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clin med > bone and joint pathology > Flashcards

bone and joint pathology Flashcards

1
Q

how does osteoporosis occur?

A

it is due to a decrease in bone mass

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2
Q

the decrease of bone mass seen in osteoporosis leads to what?

A
  1. bone reabsorption and destruction (occurs due to the osteoclast activity)
  2. bone formation (osteoblast activity)
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3
Q

the decrease in bone mass often leads to an increase in what?

A

the risk for fractures

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4
Q

what is a primary disorder

A

the diagnosis

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5
Q

what is a secondary disorder

A

due to another diagnosis

think metapause can cause osteoporosis

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6
Q

what is the epidemiology of osteoporosis

A

incidence of osteoporosis increases with age

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7
Q

what vitamins/ molecules are associated with osteoporosis?

A

calcium phosphate and collagen

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8
Q

The WHO criteria for osteoporosis is?

A

bone mineral density (BMD) at hip or spine > 2.5 SD bellow young normal mean reference population

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9
Q

The WHO criteria for osteopenia is ?

A

BMD 1.0 - 2.5 SD below young normal mean reference population

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10
Q

what are the stats associated with osteoporosis

A

-10 million in the USA with osteoporosis
33.6 million in the USA with osteopenia

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11
Q

At what ages is bone loss from osteoporosis seen in men and women?

A

women 1% per year after 30-35
50-55 for men

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12
Q

what is the correlation seen in bone loss and menopausal women?

A

accelerated loss in post metapausal women.
5% per year for 3-5 years

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13
Q

what is the red flag for PTs dealing with osteoporosis?

A

PT should avoid movements that can result in spinal fractures, including:
- forward bending
- twisting motions
- lifting heavy objects
- sudden forceful movements involving spinal stability

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14
Q

what are the clinical manifestations for osteoporosis?

A
  • structural weakening
  • decreased ability to support loads
  • high risk of fractures
  • acute LBP
  • Kyphosis
  • Hip and vertebra fractures (compression fractures can be asymptomatic)
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15
Q

what is the percentage of individuals that will experience orthopedic problems related to osteoporosis?

A

1/3 will experience orthopedic problems related to osteoporosis

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16
Q

what is type 1 osteoporosis?

A

postmenopausal osteoporosis, caused by a deficiency in estrogen

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17
Q

what is type 2 osteoporosis

A

senile osteoporosis, vitamin D deficiency and decreased ability to absorb calcium

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18
Q

what issues are associated with type 2 osteoporosis?

A

Endocrine issues: hyperplasia of the parathyroid, diabetes mellitus
Gastrointestinal issues: malnutrition
Drug issues: steroids, heparin

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19
Q

what are the non-modifiable risk factors for Osteoporosis?

A

Age➔ decreased ability to make new bone
Gender
Body Size
Ethnicity
Genetics

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20
Q

what are the modifiable risk factors for Osteoporosis?

A

Smoking
Alcohol
Decreased Estrogen or Androgens ➔ menopause or hypogonadism
Low BMI
Low Dietary Calcium and Vitamin D
Lack of Weight Bearing Exercise➔ decreased PA
Medication

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21
Q

what are the morphological risk factors for Osteoporosis?

A

Thin cortex
Thin Trabeculae

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22
Q

how do you diagnose osteoporosis? (what machine do you use)

A

DEXA scans for bone density measurements

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23
Q

what are the risk factors for osteonecrosis?

A
  • Corticosteroids
  • Trauma
  • Radiation
  • Smoking
  • Alcohol
  • Idiopathic
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24
Q

what are the clinical presentation of osteonercrosis

A

Epiphysis of the femur most common
Progressive joint pain

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25
Q

osteonecrosis can lead to what

A

fractures and trauma to the bone

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26
Q

osteomalacia is characterized as a deficiency of what vitamin?

A

due to a deficiency in vitimin D

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27
Q

osteomalacia is known as?

A

soft bone disease

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28
Q

what are the symptoms of osteomalacia?

A

severe pain
fractures
weakness
deformities

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29
Q

what are the diagnostic tests for osteomalacia

A

x-ray
urinalysis/CBC
bone scans
bone biopsy

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30
Q

what are the two types of osteomyelitis

A

pyogenic and tuberculous

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31
Q

how does infection occur with osteomyelitis

A

infection of the bone via blood stream or bone directly

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32
Q

what patient population is osteomyelitis most seen?

A

more common in children and immunosuppressed children

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33
Q

how can diabetes be connected to osteomyelitis?

A

foot ulcers and neuropathy

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34
Q

what are the symptoms of osteomyelitis

A
  1. fever
  2. swelling
  3. warmth
  4. redness
  5. pain
  6. fatigue
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35
Q

what bones show pyogenic osteomyelitis the most?

A

long bones and vertebral bones

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36
Q

what is the morphology of pyogenic osteomyelitis?

A

infection can lift the periosteum
impair blood flow - ischemia
necrotic bone fragments called sequestrum

37
Q

what are the normal laboratory findings associated with osteomyelitis?

A

leukocytosis

38
Q

what do the radiographic findings show for osteomyelitis?

A

bone destruction

39
Q

tuberculous osteomyelitis mostly effects what?

A

spine most commonly affected
knees and hips

40
Q

what patient population is at a high risk for fractures

A

OLDER ADULTS

41
Q

why is there a higher risk of fractures in older adults?

A

osteoporosis
co morbidities
dementia
poly pharmacy
age

42
Q

how many are hospitalized by hip fractures a year?

A

300,000 older adults 65+ hospitalized per year

43
Q

when talking about falls will the patient return to the full function that they had before the fall?

A

NO the patient will not return to the function they had before the fall

44
Q

what are some risk factors for patients with hip fractures?

