Pathologies of Bone Flashcards
1
Q
A discontinuity of bone. The most common type of bone lesion.
A
Fractures
2
Q
What are the three major categories of fractures?
A
- Fracture caused by sudden injury [most common]
- Fatigue or stress fractures
- Pathologic fractures
3
Q
The following are types of fractures. Except:
- Closed [simple]
- Open [compound]
- Complete fracture
- Incomplete
- Comminuted
- Compression
- Impacted
- Stress
- Aggravated
- Avulsion
- Pathologic
A
Except: 9
4
Q
Type of Fracture wherein bone fragment connected to a ligament or tendon breaks off from main bone.
A
Avulsion
5
Q
Type of Fracture wherein penetrates through the skin.
A
Open [compound]
6
Q
_________ - occurs in a bone weakened by disease, e.g. secondary to osteoporosis or bone tumour .
A
Pathologic Fracture
7
Q
What are the three Fracture types according to its orientation?
A
- Oblique - approx. 45 degrees to long axis of bone
- Spiral - twisting or torque
- Transverse - 90 degrees to long axis of bone
8
Q
Five types of Epiphyseal Fractures:
A
- Type I
- Type II
- Type III
- Type IV
- Type V
9
Q
_______ - compression fracture through the growth plate (least common), can often stunt growth
A
Type V
10
Q
_______ - fracture through the growth plate which carries a corner of the metaphysis [occurs in 75% of cases]
A
Type II
11
Q
______ - an oblique fracture through the epiphysis, growth plate and metaphysis.
A
Type IV
12
Q
________ - fracture through the growth plate and a part of the epiphysis.
A
Type III
13
Q
_______ - isolated fracture through the growth plate.
A
Type I
14
Q
The following are named Fractures. Except:
- Jefferson’s
- Chauffeur’s
- Maisonneuve
- Washington’s
- Bucket handle
- Morton
- Lap Belt
- Bedroom
A
Except: 4
15
Q
________ - also known as Dancer’s, transverse stress fracture of proximal shaft of fifth metatarsal.
A
Jones’ fracture
16
Q
_______ - fracture of distal radius with dorsal displacement of distal segments. Often involves ulnar styloid process.
A
Colles’
17
Q
________ - fracture of 4th or 5th metacarpal
A
Bar room
18
Q
________ - partial dislocation of ankle with fracture of fibula above the lateral malleolus and rupture of distal tibiofibular ligament.
A
Pott’s
19
Q
__________ - fracture of proximal fibula with disruption of tibiofibula syndesmosis from ankle eversion .
A
Maisonneuve
20
Q
_______ - fracture of superior pubic ramus and ischiopubic junction on opposite sides and SI joint on side of impact. It is due to side impact .
A
Bucket handle
21
Q
_______ - avulsion of spinous processes of lower cervicals caused by auto accident, diving, wrestling - [hyperflexion] .
A
Clay shoveler’s
22
Q
_________ - fracture of tibial plateau
A
Bumper / Fender
23
Q
__________ - fracture of anterior body of C2 through pedicles [hyperextension] .
A
Hangman’s
24
Q
_________ - horizontal fracture through maxillary above apices of teeth .
A
LeFort [3 types]
25
\_\_\_\_\_\_\_\_\_ - burst fracture of C1 due to compression
Jefferson's
26
\_\_\_\_\_\_\_\_ - transverse fracture of usually L1, L2 or L3
Lap Belt, aka Chance
27
\_\_\_\_\_\_\_\_\_\_\_\_ - fracture of distal radius and ulna with ventral displacement of distal segments.
Smith's, aka reverse Colles
28
The followiing are stages of Bone healing. Except:
1. Hematoma formation [1-2 days]
2. Formation of fibrocartilaginous callus called procallus [2 days to 3 weeks]
3. Invasion of Macrophages to support osteogenesis.
4. Bony callus formation [3rd to 4th week]
5. Remodeling
Except: 3
29
True or False
1. Healing also depends on the site of the fracture, the condition of the fragments, hematoma formation and other host factors.
2. Healing depends on the age of the individual:
Children: 4-6 weeks
Adolescents: 6-8 weeks
Adults: 10-18 weeks
True
30
What are the treatment of Fractures?
Treatment:
- Reduce fracture
- Immobilization and splinting
- Surgery to insert pins, screws or rods
- Physical therapy to encourage healing and prevent contracture and adhesions
- If conditions such as Complex Regional Pain Syndrome, embolisms or infections occur, more
specific treatment may be required
31
\_\_\_\_\_\_\_\_\_ - refers to any painful state of the supporting structures of the body—bones, ligaments, joints, tendons or muscles.
Rheumatism
32
\_\_\_\_\_\_\_\_\_ - is a form of rheumatism in which the joints have become inflamed. Refers to many different diseases, most of which are characterized by inflammation of one or more joints. Inflammation, pain, and stiffness may also be present in the adjacent tissues.
Arthritis
33
A degenerative joint disease in which joint cartilage is gradually lost. Commonly known as wear-and-tear arthritis. The most common type of arthritis.
Osteoarthritis
34
What is the etiology of osteoarthritis?
