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D&D Final > Disorders of the Skeletal System : Metabolic and Rhuematic Disorders > Flashcards

Disorders of the Skeletal System : Metabolic and Rhuematic Disorders Flashcards

1
Q

What is Osteoporosis?

A

a metabolic bone disorder

characterized by a decrease in bone mass and density, combined with loss of bone matrix and mineralization

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2
Q

What may be the first indicator of osteoporosis?

A

bone fracture

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3
Q

What is the patho behind Osteoporosis?

A

bone reabsorption exceeds bone formation

remaining bone is normal

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4
Q

Who is osteoporosis usually seen in?

A

post menopausal women (b/c lack of estrogen)

short women more than tall women
thinner women more than thicker women

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5
Q

Why don’t we just give estrogen to post menopausal women?

A

because estrogen has been linked to cancer

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6
Q

What are the predisposing factors for Osteoporosis?

A

smoking
calcium deficit
sedentary lifestyle
aging
Osteopenia
Hormonal Factors (Hyperparathyroidism or Cushing’s Syndrome)
Long Term intake of glucorticoids (steroids) such as Prednisone

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7
Q

What is osteopenia?

A

mineral bone density lower than normal but not osteoporosis

can contribute to the pathology of all metabolic bone diseases

mostly diagnosed after a bone fracture

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8
Q

When does bone density peak?

A

30 years old

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9
Q

Which race is at a higher risk of Osteoporosis?

A

European and Asian have higher risk

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10
Q

If your mother had osteoporosis are you at a greater risk to develop osteoporosis in your lifetime?

A

yes, at up to an 80% increase in likelihood

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11
Q

What are the modifiable risk factors for osteoporosis?

A

excessive alcohol, Vitamin D deficiency (calcium carrier), tobacco smoking, malnutrition, underweight, inactivity

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12
Q

How does tobacco increase the risk of osteoporosis?

A

tobacco smoking increases the breakdown of estrogen(look like a man)

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13
Q

What is Osteomalacia?

A

defective mineralization of bone WITHOUT the LOSS of bone matrix

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14
Q

What are the two causes of Osteomalacia?

A

inadequate calcium

inadequate phosphate

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15
Q

Osteomalacia is highly seen among…

A

the elderly

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16
Q

Can Osteomalacia be treated?

A

can be treated with diet if that is the cause

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17
Q

What is a matrix?

A

intracellular substance of tissue/s from which a structure develops

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18
Q

Children with what disease are at risk for Osteomalacia?

A

Rickets

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19
Q

What is Rickets?

A

Failure or delay in calcification of the growth plate

seen in children

several forms

may be nutritional: Vitamin D dependent or Vitamin D resistant

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20
Q

What is Rickets generally caused by?

A

Vitamin D deficiency

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21
Q

Premature Osteoporosis is being seen in who?

A

female athletes (they don’t menstruate)

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22
Q

What is Paget’s Disease?

A

Chronic

significant bone reabsorption followed by hectic bone reformation

bones are irregular and fracture easily
bones tend to bow or take abnormal shapes

Clinical features are going to vary depending on the extent of the disease

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23
Q

What are the commonly affected areas with Paget’s Disease?

A

pelvis, femur, lower lumbar vertebrae

*this differentiates this disease from osteoporosis

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24
Q

What is Rheumatoid Arthritis (RA)?

A

autoimmune disorder causing chronic systemic inflammatory disease

can effect tissue or organs but primarily flexible synovial joints

major cause of disability, can cause loss of function

Remissions and exacerbations

Severity varies from mild to severe, reflecting the number of joints involved (polyarticular)

