Exam 1 Flashcards
(179 cards)
1
Q
Epidemiology is the who are the why?
A
The who
2
Q
Etiology is the who or the why?
A
The why
3
Q
What is Klippel-Feil syndrome?
A
Congenital fusion of 2 or more cervical vertebrae
4
Q
Klippel-Feil Syndrome is idiopathic. What does that mean?
A
Your born with it. It’s not acquired
5
Q
What pathology is usually seen with Klippel-Feil Syndrome?
A
Sprengel’s Deformity which is a fused scapula. Scapula never descended
6
Q
How many people have Klippel-Feil Syndrome?
A
1 in 40,000
7
Q
What is the difference between Type 1 and Type 2 congenital kyphosis?
A
Type 1 is failed development (severe)
Type 2 is failed segmentation (mild)
8
Q
Why is type I congenital kyphosis severe?
A
The spinal cord is compressed
9
Q
Which pathologies that we talked about are congenital disorders?
A
Achondroplasia, Cleidocranial dysplasia, osteogenesis imperfecta, osteopetrosis
10
Q
What does it mean to be a congenital disorder?
A
An often-inherited disorder.
11
Q
Congenital disorders effect what part of the skeleton?
A
The whole skeleton
12
Q
What is dysplasia?
A
Mutations that interfere with growth and bone remodeling
13
Q
What type of disorders is dysplasia seen in
A
Congenital disorders
14
Q
What is Cleidocranial Dysplasia?
A
Absent/under developed clavicles
15
Q
Besides absent/ under-developed clavicles, what other symptoms are seen with Cleidocranial dysplasia?
A
Dental abnormalities, delayed closure of cranial sutures, short stature
16
Q
What causes Cleidocranial dysplasia?
A
Genetic inheritance- abnormality in RUNX2 gene
17
Q
What is the RUNX2 genen important for?
A
Function during skeletal formation and bone maintenance
18
Q
What is the most common form of dwarfism and skeletal dysplasia?
A
Achondroplasia
19
Q
What is the main symptom of achondroplasia?
A
Shortened long bones
20
Q
Achondroplasia increases the odds of having what?
A
Stenosis of foramen magnum and spinal stenosis
21
Q
Define stenosis
A
Narrowing
22
Q
What is the abnormality in the vertebrate most commonly seen with achondroplasia?
A
Bullet vertebrae
23
Q
What are some pathologies caused by having bullet vertebrae?
A
Hyperlordosis, hyperkyphosis, scoliosis
24
Q
Frontal bossing is another feature seen in those with achondroplasia. What is frontal bossing?
A
Forehead protrusion
25
Trident hand is typically seen with what disorder?
Achondroplasia
26
What is the pathogenesis (how) of achondroplasia?
Inhibited endochondral growth and decreased cartilage synthesis.
27
Achondroplasia’s Decreased cartilage synthesis causes what?
Short/ bowed legs, frontal bossing, mid face hypoplasia
28
What is the epidemiology of achondroplasia?
Epidemiology is the who if you forgot. People who have the mutated FGFR3 gene.
29
What is the etiology of achondroplasia?
90% of the time, the mutated FGFR3 gene is spontaneous and most commonly from sperm. 10% are autosomal dominant.
30
What are other names for osteogenesis imperfecta?
Brittle bone disease
Type I collagen disease
31
What is brittle bone disease?
A condition resulting in brittle bones and weak connective tissue due to altered type I collagen
32
What is the lifespan of the 2 types of Osteogenesis?
Type 1: normal lifespan
Tyler 2: lethal in utero
33
What is affected by Type I collagen disease?
Bones, eyes, teeth, inner ear bones, skin and joints
34
What is blue sclara?
When the white part of the eyes looks blue. Seen in osteogenesis imperfecta/brittle bone disease/ Type I collagen disease
35
What are some symptoms seen during childhood in those with type I collagen disease?
Fractures, bowing, scoliosis, hearing loss, dwarfism
36
What is the status of adjusting those with osteogenesis imperfecta?
It’s contraindicated
37
What is the pathogenesis of Brittle Bone disease?
Mutated Type 1 Collagen causing a premature breakdown. It’s autosomal dominant.
38
How common is Type I collagen disease?