It results from a combination of aging, obesity, irritation of the joints, muscle weakness, and wear and abrasion.
35
Osteoarthritis mainly affects:
Articular cartilage
36
The following are signs and syptoms of Osteoarthritis. Except:
1. Pain
2. Stiffness
3. Crepitus
4. Swelling nodes on interphalangeal joints
5. Knees and hips are sore
6. Bruising on the affected areas
7. Morning stiffness until the joint is warmed up
8. May have no early symptoms
9. Nodes on the finger joints [Heberden and Bouchard
Except: 6
37
What are the diagnostic procedure to determine osteoarthritis?
1. Physical exam and history
2. X-ray can confirm
38
The followng are treatment of Osteoarthritis. Except:
1. Analgesic or anti-inflammatory medication or herbs.
2. Massage or acupuncture may help relieve pain and swelling.
3. Cortisone injections in the joint
4. Reduce stress on the joint but maintain strength and flexibility
5. Pain management techniques
6. Weight gain program
7. Joint replacement surgery [Most
common reason for hip and knee surgery]
Except: 6
Weight loss not weight gain
39
\_\_\_\_\_\_\_\_\_ - is the temporary displacement of two bones at the joint with complete loss of contact between the articulating surfaces.
Dislocation
40
If the contact between the surfaces is only partially lost due to injury. This is called:
subluxation or separation
41
Most common areas of dislocations and subluxations are the following. Except:
1. Shoulder
2. Elbow
3. Wrist
4. Mandible
5. Jaw
6. Hip
7. Knee
Except: 4
42
What are the causes of dislocation?
1. Trauma from motor vehicle accidents [MVA] or sports
2. Congenital or acquired damage can contribute
43
What are the manifestations of dislocation?
* Misshapen joint
* Swelling
* Discolouration
* Loss of function and pain
* Subluxations exhibit similar but less severe symptoms
44
Treatment of Dislocation are the following. Which of these treatment is not included?
1. Realign bones [reduction]
2. Immobilization
3. Bone transplantation
4. Physical therapy
5. Surgery may be required
6. Pain modalities
Not included: 3
45
Joint trauma that stretches or tears ligaments. Commonly occurs in the ankle, wrist, elbow and knee but the low back and sacroiliacjoints are common areas as well. This condition is called:
Sprain
46
Grade of Severity of Sprain:
Microscopic damage but not torn. Minimal instability.
Grade I
47
Grade of severity of Sprain:
Complete rupture. Gross instability. May be avulsion fracture. Significant swelling and loss of function.
Grade III
48
Grade of severity of Sprain:
Partially torn. Swollen and muscle splinting evident. Moderate instability.
Grade II
49
What are the causes of sprain?
* Overstretch
* Trauma
50
What are the manifestations of Sprain?
- Pain, swelling, redness, loss of function, heat []
- Discolouration
51
Treatment of Sprain are the following. Except:
1. Rest, ice, elevate, compress [RICE]
2. Analgesics or anti-inflammatory medications or herbs
3. Brace, crutches or taping
4. Amputation
5. Surgery in severe cases
6. Physical therapy
Except: 4
52
This refers to a group of inherited disorders of connective tissue caused by mutations in the gene for collagen. It affects the skeleton, joints, ears, ligaments, teeth, sclera and skin.
Osteogenesis imperfecta
53
Osteogenesis imperfecta is also nown as:
Brittle bone disease
54
The following describes Type I Osteogenesis imperfecta. Which is not true?
1. multiple function at birth, blue sclera, hearing problems, teeth
2. function usually occur after the adolescent begins puberty
3. stature is more or less unaffected
4. this is the most common form
Answer: 2
55
Describe Type II Osteogenesis imperfecta.
_Type II_
* lethal
* stillborn or die within a few days, due to crushing of bones
* during delivery or uterine contractions
* Sclera are blue
56
An acute or chronic bone infection, usually caused by bacteria. *Osteo* relates to bone and *myelo* relates to the marrow cavity.
Osteomyelitis [Pyogenic Osteomyelitis]
57
Usually bacterial cause from infection of an open wound. Can be from local trauma or can spread via the bloodstream [hematogenous route].
Acute Osteomyelitis
58
What is the common bacteria that causes acute Osteomyelitis?
staphylococcus aureus
59
What are the symptoms of Acute Osteomyelitis?
* Fever
* chills
* malaise
* pain
* poor healing at wound site
* wound drainage
60
What are the areas that are commonly affected with Acute Osteomyelitis ?
children - the long bones are usually affected.
adults - the vertebrae and the pelvis [sacroiliac joints and symphisis pubis].
61
Results when an acute infection persists longer than 6-8 weeks. Usually occurs in adult.
Chronic osteomyelitis
62
True or False:
_Chronic osteomyelitis _
* May persist for years or recur when resistance is lowered.
* More difficult to diagnose since the symptoms are minimal
* isolated
True
63
What are common organisms that are commonly causeds Chronic osteomyelitis?
* E. coli
* pseudomonas
* staphylococcus epidermidis
64
\_\_\_\_\_\_\_\_\_\_ - a fragment of necrotic bone that is separated from the surrounding living bone.
