building exercises)

(b) Drugs / diseases:

  • Aluminum containing antacids
  • Anticonvulsants
  • Heparin
  • Corticosteroids
  • Diabetes
  • Malignancy
  • Hyperparathyroidism
  • Hyperthyroidism
26
Q

Cause / Examples / Mechanism:

  • Aluminum containing antacids / ? / ?
  • Anticonvulsants / ? / ?
  • Heparin / ? / ?
  • Corticosteroids / ? / ?
  • Diabetes / ? / ?
  • Malignancy / ? / ?
  • Hyperparathyroidism / ? / ?
  • Hyperthyroidism / ? / ?

MSK

A

no clue

27
Q

Osteoporosis:

  • Clinical Manifestations = ?

MSK

A

Osteoporosis - Clinical Manifestations:

(a) Loss of trabeculae from cancellous bone and thinning of the cortex.

(b) Minimal stress causes fracture:

  • Vertebral bodies
  • Hips
  • Radius
  • Ribs
  • Femur (most common)
  • Bone pain
  • Decrease activity tolerance
28
Q

Osteoporosis:

  • Diagnosis = ?
  • T Scores = ?
  • X rays = ?
  • T-Score = ?

MSK

A

Osteoporosis - Diagnosis:

(a) History / Drugs

(b) Bone mineral density:

  • Measurement of mineral content of bone in g/cm^2 for the area of the body that has been scanned.
  • Dual energy x ray absorptiometry (DEXA)
  • Reported in terms of standard deviation from the average peak bone mass of a 30 year old healthy young adult; T score.

(c) X rays:

  • Increased translucency
  • Cortical thinning
  • Abnormal trabeculae
  • Fractures

  • Osteopenia is a loss of bone mass or bone mineral density.
  • It is the stage before osteoporosis, and without treatment, it can progress to osteoporosis.
29
Q

Management of Osteoporosis

  • Treat = ?
  • Prevent = ?
  • Manage = ?

MSK

A

Keys to Management of Osteoporosis:

(1) Treatment of the underlying cause

(2) Prevention:

  • Adequate nutrition and calories, low fat diet with calcium supplements (premenopausal 1000 mg/day, postmenopausal 1500 mg/day) and magnesium rich foods
  • Regular physical activity
  • Reduce / eliminate alcohol or tobacco
  • Vitamin D therapy (400-800 IU) / exposure to sunshine- helps body absorb, synthesize and transport calcium within body

(3) Management:

  • Bisphosphonates (inhibit bone resorption)
  • Hormonal therapy
  • Calcitonin (decreases osteoclastic activity)
30
Q

Osteomalacia:

  • What is it = ?
  • Causes = ?

MSK

A

Osteomalacia:

(a) Inadequate mineralization of new bone matrix results in a softening of bone.

(b) Causes:

  • Lack of dietary calcium / vitamin D
  • Insufficient calcium absorption from the intestine.
  • Biliary / intestinal diseases / anticonvulsant medication.
  • Phosphate deficiency, due to renal loss or decreased intestinal absorption.
  • Long term use of antacids - contain aluminum hydroxide that binds with dietary form of phosphorous and prevents absorption in GI.
  • Long standing hyperparathyroidism
31
Q

Osteomalacia:

  • Risk Factors = ?

MSK

A

Osteomalacia - Risk Factors:

(a) Older adults

(b) Intestinal malabsorption

  • Disease of small intestine
  • Biliary obstruction
  • Chronic pancreatic insufficiency

(c) Long term use of

  • Anticonvulsants
  • Tranquilizers
  • Sedatives
  • Muscle relaxants
  • Antacids

(d) Diet deficient in Vit D

  • (Northern India, Japan, Northern China)

(e) Conditions that affect the absorption of calcium and action of vitamin D

  • History of hyperparathyroidism, chronic renal failure
32
Q

Osteomalacia:

  • Pathogenesis = ?

MSK

A

Osteomalacia - Pathogenesis:

  • Generalized decrease in calcification of matrix and increase in uncalcified matrix.
  • Failure of calcium salts to be deposited in osteoid, leaving a bone that has not calcified / matured.
  • Accumulation of osteoid, bone strength declines.

Osteomalacia

  • Often referred to as “soft bone disease “, is a metabolic bone disorder characterized by the inadequate mineralization of bone tissue.
33
Q

Osteomalacia:

  • Clinical Manifestations = ?

MSK

A

Osteomalacia - Clinical Manifestations:

(a) Initially, diffuse, generalized aching and fatigue in the presence of anorexia and weight loss.