1 in 20,000
39
What stands out in x rays of children with osteogenesis imperfecta that have been treated with biphosphonates?
Zebra stripes in bone
40
________ is associated with normal bone strength, but frequently with stenosis of the foramen magnum and lumbar spinal stenosis
Achondroplasia
41
_______ frequently involves localized abnormalities in development of clavicles and teeth.
Cleidocranial dysplasia
42
Individuals born with_______ will be affected by an incomplete formation of one or more vertebral bodies
Type I congenital kyphosis
43
If x-rays look radiolucent, the bone is more dense or less dense?
Less dense
44
X rays that are radiolucent, areas appear darker or lighter?
Darker
45
If someone said areas look brighter/whiter on an x ray it is called what?
Radiopaque/radiodensity
46
High density bone appears ________ on x ray?
Bright/white
47
Marble bone disease is also called what?
Osteopetrosis
48
T or F: bone that is very dense is stronger?
False
49
Why is the bone weak in osteopetrosis?
Because it never breaks down old bone. Just building new bone on top of it.
50
What is skeletal sclerosis?
Increased density of bone
51
What is osteopetrosis
Group of genetic disorders causing skeletal sclerosis, bony stenosis, and deranged hematopoiesis.
52
What disease did we talk about this unit that corresponds with Erlenmeyer flask deformity?
Osteopetrosis
53
Erlenmeyer flask deformity is also called?
Fills medulla
54
What type of fracture is common in osteopetrosis patients?
Chalkstick fracture aka pathologic fracture. Bone is so brittle it snaps like chalk
55
What is the how of osteopetrosis?
Decreased osteoclast activity causing an inability to remodel and reabsorb bone leading to thick, dense, brittle bone
56
Osteopetrosis has a loss of hematopoietic bone marrow causing reduced what?
Production of red and white blood cells
57
What is treatment of osteopetrosis?
Decreased calcium intake and/ or stem cell transplant
58
What is the who and why of osteopetrosis?
Inherited
59
What is acquired severe loss of bone density and mass?
Osteoporosis
60
What does a DEXA scan measure?
Bone mineral density (BMD)
61
Many times, patients don’t know they have osteoporosis until _________.
They have a fracture
62
What is osteopenia?
A milder loss of bone density and mass than what’s seen in osteoporosis
63
Osteopenia and osteoporosis both have decreased __________ and increased ________
Bone mass
Porosity
64
What are the main areas we see osteoporosis in?
Trabecular/spongy/cancellous bone.
Vertebral bodies, femoral neck, and calcaneous
65
What does the DEXA scan determine?
Risk for fracture
66
A DEXA scan greater than 2.5 deviations below is what?
Osteoporosis
Osteopenia
Osteoporosis
67
A DEXA scan between 1-2.5 standard deviations below is what?
Osteoporosis
Osteopenia
Osteopenia
68
What is a T-score?
DEXA compared to peak bone mineral density
69
What is Z- score?
DEXA compared to age and gender matched BMD
70
Is the T core or Z score more commonly used?
T score
71
Localized osteoporosis is caused by what?
Disuse
72
What are the types of osteoporosis affecting the entire skeleton?
Primary and secondary
73
Who is more likely to get primary osteoporosis?
Those who are senile and/or post menopausal
74
What are 2 more symptoms seen in secondary osteoporosis?
Neoplasia, body-wide immobilization
75
Who are we more likely to see secondary osteoporosis in?
Those with hyperparathyroidism, nutrient deficiencies, those who use corticosteroids, alcohol, or tobacco
76
Why does menopause contribute to osteoporosis?
There is decreased serum estrogen leading to increased osteoclast activity
77
Why does aging contribute to osteoporosis?
There is decreased synthetic activity of osteoblast and reduced physical activity
78
How much bone mass is lost each year after mid 20’s
0.7%
79
Why does osteoporosis affect women due to estrogen levels but doesn’t affect men as much when they have low estrogen levels regularly?
Because it’s the fluctuation of estrogen. Not necessarily estrogen levels being low.
80
What type of exercise is beneficial to our osteoporotic patients?
Weight training
81
Vitamin D deficiency leads to 2 diseases. What are they?
Rickets: childhood version
Osteomalacia: adult version
82
What is rickets
Undermineralized bone causing bones to be weak and bow. Patient also has poor growth plates.