Sequestrum
65
\_\_\_\_\_\_\_\_\_ - new bone forms a sheath, around a necrotic sequestrum.
Involucrum
66
\_\_\_\_\_\_\_ - the hole formed in the bone during the formation of a draining sinus.
Cloaca
67
Tests for Chronic osteomyelitis may include the following. Except:
1. Bone scan
2. Lumbar puncture
3. Blood cultures affected bones
4. MRI
5. Needle aspiration of the area around
6. Bone lesion biopsy
Except: 2
68
What are the treatment of Chronic osteomyelitis?
1. Long-term antibiotics [6 weeks]
2. Surgery and immobilization
69
Condition that is usually caused by the spread of a primary infection elsewhere in the body (e.g.respiratory tract). Psoas abscess often associated with bone infection. More resistant to treatment. Treated with anti-tuberculosis drugs but may require surgery.
Tuberculous Osteomyelitis
70
Tuberculous Osteomyelitis in the thoracic or lumbar spine is called:
Pott disease
71
\_\_\_\_\_\_\_\_\_\_\_ - causes bones to grow too large and weak. Found in the spine, pelvis, skull, or leg bones. The disease may affect only one bone or several bones but it does not affect the entire skeleton.
Paget‘s disease
72
Paget's disease is also known as:
Osteitis Deformans
73
What is the characteristic of bones with Paget‘s disease?
May break more easily
74
True or False:
About one million people in the United States have Paget‘s disease. The disease is more common in older people and those of Northern European descent. Men are more likely than women to contract this disease.
True
75
What is the cause of Paget‘s disease?
Doctors are not sure what causes Paget‘s disease. In some cases, it is thought that a virus may be the cause. It also tends to run in families.
76
Phase 1 of paget's disease is known as:
Intense Osteoclastic activity
## Footnote
77
Phase 2 of Paget's disease is known as:
Osteolytic - Osteoblastic activity [mixed]
78
Phase 3 of paget's disease is known as:
Dense bone deposition
79
True or False:
Phase 1: Intense Osteoclastic activity
1. Woven bone formation
2. Ineffective mineralization
False
The following describes Phase II of paget's disease
80
What phase of Paget's disease describes the following?
1. Bone resorption predominates
2. Bone turnover is 20 times normal rate
Phase 1: Intense Osteoclastic activity
81
What phase of Paget's disease that describes the following?
1. Bone is disorganized and sclerotic
2. Weaker than normal bone is created
Phase 3: Dense bone deposition
82
Symptoms of paget's disease. Which of the following are not included?
1. Asymptomatic in 70% of cases
2. Rest or night pain
3. Weight bearing pain
4. Warming of limb
5. Limb bowing
6. Occipital forehead dominant
7. Skull enlargement
8. Loose teeth
9. Headaches
10. Vision loss
Answer: 6 and 10
83
Symptoms of Paget's disease. True or False:
Symptoms get worse slowly and the disease does not spread to other bones.
True
84
What are the Test done to determine presence of Paget's disease?
* Most often, Paget‘s disease is diagnosed with x-rays.
* An alkaline phosphatase blood test.
* A bone scan. Can show which bones the disease have been affected.
85
What are the two main types of medicines that are approved to treat Paget‘s disease?
1. Bisphosphonates
2. Calcitonin
86
These medicines help relieve pain and keep Paget's disease from getting worse.
Bisphosphonates
87
What is the hormone made by the thyroid gland that suppresses osteoclasts and promotes excretion of Ca and Ph in kidneys?
Calcitonin
88
\_\_\_\_\_\_\_\_\_\_ - is a disease characterized by low bone mass and deterioration of bone tissue. This leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine and wrist.
Osteoporosis
89
Osteoporosis is often known as:
"the silent thief"
90
What is the best defense against developing osteoporosis later?
Building strong bones during childhood and adolescence. Peak bone mass is achieved at an early age, age 16 in girls and age 20 in young men.
91
Who are high risk in having Osteoporosis?
Women and men alike begin to lose bone in their mid-30s; as they approach menopause, women lose bone at a greater rate, from 2-5 per cent per year.
92
The following are risk factors of Osteoporosis. Which is not included:
1. age
2. lack of activity
3. vertebral compression fracture
4. family history
5. \>3 months use of glucocorticoid drugs and medical conditions that inhibit absorption of nutrients.
6. low potassium or vitamin intake.
7. Probably a multifactorial cause.
Except: 6
93
What are the treatment of Osteoporosis?
1. Medications
2. Bisphosphonates
3. Selective estrogen receptor modulators
4. Hormone replacement therapy
5. Calcitonin
6. Bone metabolism regulator: Denosumab
is a new class of osteoporosis treatment
7. human monoclonal antibody
8. diet rich in calcium and vitamin D
9. Regular exercise or physical activity
94
What is the ideal daily intake of calcium?
about 1000 mg daily
95
True or False:
Intake of Vitamin D.
400-1000 i.u. per day up to 50 yrs old [upper tolerance is 2000 i.u.]
True
96
What is the normal daily intake of protein?
Protein - about 75 grams a day [bones are 50% protein]