A

95% due to falls
75% women
mortality 20% associated with medical complications
50
5 will not regain functional baselines
majority will be treated by surgery

45
Q

what is the red flag when treating a patient with fractures?

A

PAIN MEDICATION CAN CAUSE DISORIENTATION OR SEDATION AND INCREASE FALL RISK

46
Q

Vetebral compression fractures are caused by?

A

osteoporosis

risk factors:
postmenopausal women
advanced age for males and females

47
Q

what are the clinical manifestations seen in patients with Vetebral compression fractures?

A

typically causes severe pain
decreased ability to perform ADL’s
often due to bending, lifting, and standing from a chair.

48
Q

red: what does a complete fracture mean

A

extends through the bone

49
Q

red: what does a incomplete fracture mean

A

does not extend through the bone

50
Q

red: what does a closed fracture mean

A

intact overlaying skin

51
Q

red: what does a compound fracture mean

A

lacerated skin, exposed bone

52
Q

red: what does a comminuted fracture mean

A

bone is broken into many smaller fragments

53
Q

red: what does a displaced fracture mean

A

edges of the fractured bone are no longer aligned

54
Q

red: what does a pathologic fracture mean

A

fracture at the site of pathology ie. tumor

55
Q

red: what does a spiral fracture mean

A

along the shaft of the bone

56
Q

what is the timeline for the inflammation phase of a fractures healing?

A

0-2 weeks

site protection and clearance

57
Q

what is the timeline for the callus formation phase of a fractures healing?

A

2-3 weeks

scaffold for new bone
soft to hard
fluffy opacity on x-rays

58
Q

what is the timeline for the union phase of a fractures healing?

A

4- 6 weeks

bridging by cartilage
immature bone
feature is stable but weak

59
Q

what is the timeline for the consolidation phase of a fractures healing?

A

6-8 weeks

all callus replaced by bone
immature bone- la cellar bone
bone is secure

60
Q

what is the timeline for the remodeling phase of a fractures healing?

A

1-2 years

continued osteoblast and osteoclast activity
reshaping to best density and shape

61
Q

what type of diseases is osteoarthritis?

A

degenerative joint disease

62
Q

what is the patient population for OA

A

gradual onset of symptoms after 40 years of age
65+ 50% diagnosed with OA

63
Q

how many people in the us have OA

A

30 million

64
Q

who gets OA more women or men

A

women

65
Q

how does OA occur

A

occurs as a result of degeneration of the articular cartilage

66
Q

what is the pathogensis of OA

A

Normal articular cartilage undergoes turnover of bone➔ in osteoarthritis this turnover does not occur

Due to wear and tear and genetic factors

Can also be secondary➔ due to trauma or poor biomechanics

67
Q

what joints are involved with OA

A

Weigh bearing joints➔ hips and knees
Lower lumbar vertebrae
Cervical vertebrae
Interphalangeal joints

68
Q

what might you see in a patients hand that has OA

A

bouchards nodes (in the pip)
Heberdens nodes (dip )

69
Q

what is primary osteoarthritis

A

no identifiable reason for arthritis development

70
Q

what is secondary
osteoarthritis

A

a likely cause for osteoarthritis exists

joint injury in professional athletes

71
Q

what are the risk factors for OA

A

Age
Joint Injury
Obesity
Genetics
Anatomic Factors
Gender

72
Q

what are the clinical manifestations of OA

A

Aching pain ➔ progressively worse
Decreased mobility
Morning stiffness
Joint crepitus

Advanced stages ➔ bone on bone

73
Q

what do most OA patients report?

A

43% report functional limitations
Associated with depression

74
Q

what is rheumatoid arthritis?

A

An autoimmune disorder with an unknown antigen–antibody combination

75
Q

what is rheumatoid arthritis associated with?

A

hypersensitivity of immune systems and synovial inflammation

76
Q

what joints are affected by RA?

A

Metacarpophalangeal
Interphalangeal
Feet
Wrist
Ankle
Elbows
Knees

77
Q

what is the morphology of RA?

A

Edematous and thick synovium with rough surface projections

78
Q

what are the radiological findings for RA?

A

Osteopenia
Narrow joint space with bony erosions

79
Q

what are the clinical presentations of RA

A

Morning stiffness
3+ joints affected. (systemic)
Symmetric involvement of joint on the hand
Weight loss
Fatigue
Fever
Warm tender joints
Radial deviation of wrist
Ulnar deviation of phalanges
Stiffness after activity

80
Q

what is the key clinical presentation of RA

A

wrist collapse

end-stage RA complete destruction of the carpal bones and radioulnar joint

81
Q

morning stiffness for RA will last for

A

30 minutes

82
Q

morning stiffness for OA will last for

A

> 1 hr

83
Q

give an overview for the differences between OA and RA

A

OA vs RA
Osteoarthritis is degeneration of articular cartilage, and is often associated with wear and tear; therefore, symptoms will improve with rest.
Rheumatoid arthritis, the disease is caused by the formation of a pannus, which causes fusion of the joint. Rest allows the fusion to progress and causes the joint to become stiffer; thus, conversely, use will keep the joint more mobile and decrease stiffness.

84
Q

morphological of OA

A

Articular cartilage ➔ collagen network damage = water absorption = chondrocyte activation = inflammatory response

85
Q

what is Eburnation seen in OA

A

thickened and polished subchondral bone

86
Q

what is Subchondral cysts seen in OA

A

synovial fluid leaks through defective cartilage into subchondral bone

87
Q

what is Osteophytes seen in OA

A

bony outgrowths at the interphalangeal joints

88
Q

what is Joint mice seen in OA

A

loose fragments of cartilage and bone in the joint

clin med (19 decks)

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