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Clin Med Exam 2 > Bone Joint Pathology > Flashcards

Bone Joint Pathology Flashcards

1
Q

Structure of a Typical Long bone
Outside to Inside =

A

Shaft – diaphysis – compact or cortical bone = denser and harder

Medullary cavity is at center = bone marrow sits there

End of long bone – proximal and distal – epiphysis

Spongey bone – in ends of long bone

Metaphysis – where growth plate sits

Periosteum = connective tissue that lines the bones

Articular cartilage covers ends of bones

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2
Q

Osteoporosis (brittle bone disease) =

A

Due to a decrease in bone mass = bone reabsorption and destruction (osteoclast activity)» bone formation (osteoblast activity)

Due to a decrease in bone mass with a subsequent increase in the risk for fractures

Localized to one or a few bones due to disuse or generalized to the the skeletal system

Can be a primary disorder = the diagnosis

Can be secondary = due to another disorders

Epidemiology: incidence of osteoporosis increases with age

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3
Q

2 main components of bone

A

Collagen and phosphate

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4
Q

World health organization criteria:

A

Osteoporosis = Bone Mineral Density (BMD) at hip or spine > 2.5 SD below young normal mean reference population

Osteopenia = BMD 1.0 - 2.5 SD below young normal mean reference population

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5
Q

___ in USA with osteoporosis

A

~10 million

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6
Q

___ in USA with osteopenia

A

33.6 million

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7
Q

osteoporosis affects:

A

80% female
1/3 will experience orthopedic problems related to osteoporosis

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8
Q

osteoporosis bone loss:

A

~ 1% per year after 30-35 (women) & 50-55 (men)

Accelerated loss in post menopausal women: 5% per year for 3-5 years

Clinical Manifestation: structural weakening, decreased ability to support loads, high risk of fractures

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9
Q

osteoporosis red flag =

A

Advise pts to 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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10
Q

Primary Osteoporosis =

A

Type 1= postmenopausal osteoporosis, caused by a deficiency in estrogen

Type 2 = senile osteoporosis, vitamin D deficiency and decreased ability to absorb calcium

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11
Q

Secondary Osteoporosis =

A

Endocrine issues: hyperplasia of the parathyroid, diabetes mellitus

Gastrointestinal issues: malnutrition

Drug issues: steroids, heparin

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12
Q

OP Risk Factors
modifiable =

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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13
Q

OP Risk Factors
non-modifiable =

A

> age = decreased ability to make new bone
gender
body size
ethnicity
genetics

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14
Q

OP Risk Factor
Morphology =

A

thin cortex

thin trabeculae

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15
Q

Clinical Presentation of Osteoporosis:

A

> Acute LBP
Kyphosis
Hip and Vertebra Fractures = compression fractures can be asymptomatic

Diagnosis = Bone density Measurements -> DEXA Scan

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16
Q

Osteonecrosis =

A

> avascular necrosis
Fractures and trauma

Clinical Presentation of Osteonecrosis
> Epiphysis of the femur most common
> Progressive joint pain

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17
Q

Osteonecrosis risk factors =

A

> corticosteroids
trauma
radiation
smoking
alcohol

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18
Q

osteomalacia =

A

Characterized by decalcification of bones due to vitamin D deficiency = soft bone disease

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19
Q

osteomalacia symptoms =

A

Severe pain
Fractures
Weakness
Deformities

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20
Q

osteomalacia Diagnostic Tests =

A

X-ray
Urinalysis/CBC
Bone scan
Bone biopsy

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21
Q

Osteomyelitis =

A

Infection of the bone via blood stream or bone directly

More common in children and immunosuppressed adults

Diabetes -> foot ulcers & neuropathy

Medical Treatment: Antibiotics

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22
Q

Two types of Osteomyelitis =

A

> Pyogenic = most common
Tuberculous

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23
Q

Osteomyelitis Symptoms:

A

Fever
Swelling
Warmth
Redness
Pain
Fatigue

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24
Q

Pyogenic Osteomyelitis =

A

Bones most often affected: Long Bones and Vertebral Bones

Typically a staph infection = wound = disrupt blood supply

Laboratory Findings = Leukocytosis (elevated WBC count)

Radiographic Findings = Bone destruction

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25
Q

Pyogenic Osteomyelitis Morphology =

A

> Infection can lift the periosteum

> Impair blood flow = ischemia

> Necrotic bone fragment called sequestrum

26
Q

Tuberculous Osteomyelitis =

A

Spine most commonly affected

Knees and Hips

Spread of TB microbacteria between medial spinal nerves

Enters through lungs = breathing -> Goes into lymph system

27
Q

Fractures =

A

High risk in older adults = associated with osteoporosis, comorbidities, dementia, polypharmacy, age

RED FLAG: Pain medication can cause disorientation or sedation and increase fall risk