  • Hence diagnosis is difficult and delayed.

(b) Bone pain, periarticular tenderness in spine, ribs, pelvis and proximal extremities and fractures

  • (distal radius and proximal femur).

(c) Muscle weakness + softening= postural deformities.

  • Increased thoracic kyphosis, bowing of tibia and femur.
  • Waddling gait, difficulties with transitional movements like sitting to standing.
34
Q

Osteomalacia:

  • Diagnosis = ?
  • Treatment = ?

MSK

A

Osteomalacia - Diagnosis:

(a) Bone radiograph (Looser’s zone)

(b) Bone biopsy

(c) Blood test

  • Calcium, phosphate, parathyroid hormone

(d) Urine analysis

  • Asses calcium and phosphorous excretion rates

Osteomalacia - Treatment:

  • Correcting the primary disease
  • Adequate nutrition = Calcium, Vitamin D
35
Q

Paget’s disease = ?

MSK

A

Paget’s disease (Osteitis Deformans):

  • Progressive disorder of adult skeletal system.
  • Abnormal bone remodeling.
  • Increased bone resorption and extensive unorganized new bone formation.
  • Excess bone formation lacks structural stability of normal bone.
  • Complications such as deformity, arthritis, fracture, pain.
  • 2nd most common metabolic bone disease after osteoporosis.
36
Q

Paget’s disease:

  • Incidence and Prevalence = ?

MSK

A

Paget’s disease (Osteitis Deformans) - Incidence and Prevalence:

  • Increasing prevalence among adults over 50 years, men more affected.
  • Often genetic but environmental cause can activate osteoclasts.
  • Sir James Paget, described the disease 100 years ago.
37
Q

Paget’s disease:

  • Pathogenesis = ?

MSK

A

Paget’s disease (Osteitis Deformans) - Pathogenesis:

38
Q

Paget’s disease:

  • Clinical Manifestations = ?
  • Common sites = ?

MSK

A

Paget’s disease (Osteitis Deformans) - Clinical Manifestations:

(a) Simple lesion to involvement of many bones.

(b) Common sites of Paget’s disease:

  • Skull
  • Pelvis
  • Humerus
  • Ribs
  • Spine
  • Femur
  • Tibia

(c) Present long before it is detected clinically.

(d) In mild cases, few symptoms or symptom free for long and then bone pain with deformities.

(e) Overactive osteoclasts, release enough calcium in blood to cause hypercalcemia.

  • Fatigue
  • Loss of appetite
  • Abdominal pain
  • Constipation

Paget’s disease of bone is a chronic (long-lasting) disorder that causes bones to grow larger and become weaker than normal.

39
Q

Paget’s disease:

  • Neurologic clinical manifestations = ?
  • Cardiovascular clinical manifestations = ?
  • Musculoskeletal clinical manifestations = ?

MSK

A

Paget’s disease (Osteitis Deformans) - Clinical Manifestations:

(a) Neurologic:

  • Headache if skull involved; 8th cranial nerve affected because of the involvement of ossicles.
  • Tinnitus, vertigo, hearing loss.
  • Other nerve leading to compression, spinal cord syndromes (paraplegia, muscle weakness, compression neuropathy) - because of enlarged Pagetic bones.

(b) Cardiovascular:

  • Due to vasodilatation of blood vessels in the bone and skin, subcutaneous tissue overlying the affected bones.
  • When 1/3rd of skeleton is involved- severe increase in cardiac output- heart failure.

(c) Musculoskeletal:

  • Bones change in shape, size, directions causing bone pain (deep and worse at night), arthritis, deformities and fracture (esp. in bones subjected to greater stress).
  • Postural deformities (increased kyphosis, bowing of femur and tibia, coxa vara, waddling gait).
40
Q

Paget’s disease:

  • Diagnosis = ?

MSK

A

Paget’s disease (Osteitis Deformans) - Diagnosis

(a) Alkaline phosphatase

  • 10-20 times higher than normal

(b) Bone scan: to detect rapid turnover

(c) Radiographs:

  • Picture frame appearance
  • Bowing of bones
  • Cotton wool appearance
41
Q

Paget’s disease:

  • Treatment = ?

MSK

A

Paget’s disease (Osteitis Deformans) - Treatment:

(a) Drugs to inhibit osteoclastic activity.

(b) Biphosphonates

(c) Calcitonin

(d) Non steroidal anti-inflammatory drugs:

  • Adequate dose of calcium
  • Vitamin D
  • Surgery - decompress nerves

DPT 682 - Pathophysiology (16 decks)

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