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Orthopedics > Basic Sciences: Section 1 Bone > Flashcards

Basic Sciences: Section 1 Bone Flashcards

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1
Q

Endocrine effects on bone healing:

Cortisone

A

Negative, decreased callus proliferation

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2
Q

Endocrine effects on bone healing:

Calcitonin

A

Positive(?), Unknown

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3
Q

Endocrine effects on bone healing:

TH, PTH

A

Positive, Bone remodeling

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4
Q

Endocrine effects on bone healing:

GH

A

Positive, increased callus formation

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5
Q

Stages of graft healing

A
  1. Inflammation, chemotaxis
  2. Osteoblast differentiation
  3. Osteoinduction
  4. Osteoconduction
  5. Remodeling, continues for years
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6
Q

Under optimal stability what type of frature healing takes place?

A

Intramembranous ossification

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7
Q

Under instability what type of frature healing takes place?

A

Enchondral ossification

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8
Q

Under extreme instability what type of frature healing takes place?

A

Pseudoarthrosis

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9
Q

Three histologic phases of distraction osteogenesis?

A
  1. Latency Phase, 5-7 days, no distraction
  2. Distraction Phase, 1mm/day, 1 inch/month
  3. Consolidation Phase, 2x longer than distraction phase
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10
Q

Dietary requirment of Calcium in children?

A

600 mg/day

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11
Q

Dietary requirment of Calcium in adolescents and young adults (10-25)?

A

1300mg/day

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12
Q

Mechanism of PTH

A
  • cAMP
  • decreased serum calcium stimulates Beta-2 receptors to release PTH.
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13
Q

Mechanism of Calcitonin

A
  1. Increased serum Ca cause secretion of Calcitonin by parafollicular clear cells of the thyroid gland
  2. Controlled by Beta-2 receptors
  3. Inhibits osteoCLAST resorption
  4. decreases serum Ca
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14
Q

Hypercalcemia symptoms

A
  1. Polyuria
  2. Polydypsia
  3. Kidney stones
  4. Excessive bony resorption
  5. CNS effects - confusion, stupor, weakness
  6. Constipation
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15
Q

Primary hyperparathyroidism

A
  • Overproduction of PTH (parathyroid adenoma MC)
  • Increased osteoclastic resorption
  • High Ca, PTH, Alk phos, and urinary phos
  • Low serum phos
  • Brown tumors
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16
Q

Pseudohypoparathyroidism (PHP)

A
  • PTH receptor abnormality, PTH has no effect - blocked by cAMP pathway or lack of cofactors (Mg)
  • PTH is normal or high
  • Low Ca, High Phos
  • Genetic disorder
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17
Q

Albrights hereditary osteodystrophy

A
  • Form of pseudohypoparathyroidism
  • PTH receptor abnormality
  • Short 1st, 4th, 5th metacarpals/tarsals (brachydactyly)
  • Exostosis
  • Obesity
  • MR
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18
Q

Pseudo-pseudohypoparathyroidism

(pseudo-PHP)

A
  • Phenotype of PHP
  • PTH response is normal
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19
Q

Renal osteodystrohpy:

High-turnover

A
  • Kidney disease:
    • Decreased phosphate excretion –> very high serum Phos –> decrease Ca –> very high PTH –> SECONDARY HYPERPARATHYROIDISM
  • Rugger Jersey spine, osteitis fibrosa, amyloidosis
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20
Q

Renal osteodystrohpy:

Low-turnover

A
  • Normal PTH, elevated Ca and normal Phos
  • Due to aluminum deposition in bones which
    • decreases mineralization of bone
    • decreases proliferation of osteoblasts
    • impairs release of PTH from parathyroid glands
  • Rugger Jersey spine, osteitis fibrosa, amyloidosis
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21
Q

Sustained increase in PTH (secondary hyperparathyroidism) is caused by which mechanisms?

A
  • Diminished renal excretion of Phosphorus
  • Hypocalcemia
  • Impaired Calcitriol
  • Altered control of PTH release
  • Skeletal resistance to PTH
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22
Q

Phosphorus retention causes PTH secretion in what three ways?

Study These Flashcards
A
  1. Phos binds to serum calcium –> hypocalcemia –> increaed PTH production
  2. Phos impairs 1-alpha-hydroxylase–> decrease production of active vitamin D–> increase PTH
  3. Phos direct stimulation of PTH synthesis
23
Q

Rickets:

Vitamin D deficiency

Study These Flashcards
A
  • Insufficient Vit D in diet/malabsorbtion
  • Bone deformities and hypotonia
  • Rachitic Rosary (enlarged costochondral junction)
  • Wide growth plates
  • decrease Ca and Phos
  • High PTH and Alk phos
  • Physeal widening/cupping on Xray
24
Q

Rickets:

Vitamin D dependant

Study These Flashcards
A
  • Type I - pseudo-vitamin D deficiency
    • Very low active Vit D (1-alpha hydroxylase is defective)
    • Osteomalacia
  • Type II
    • Very high active Vit D (Vit D receptor defective)
    • Osteomalacia
    • Alopecia
    • Poor mineralization
25
Rickets: Vitamin D resistent
* AKA hypophosphatemic rickets * MC form * Decrease renal tubular phosphate resoprtion --\> Phos spilling into urine * Vit D iis inappropriatly normal * **Classic triad** 1. Hypophosphatemia 2. Lower limb deformities 3. Stunted growth rate
26
Hypophosphatasia
* Caused by **very low alkaline phosphatase** * Bone deformities and hypotonia * **Early loss of teeth** * Osteomalacia * Elevated urine **phosphoethanolamine** is diagnostic
27
Scurvy
* Vitamin C deficiency --\> decrease chondroitin sulfate synthesis --\> defective collagen * **BLEEDING** (gums, effusions, ecchymosis) --\> iron def. --\> fatigue * Thin cortices * **Corner sign** (metaphyseal clefts) * Osteopenia * Widening **zone of provisional calcification**
28
Paget's disease
* Osteoclastic abnormality --\> increased bone turnover * Bone deformities --\> fractures, pain, CHF * **"Picture frame vertabrae"** * High serum Alk Phos * High urinary **hydroxyproline** levels * **Virus-like inclusion bodies in osteoclasts** * Phases * Active * Lytic - osteoclastic bone resorbtion * Mixed * Sclerotic - osteoblastic bone formation * Inactive
29
Hyperthyroidism
* Hypermetabolism --\> increased bone turnover --\> **High Ca** * **Normal Phos, Alk Phos, Vit D and PTH** * Increased free thryroxin * Decreased TSH
30
Vitamin D intoxication
* Vitamin D cross reacts with intestines --\> increasd absorption of Ca * High Ca and very high Vitamin D * Tachy, tremors
31
Hypoparathyroidism
* Decreased Ca and increased Phos * **Basal ganglia calcification** * MC cause is iatrogenic
32
Osteoporosis
* Type I * postmenopausal * affects trabecular/cancellous bone * Type II * age-related * affects **BOTH** cortical and trabecular bone * Tx with 1000-1500 mg Ca and 400-800 IU of Vit D per day
33
Idiopathic transient osteoporosis of the hip
* uncommon * most common in 3rd trimester or pregnancy, can occur in men as well * localized osteopenia without hx of trauma * self-limiting, resolves within 6-8 months (this differentiates it from osteonecrosis)
34
Osteomalacia
* qualitative defect - mineralization issue * Caused by: * Vit D deficient diet * GI disorders of absorbtion * Renal osteodystrophy * Drugs * antacids (contain aluminum) * Phynytoin * Alcoholism * Xrays * **Looser's zone fractures**
35
Osteogenesis imperfecta
* Glycine substitution in procollagen --\> failure of collagen cross-linking --\> Type I collagen mutation
36
Lead poisoning
* Short stature * Decreased bone density * Altered chondrocyte response to **PTH-related protein** and **TGF-B**
37
Osteopetrosis
* Marble bone disease * Impaired osteoclast/chondroclast function (no ruffled border or clear zone) --\> failure of bone resorption --\> sclerosis and obliteration of the mudullary canal * Infantile AR form * more severe, hepatosplenomegaly, aplasastic anemia * AD "tarda" form * generalized osteosclerosis, rugger jersey spine
38
Osteopoikilosis
* Spotted bone disease * Islands of deep cortical bone appear within the medullary cavity and cancellous bone of the long bones * hands/feet MC
39
Osteonecrosis
* Death of bone not caused by infection * Typically caused by loss of blood supply - Hip MC * A/w * Chronic steroid use * Alcoholism * Sickle cell disease * Dysbarism (caisson's disease) * Radiation therapy * Gaucher's disease * Histologic chronology * autolysis of osteocytes and necrotic marrow --\> inflammation of invasion of new mesenchymal cells --\> new woven bone over top dead trabeculae --\> resorption of dead trabeculae --\> COLLAPSE (sometimes)
40
Chandler's disease
Osteonecrosis of femoral head in adults
41
Osteochondrosis: Van Neck's disease
ischiopubic synchondrosis 4-11 years
42
Osteochondrosis: Legg-Calve-Perthes diseaes
Femoral head 4-8 years
43
Osteochondrosis: Osgood-Schlatter disease
Tibial tuberosity 11-15 years
44
Osteochondrosis: Sinding-Larsen-Johansson syndrome
inferior patella 10-14 years
45
Osteochondrosis: Blount's disease
Proximal tibial epiphysis 1-3 years (infants) 8-15 years (adolescents)
46
Osteochondrosis: Sever's disease
Calcaneus 9-11 years
47
Osteochondrosis: Kohler's disease
Tarsal navicular 3-7 years
48
Osteochondrosis: Freiberg's infarction
Metatarsal head 13-18 years
49
Osteochondrosis: Scheurmann's disease
Discovertebral junction 13-17 years
50
Osteochondrosis: Panner's disease
Capitellum of humerus 5-10 years
51
Osteochondrosis: Thiemann's disease
Phalanges of hand 11-19 years
52
Osteochondrosis: Keinbock's disease
Carpal lunate 20-40 years
53

Orthopedics (5 decks)

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