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Year 1 Semester 2 > Osteology > Flashcards

Osteology Flashcards

1
Q

Explain cessation of bone growth

A
  • Growth in height ceases at the end of puberty
  • Sex steroids stimulate growth spurt but promotes closure of epiphyseal plates
  • Growth in length ceases, cell proliferation slows and plate thins
  • Plate is invaded by blood vessels, epiphyseal and diaphyseal vessels unite
  • May leave a line visible on X-rays
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2
Q

Give some examples of bones with one ossification centre

A
  • Carpals
  • Tarsals
  • Ear ossicles
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3
Q

How many ossification centres do most bones have?

A

2+

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4
Q

How many ossifications centres does the head of the humerus have?

A

3

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5
Q

Describe the 1st zone of the epiphyseal plate

A

Resting (quiescent) zone

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6
Q

Describe the 2nd zone of the epiphyseal plate

A
  • Growth (proliferation) zone

- Cartilage cells undergo mitosis

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7
Q

Describe the 3rd zone of the epiphyseal plate

A
  • Hypertrophic zone

- Older cartilage cells enlarge

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8
Q

Describe the 4th zone of the epiphyseal plate

A
  • Calcification zone

- Matrix becomes calcified; cartilage cells die; matrix begins deteriorating

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9
Q

Describe the 5th zone of the epiphyseal plate

A
  • Ossification (osteogenic) zone

- New bone formation is occurring

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10
Q

What does normal bone growth and development require?

A
  • Calcium
  • Phosphorus
  • Vitamins A, C and D
  • Balance between growth hormone, thyroid and parathyroid hormones, oestrogen and androgens
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11
Q

Describe the cortical/compact bone

A
  • 80% of bone
  • Location: shafts of long bones
  • Structure: concentrically arranged lamellae - haversian systems
  • Function: mechanically strong
  • Periosteum: thick
  • Turnover: slow
  • Blood supply: slow
  • Fracture patterns: direct or indirect violence may result in deficits at the fracture site leading to non-union
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12
Q

Describe the cancellous/trabecular bone

A
  • 20% of bone
  • Location: ends of long bones, vertebral bodies, flat bones
  • Structure: meshwork of trabeculae with intercommunicating space
  • Function: metabolic
  • Periosteum: thin
  • Turnover: rapid
  • Blood supply: rich
  • Fracture patterns: honeycomb structure fails as the result of compression
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13
Q

Define a fracture

A

A complete or incomplete break in a bone

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14
Q

What are ways of describing a fracture?

A
  • Site
  • Open to surface
  • Contaminated
  • Associated soft tissue injury
  • Joint involvement
  • Number of pieces
  • Alignment
  • Degree of separation
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15
Q

What are some fracture patterns?

A
  • Transverse
  • Linear
  • Oblique non-displaced
  • Oblique displaced
  • Spiral
  • Greenstick
  • Comminuted
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16
Q

Describe the bone remodelling units

A
  • Consists of osteoclasts and osteoblasts

- Keep adult bone mass relatively constant in the face of developmental, physiological and physical demands

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17
Q

What are the three major phases of fracture healing?

A
  • Reactive phase
  • Reparative phase
  • Remodelling phase
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18
Q

Describe the reactive phase of fracture healing

A
  • Fracture and inflammatory phase (haematoma)

- Fibroblasts in the periosteum proliferate to form granulation tissue around the fracture site

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19
Q

Describe the reparative phase of fracture healing

A
  • Callus formation - osteoblasts quickly form woven bone, to bridge the gap
  • Woven bone is weak as the collagen fibres are arranged irregularly
  • Lamellar bone laid down - collagen organised in regular sheets to give strength and resilience
20
Q

Describe the remodelling phase of fracture healing

A

-Remodelling by osteoclasts to restore original bone shape

21
Q

What are the two types of treatment of fractured bone?

A
  • Conservative

- Intervention

22
Q

What is conservative treatment?

A
  • Simple fracture with low risk of non-union
  • Dependent on natural healing process
  • +/- immobilisation
  • Rehabilitation
23
Q

What is intervention treatment?

A
  • Fractures with limb threat or risk of non union
  • Augment natural healing with replacement or strengthening
  • +/-immobilisation
  • Rehabilitation
24
Q

Describe septic arthritis

A
  • Hot swollen joint(s)
  • All ages can be affected but septic arthritis is more common in elderly people and very young children
  • Delayed treatment can lead to irreversible damage
  • Case-fatality approximately 11-50%
  • Resistance to conventional antibiotics is increasing
25
Q

What are four ways to determine septic arthritis?