83
What is the how of rickets?
Failed osteoid formation and/or failed deposition of bone in the growth plates
84
Is rickets or osteomalacia more severe?
Rickets
85
Why do children get rickets?
Deficiency in vitamin D either dietary or UV. Could be due to malabsorption or chronic renal disorders as well.
86
What is osteomalacia?
Undermineralized bone causing bone to be weak and prone to fracture
87
What is the pathogenesis of osteomalacia?
Failed remodeling of bone and/or Undermineralized matrix accumulation
88
Why do people get osteomalacia?
Deficiency in vitamin D either dietary or UV. Could also be due to malabsorption or chronic renal disorders
89
When you hear hyperparathyroidism, what should you think?
Taking too much Ca+ from bone
90
What is primary hyperparathyroidism?
Autonomous PTH production most commonly caused by an adenoma.
91
What is increased in primary hyperparathyroidism?
osteoclast activity
Renal tubular resorption of Ca+
92
What is secondary hyperparathyroidism?
Retail failure occurs meaning we can’t regulate Ca+ levels causing hypocalcemia causing an increase in PTH
93
Primary hyperparathyroidism is asymptomatic a lot of times. But what are some symptoms patients may experience?
Kidney stones (MC), bone pain, peptic ulcers, depression, anorexia, nausea, demineralization/pathologic fracture
94
What are some skeletal changes we may see in x rays of those with hyperparathyroidism?
Salt and pepper skull, multiple myeloma, rugger-Jersey spine, subperiosteal resorption (radial side, middle phalanges)
95
What is treatment of hyperparathyroidism?
Depending on if it’s primary or secondary. However mostly just drinking water, physical activity, and avoiding diuretics.
96
Is hyperparathyroidism reversible when PTH levels are normalized?
Yes
97
What is the acronym for hyperparathyroidism symptoms?
Painful bones, renal stones, abdominal groans, and psychic moans
98
What is the pathogenesis (how) of hyperparathyroidism?
Parathyroid adenoma. This causes increases in parathyroid hormone (PTH), increased osteoclast activity, and increases Ca2+ in blood
99
What is a brown tumor?
In hyperparathyroidism, cortical and trabecular bone gets resorbed and replaced by loose connective tissue forming a brown tumor
100
What is a skeletal feature of advanced hyperparathyroidism causing the bone to have a cystic appearance?
Osteitis fibrosa cystica
101
Who does hyperparathyroidism most commonly effect?
Post-menopausal women
102
What is the etiology of hyperparathyroidism?
Primary: idiopathic (parathyroid adenoma)
Secondary: kidney failure
103
What is called Shaggy bone?
Pager disease
104
Osteitis deformans is another name for what?
Paget Disease
105
What is Paget Disease?
Disordered bone remodeling in the axial skeleton. Rare in extremities.
106
What are the symptoms of Osteitis Deformans?
80% is asymptomatic. Otherwise, bone pain, bowing, nerve compression, and an increased fracture risk. 1% experience osteosarcoma (poor prognosis)
107
How is Paget Disease diagnosed?
Increase in alkaline phosphatase in serum. This is a byproduct of osteoblast activity.
108
What type of fracture is common with Paget disease?
Chalkstick fracture
109
What disease causes a mosaic jigsaw puzzle pattern in bone?
Paget disease (osteitis deformans)
110
You take x-rays of a patient’s spine. One vertebrae appears very radiopaque. What is this called?
Ivory vertebrae sign
111
What are the causes of ivory vertebra sign?
1. Paget disease
2. Metastatic cancer (prostate)
3. Lymphoma
112
What is the pathogenesis of Paget disease?
Disordered bone remodeling due to excessive osteoclast activity and reactionary increase of osteoblast activity
113
What’s the 1st stage of Paget Disease?
Regional osteoclastic activity
114
What is the second stage of osteitis deformans?
Osteoblastic activity causing disorganized excessive bone. It’s greater mass and poor quality gives the shaggy appearance
115
What is the 3rd stage of Paget Disease?
Sclerotic Phase (osteosclerotic)
116
What’s the epidemiology of Paget disease?
Older Caucasian males. 2% less than 50 yrs old. 10% more than 80yrs old
117
What is the etiology of Paget Disease?