28
Q

Hip Fractures:

A

> 300,000 older adults 65+ hospitalized per year

95% due to falls

75% women

Mortality: 20% associated with medical complications

50% will not regain functional baseline  premorbid level

Majority treated surgically = followed by rehabilitation

29
Q

Vertebral Compression Fractures =

A

caused by osteoporosis

25% postmenopausal women, advanced age for males and females

Typically causes severe pain = decreased ability to perform ADLs

Often due to bending, lifting, and standing from chair

30
Q

Fractures Types:

A

> complete
incomplete
closed
compound
comminuted
displaced
pathologic
spiral

31
Q

Complete fracture =

A

extends through the bone

32
Q

Incomplete fracture =

A

does not extend through the bone

33
Q

Closed fracture =

A

intact overlying skin

34
Q

Compound fracture =

A

lacerated skin, exposed bone

35
Q

Comminuted fracture =

A

bone broken into many smaller fragments

36
Q

Displaced fracture =

A

edges of fractured bone no longer align

37
Q

Pathologic fracture =

A

at the site of pathology ie tumor

38
Q

Spiral fracture =

A

along the shaft of the bone

39
Q

fracture healing stages:

A

inflammation
callus formation
union
consolidation
remodelling

40
Q

Inflammation =

A

site protection and clearance

healing process begins

0-2 weeks

41
Q

Callus formation =

A

scaffold for new bone

soft ->

fluffy opacity on x-ray

2-3 weeks

42
Q

Union =

A

bridging by cartilage/ immature bone

fracture stable but weak

4-6 weeks

43
Q

Consolidation =

A

all callus replaced by bone

immature bone -> lamellar bone

bone secure

6-8 weeks

44
Q

Remodelling =

A

continued osteoblast/osteoclast activity

reshaping to best density and shape

1-2 years

45
Q

Osteoarthritis =

A

OA

Referred to as degenerative joint disease

Occurs as a result of degeneration of the articular cartilage = gradual onset of symptoms after 40 years of age

30 million in US

65+ = 50% diagnosed OA

Woman»men

46
Q

Pathogenesis 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

Weigh bearing joints = hips and knees
Visually most apparent in the hands – small joints = easy to see

47
Q

Primary Osteoarthritis =

A

no identifiable reason for arthritis development

48
Q

Secondary Osteoarthritis =

A

likely cause for osteoarthritis exists (joint injury among professional athletes)

49
Q

OA Risk Factors =

A

Age
Joint Injury
Obesity
Genetics
Anatomic Factors
Gender

50
Q

Morphology of OA =

A

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

Eburnation = thickened and polished subchondral bone

Subchondral cysts = synovial fluid leaks through defective cartilage into subchondral bone

Osteophytes = bony outgrowths at the interphalangeal joints

Joint mice = loose fragments of cartilage and bone in the joint

51
Q

Radiologic OA Findings =

A

Narrow joint space

Subchondral sclerosis

Osteophyte formation

52
Q

Clinical Presentation of OA =

A

Aching pain = progressively worse
Decreased mobility
Morning stiffness
Joint crepitus

Advanced stages = bone on bone

43% report functional limitations

Associated with depression

53
Q

Rheumatoid Arthritis =

A

An autoimmune disorder with an unknown antigen–antibody combination

Occurs in 1% of the population

Most patients are 40–70 years of age

females&raquo_space;> males, with a ratio of 3:1

Hypersensitivity of Immune System & Synovial Inflammation

54
Q

Rheumatoid Arthritis Joints Affected:

A

Metacarpophalangeal
Interphalangeal
Feet
Wrist
Ankle
Elbows
Knees

55
Q

Morphology of RA

A

Edematous and thick synovium with rough surface projections

56
Q

Radiologic Findings of RA

A

Osteopenia
Narrow joint space with bony erosions

57
Q

Clinical Presentations of RA =

A

> Morning stiffness
3+ joints affected
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

58
Q

OA vs RA

A

Osteoarthritis = degeneration of articular cartilage, and is often associated with wear and tear; therefore, symptoms will improve with rest

Rheumatoid arthritis = 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.

59
Q

Joints affected OA vs RA =

A

OA = weight- bearing (hips & knees), PIP, DIP

RA = MCP, PIP, feet, ankles, elbow, knees

60
Q

Morning stiffness OA vs RA =

A

OA: <30 minutes

RA: >1 hour

61
Q

Symptoms OA vs RA =

A

OA: pain occurs with movement and is better after rest

RA: stiffness and pain are worst after inactivity

62
Q

Physical examination OA vs RA =

A

OA: Hebrden and Bouchard nodes

RA: rheumatoid nodules, radial deviation of wrist, ulnar deviation of phalanges

Clin Med Exam 2 (10 decks)

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