often larger joints but can be in smaller joints

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25
What does Polyarticular mean?
involving many joints
26
RA has a higher incidence in who?
women than men
27
Discuss the development of RA
1) ABNORMAL IMMUNE RESPONSE, causing inflammation of the synovial membrane with vasodilation, increase permeability, and formation of exudates, causing the typical red, swollen, and painful joint 2) Rheumatoid Factor (antibody against immunoglobin G) is present in the majority of patients with RA 3) After the FIRST period of acute inflammation (in capsule around joints in the synovium), the joint MAY RECOVER COMPLETELY..... but.... * During subsequent EXACERBATIONS the process will CONTINUE into.......... - Synovitis - Pannus Formation - Cartilage Erosion - Fibrosis - Ankylosis
28
Define Pannus
fibrous tissue in synovium
29
Define Fusion
when you cant move a joint
30
What is Ankylosis?
fusion
31
Define exacerbations?
flare ups
32
Synovitis
inflammation of the synovial membrane
33
Pannus formation
unique to RA. (HALLMARK) | Not seen in other inflammatory arthritis
34
Cartilage Erosion
abnormal layer of fibrovascular tissue or granulation tissue
35
Ankylosis
Stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint
36
What are the complications of RA?
- atrophy of muscles - alignment shifts - inflammation/pain - contractures/deformities - mobility impaired - systemic effects
37
What are some nonpharmalogical things we can suggest for RA patients?
Physical Therapy Occupational Therapy Nutritional Therapy
38
What are some Pharmalogical treatments of RA?
Analgesics (pain killers) | Steroids (to decrease autoimmune response)
39
What is Systemic Lupus Erythematosus (SLE)?
Chronic Inflammatory Condition-NO CURE Unknown etiology UNPREDICTABLE- each person with SLE may experience different manifestations Harms heart, joints, skin, lungs, nervous system tissues can be FATAL, esp. due to cardiovascular disease
40
What is the patho behind Systemic Lupus Erythematosus ?
for some unknown reason patients with SLE develop AUTOANTIBODIES that damage different tissues around the body. some SLE patients produce antibodies against RBC
41
What are the Clinical Manifestations of SLE?
can affect many systems: musculoskeletal, skin, cardiovascular, lungs, kidneys, CNS Onset could be Acute or Insidious (creeps up like an old pair of undies) Exacerbations and Remissions Arthralgia and Arthritis (early) [*joint pain is a common early symptom*] Skin (Butterfly Rash) - don't always have this Wide range of S/S so diagnosis can be elusive
42
Butterfly Rash is a hallmark of which disorder?
SLE | Systematic Lupus Erythematosus
43
What is the difference between Arthralgia and Arthritis?
Arthralgia is non-inflammatory and Arthritis is Inflammatory
44
What is SLE often called? Why?
The Great Imitator b/c it mimics so many diseases with the wide range of S/S
45
What is Scleroderma?
Autoimmune disorder characterized by fibrosis (or hardening "sclero"), vascular alterations and autoantibodies Effects the CONNECTIVE TISSUE, primarily skin
46
What is the Classic Characteristic of Scleroderma?
Fibrosis
47
Who is Scleroderma most often seen in?
women
48
Is there treatment for Scleroderma?
no
49
Limited Vs. Diffuse Systemic Sclerosis (scleroderma)
1. Limited Cutaneous = skin only (forearms, fingers and face) - "CREST" 2. Diffuse is progressive skin involvement and other organs
50
What does the acronym CREST stand for?
Clinical Manifestations of LIMITED scleroderma ``` Calcinosis Raynaud's Esophageal Dysfunction Sclerodactyly Telangiectasias ```
51
Calcinosis (in LIMITED SLE)
deposits of calcium nodules in skin
52
Raynaud's (in LIMITED SLE)
exaggerated vasoconstriction in hands
53
Sclerodactyly (in LIMITED SLE)
skin thickens on fingers
54
Telangiectasias (in LIMITED SLE)
dilated capillaries on the face, hands, and mucus membranes
55
What is Ankylosing Spondylitis ? (and what does it effect?)
Autoimmune disease Chronic Progressive Inflammatory Effects.... 1. Sacroiliac joints 2. intervertebral spaces 3. Costovertebral joints of the axial skeleton
56
Discuss the progressive process of Ankylosing Spondylitis?
Vertebral joints become inflamed Fibrosis and calcifications or fusion of joints Inflammation begins and progresses up spine Kyphosis Osteoporosis Lung expansion may be limited
57
How does inflammation present in Ankylosing Spondylitis?
progresses up the spine
58
Why does Kyphosis develop in Ankylosing Spondylitis patients?
kyphosis develops as result of rigidity and loss of normal curvature
59
Why is Osteoporosis common in Ankylosing Spondylitis patients?
because of pathological compression fractures
60
What is Bamboo Spine?
complete fusion and rigidity of spine from Ankylosing Spondylitis
61
In what autoimmune disease to the patients become plasticized?
Scleroderma
62
Can Scleroderma be fatal?
Yes because they can develop organ system complications that can be fatal ( Diffuse Systemic Sclerosis)
63
What is Osteoarthritis ?
Degenerative "non-inflammatory" joint disease
64
Osteoarthritis is often seen in which joints?
frequently occurs in weight bearing joints
65
Discuss the mechanisms and patho behind Osteoarthritis?
Articular cartilage of joints is lost through erosion from excessive mechanical stress. Surface becomes rough and worn interfering with easy joint movement. Tissue damage appears to cause release of enzymes from the cells that accelerates degeneration of the cartilage. Subchondral bone may be exposed and damaged, leading to bone spurs developing. Pieces of bone spurs break off in the joint, causing further irritation joint space becomes narrow (evidenced by crepitus and grinding)
66
What are the S/S of OA (osteoarthritis)?
joint pain (can be debilitating), crepitus, stiffness *no systemic S/S with OA which is how it is differentiated from RA
67
What is the treatment for OA?
exercise Analgesics (pain killers) Nutrition
68
OA can lead to bone spurs... why?
Because of the degeneration of the cartilage Subchondral bone may be exposed and damaged which leads to the development of bone spurs.
69
What is a complication of bone spurs with OA?
Pieces of bone spurs could break off in the joint causing further irritation
70
T/F The risk of Osteoarthritis does not increase with age.
FALSE | Osteoarthritis is associated with increased risk with age
71
Discuss the Evolution of Osteoarthritis. (in what order are things effected?)
1. Bone 2. Cartilage 3. Thinning of Cartilage 4. Cartilage Remnants 5. Destruction of Cartilage
72
What is Gout/Gouty Arthritis?
deposits of URIC ACID/urate crystals in joints. Cause an acute inflammatory response. affects a single joint
73
What are the S/S of Gout?
affects a single joint redness/swelling of joint pain with severe pain
74
What is a common site for Gout to be seen?
the Big Toe
75
What could precipitate and attack of gout?
a sudden increase in serum uric acid levels
76
How do we diagnose Gout?
attain a sample of the fluid
77
What is Gout sometimes called?
"The King's Disease" because it is associated with a diet that a rich person would have (red wines, Red Meats)
78
Who is Gout commonly seen in?
men over 40
79
How do we treat Gout?
diet modifications (less uric acid) and medications

D&D Final (6 decks)

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