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Bioscience II > Skeletal Pathology > Flashcards

Skeletal Pathology Flashcards

1
Q

3 steps to reducing a fracture are:

A
  1. ) Alignment
  2. ) Immobilization (internal vs. external)
  3. ) Preservation/Restoration
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2
Q

Why does a fracture hurt?

A

The periosteal membrane is highly innervated

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3
Q

List the steps of fracture healing in order:

A
  1. ) Hematoma formation
  2. ) Fibrocartilaginous (soft) callus
  3. ) Bony (hard) callus
  4. ) Remodeling
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4
Q

Hematoma formation occurs ___________ and is indicated by:

A

1 - 2 days following fracture;

Injured blood vessels and surrounding soft tissue turn into blood clot and new blood vessels develop/penetrate

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5
Q

The fibrocartilaginous callus forms within _________. It reaches max girth around ____________. This is good for stabilizing but not:

A

1 week

2 - 3 weeks

Bearing weight

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6
Q

What phase of fracture healing involves fibroblast and osteoblast migration?

A

The fibrocartilaginous callus

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7
Q

Some fibroblasts may become _________________ during the the fibrocartilaginous callus phase.

A

Chondrocytes

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8
Q

A bony callus is formed as ossification occurs during the _________________ week.

A

3rd and 4th

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9
Q

What do osteogenic cells do during the bony callus phase?

A

Become osteoblasts to lay down trabeculae

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10
Q

What is a “radiographic union” and in what phase does it occur?

A

When two pieces of bone fuse together.

During the bony callus phase

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11
Q

Remodeling can take 10-18 weeks for the average adult, but what factors could affect this?

A
  • Health
  • Nutriton
  • Location
  • Type of fracture
  • Less SA (long bone) take longer to heal
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12
Q

What comes in during the remodeling phase that hasn’t appeared in any other phases thus far, and what does it do?

A

Osteoclasts. Resorption of any dead bone or overgrown bone to help re-establish medullary cavity and re-organize new bone

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13
Q

What type of bone is finally generated during the remodeling phase?

A

Compact bone!

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14
Q

Osteomyelitis is an acute or chronic (>6-8 weeks) infection of bone that has three origins… what are they?

A

Hematogenous - blood borne
Contiguous - Adjacent infection
Exogenous - direct trauma (including surgery!!)

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15
Q

Hematogenous osteomyelitis is not very common, but the most common way to contract it is through what bacteria in what population?

A

S. aureus in children or older/frail adults

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16
Q

Hematogenous osteomyelitis may form an ______________________ and is cured via:

A

Externally draining infection

Antibiotics, irrigation, and drainage (I and D)

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17
Q

What can lead to necrotic bone becoming trapped in a sinus in osteomyelitis (aka what leads to necrosis)?

A

Compression

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18
Q

What is a sequestrum?

A

A piece of trapped necrotic bone

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19
Q

What is a involucrum?

A

New reactive bone formed AROUND a sequestrum

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20
Q

Treatment for contiguous and exogenous osteomyelitis?

A

Antibiotic cement beads!

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21
Q

The pt. I had during mini clinical has ____________ osteomyelitis from a botched foot surgery so she had cement antibiotic beads placed in her foot.

A

Exogenous

22
Q

Where is the most common site of infection for tuberculosis? And where is it spread from?

A

vertebrae and long bones of extremities, occasionally soft tissues and joints.

Spread from lungs or lymph nodes

23
Q

What can bone destruction and abscess formation from tuberculosis lead to?

A

Deformities (kyphosis and scoliosis)

24
Q

What is osteonecrosis and where is a common site in 10% of joint replacements?

A

Bone death due to ischemia as a result of fracture, thrombus, embolism, infection, compression/pressure.

Femoral head/neck

25
Q

How do you treat osteonecrosis?

A

Immobilization, decreased weight bearing, joint replacement?

26
Q

What is the difference between a primary and metastatic neoplasm of bone?

A

Primary = origin in bone

Metastatic = traveled from another tissue (cancers can metastasize to bone)

27
Q

Both benign and malignant neoplasms of bone can be of concern because…

A

Growing of tissue can lead to fracture

28
Q

Osteoma vs. Osteosarcoma:

A

Osteosarcoma is malignant

29
Q

Most benign tumors are “osteochondromas”, these are…

A

An aberrant growth of lateral epiphyseal cartilage between cartilage and bone.

Commonly found in children

asymptomatic

30
Q

Osteosarcoma is the most common primary cancer of bone with a _________ link and increased incidence in what population?

A

genetic link

adolescents

31
Q

What increases risk of osteosarcoma?

A

Paget’s disease and radiation exposure

32
Q

Signs and symptoms of osteosarcoma?

A

Deep local pain
night pain
presence of a mass
impairment of function

33
Q

Treatment of osteosarcoma?

A

Amputation

Chemo

34
Q

Ewing’s sarcoma is the second most common type of bone cancer in children/teens and is most common in which bones?

A

Long bones (especially femur)

Prognosis is poor if metastasis occurs

35
Q

Benign and malignant tumors are both (primary/metastatic) bone disease:

A

Primary

36
Q

Metastatic bone disease is (more/less) common than primary:

A

MORE

37
Q

What types of cancers commonly metastasize to the bones:

A

Prostate, breast, and lung

38
Q

What part of the skeleton is usually affected with metastatic bone disease?

A

Axial skeleton

39
Q

(Hypocalcemia/hypercalcemia) is commonly related to metastatic bone disease:

A

HYPERcalcemia (loop diuretics to treat?)

40
Q

Metabolic bone disease is an imbalance between:

A

Bone formation and resorption

41
Q

What factors affect the equilibrium of bone formation/resorption?

A
  1. ) Mechanical stress
  2. ) Calcium/phosphate availability
  3. ) Hormones, cytokines, and vitamins
42
Q

What turns over most each year: cortisol or trabecular bone?

A

Trabecular (25%)

43
Q

What is osteopenia?

A

A decrease in bone mass greater than expected for certain age, race, and sex. (measured with DEXA scan)

44
Q

What is type 1 osteoporosis?

A
  • due to menopausal estrogen deficiency
  • primary loss of trabecular bone
  • greatest risk for vertebral and radial fracture
45
Q

What is type 2 osteoporosis?

A
  • a.k.a senile osteoporosis (occurs usually > 70 y.o.)
  • also characterized by Ca+ deficiency
  • cortical AND trabecular bone lost more slowly
  • hip, long bone, and vertebral fractures
46
Q

What is type 3 osteoporosis?

A
  • Ca+ metabolism problems (could be via GI?)

- remember to treat underlying cause!

47
Q

Can an older woman have both type 1 and type 2 osteoporosis?

A

YES! She is above 70 and lack of estrogen. Plus if she has Ca+ deficiency, forget about it!

48
Q

Risk factors for osteoporosis:

A
  • diet
  • alcohol/nicotine/caffeine
  • sedentary
  • caucasian (even lighter skinned within race!)
  • women who are estrogen deficient
  • age
  • small framed
49
Q

Osteoporosis by itself only has one sign, but what else could happen to show it? (name both)

A

Loss of 2 inches in height

Low impact fracture (falling from standing height or less)

50
Q

Treatment for osteoporosis?

A
  • exercise and dietary changes
  • supplements
  • biophosphonates (inhibit osteoclasts)
  • Selective estrogen receptor molecules (SERM’s)

Bioscience II (6 decks)

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