A
  • Isolation of a pathogenic organism from an affected joint
  • Isolation of a pathogenic organism from another source in the context of a hot red joint suspicious of sepsis
  • Typical clinical features and turbid joint fluid in the presence of previous antibiotic treatment
  • Post-mortem or pathological features suspicious of septic arthritis
26
Q

What are some conditions that predispose septic arthritis?

A
  • Rheumatoid arthritis or osteoarthritis
  • Joint prosthesis
  • Intravenous drug abuse
  • Alcoholism
  • Diabetes
  • Previous intra-articular corticosteroid injection
  • Cutaneous ulcers
27
Q

What is osteomyelitis?

A

Inflammation of the bone and bone marrow usually caused by pyogenic bacteria, and rarely by mycobacteria or fungi

28
Q

How can bones become infected?

A
  • Haematogenous spread
  • Local spread (from septic arthritis
  • Compound fracture (open)
  • Foreign body
29
Q

Describe haematogenous spread to bones

A
  • Usually asymptomatic
  • Skin sepsis may be present but is usually absent
  • Organisms settle in growing metaphysis near growth plate
30
Q

What are some signs of osteomyelitis?

A
  • Painful swollen site
  • Fever
  • Reduced movement
  • Paraplegia
31
Q

Describe osteoprogenitor cells

A

Stem cell population, give rise to osteoblasts

32
Q

Describe osteoblasts

A

Responsible for bone formation, cover the surface of bone

33
Q

Describe osteocytes

A

Mature bone cells - embedded in lacunae, relatively inactive. Maintain bone matrix through cell to cell communication and influence bone remodelling

34
Q

Describe osteoclasts

A

Multinucleated, derived from haematopoietic cells. In response to mechanical stress and physiological demands they resorb bone matrix by demineralization

35
Q

What are the two main types of osteoporosis?

A

Type 1 - post menopausal

Type 2 - age related in those over 75 years

36
Q

Describe post menopausal osteoporosis

A
  • Affects mainly cancellous bone
  • Vertebral and distal radius fracture is common
  • Related to loss of oestrogen
  • F:M = 6:1
37
Q

Describe age related osteoporosis in those over 75 years

A
  • Affects cancellous and cortical bone
  • It is related to poor calcium absorption
  • Hip and pelvic fractures common
38
Q

What are clinical consequences of osteoporosis?

A

Increase in bone fragility. Susceptibility to fracture: micro or fragility fracture

39
Q

Describe a fragility fracture

A
  • Low energy trauma
  • Mechanical forces that would not ordinarily cause fracture
  • WHO gives example of fall from a standing height or less
39
Q

Describe a fragility fracture

A
  • Low energy trauma
  • Mechanical forces that would not ordinarily cause fracture
  • WHO gives example of fall from a standing height or less
40
Q

What are some non-modifiable risk factors for osteoporosis?

A
  • Biological sex
  • Age
  • Previous fracture
  • Family history
  • Race
41
Q

What are some modifiable risk factors for osteoporosis?

A
  • Oestrogen deficiency
  • Smoking
  • Alcohol
  • Low calcium
  • Low BMI
  • Vitamin D deficiency
  • Inactivity
42
Q

What drugs can be risk factors for osteoporosis?

A
  • Chronic corticosteroid therapy
  • Excessive thyroid therapy
  • Gonadotrophin releasing hormone agonist or antagonist
  • Anticoagulants
  • Anticonvulsants
  • Chemotherapy
43
Q

What are some pharmacological treatments of osteoporosis?

A
  • Bisphosphonates: e.g alendronate, risedronate - disrupt the activity of osteoclasts - side effects: GI upset, oesophagitis, mandibular necrosis
  • Anabolic agents - e.g intermittent parathyroid hormone (PTH)
  • Selective estrogen receptor modulators (SERMs) - e.g raloxifene
  • Ca2+ supplement
  • Hormone replacement therapy - carries an increased risk of breast cancer
44
Q

What are some non-pharmacological interventions for osteoporosis?

A
  • Exercise - weight-bearing exercise with impact - muscle-strengthening exercise
  • Nutrition - not just calcium and vitamin D, needs a balanced and healthy diet
  • Vitamin D and calcium intake - sunlight, food, supplements
  • Reduce alcohol/cigarettes

Year 1 Semester 2 (26 decks)

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