Genetic and geographic
118
What are the most common places affected by Osteitis deformans?
Pelvis, sacrum, skull
119
When do people most commonly get diagnosed with osteitis deformans?
Age 70
120
What 3 countries is Paget disease found more in?
Europe
New Zealand
Australia
121
_______ is an endocrine disorder MC from a tumor that affects the entire body but causes reduced bone mineral density in the skeleton.
Hyperparathyroidism
122
______ is a group of inherited conditions that are characterized by reduced osteoclast activity
Osteopetrosis
123
When do most individuals reach peak bone mass?
25-30
124
Which site is MC location for a pathological fracture due to osteoporosis?
Femoral neck
125
What is a closed fracture?
Intact with overlying tissue
126
What is a compound (open) fracture?
Skin is ruptured.
*At risk for infection
127
What is a comminuted fracture?
Bone is fragmented or splintered
128
What is a displaced fracture?
When the distal segment is misaligned
129
What is a pathological fracture?
Fracture at site of any pathology
130
What is a stress fracture?
Caused by repetitive use developing slowly. Found in lower leg/foot
131
If optimal healing is taking place, what should happen to a fracture during the first week?
Soft tissue callus forms. *noncalcified*
132
If optimal healing is taking place, what should happen to a fracture between weeks 2 and 3?
Development of woven bone
133
If optimal healing is taking place, what should happen to a fracture between weeks 6-8?
Endochondral ossification giving us a bony callus
134
______ fractures are at the highest risk of developing an infection post injury.
Open
135
_______ fractures are characterized by an underlying pathology that weakened the bone to the point of fracture following trivial trauma.
Pathological
136
What fracture goes straight through the growth plate?
Type I Salter-Harris fracture
137
What is type II Salter Harris fracture?
When it extends through the growth plate and the metaphysis
138
What is the most common Salter Harris fracture?
Type II
139
How many Salter Harris fractures are type II?
About 75%
140
What type of Salter Harris fracture goes through the growth plate and epiphysis?
Type III
141
10% of Salter Hardis fractures are what type?
Type III
142
What type of Salter Harris Fracture goes through the metaphysis, growth plate, and the epiphysis?
Type 4
143
T or F: Type 4 Salter Harris fracture has the worst prognosis and is the least common.
False. Type 5
144
What is a type 5 Salter Harris fracture?
The growth plate is crushed
145
What type of Salter Harris fracture is most frequently missed on x ray?
Type I
146
10% of hip injuries result in what?
Avascular necrosis aka osteonecrosis
147
What is ostsonecrosis aka avasuclar necrosis?
Ischemic necrosis of bone
148
Is osteonecrosis asymptomatic or painful?
Either or
149
Where are common places to see osteonecrosis aka avascular necrosis?
Hip, knee, shoulder, wrist, ankle
150
Osteonecrosis can cause bone to collapse/fracture which causes _______.
Osteoarthritis
151
What is the how of osteonecrosis?
Ischemia. Caused by mechanical trauma to vascularure, extravascular pressure, or thrombotic occlusion
152
How do many osteonecrotic injuries heal?
Via creeping substitution
153
Who is osteonecrosis most common in?
30-50 year olds
154
What are the risk factors of osteonecrosis?
Vascular injury
Prolonged corticosteroid use
Systemic vascular pathology
Susceptibility to thrombosis
25% are idiopathic
155
What is osteomyelitis?
Bone-marrow inflammation from an infection
156
What is the how of osteomyelitis?
Infection
1. Hematogenous (MC in children)
2. Adjacent infection (MC in adults)
3. Implantation (MC In adults)
157
What are the 2 types of osteomyelitis?
1. Pyrogenic osteomyelitis
2. Mycobacterial osteomyelitis
158
What’s the most common bacteria found in pyogenic osteomyelitis?
Staphylococcus aureus
159
How do we diagnose pyogenic osteomyelitis?
Radiography and biopsy
160
What is involucrum?
Pyogenic Osteomyelitis
The part of the bone that surrounds the infected bone
161
What is the sequestrum?
Pyogenic osteomyelitis
Entrapped necrotic bone
162
What is mycobacterial osteomyelitis?
Tuberculosis is the cause of the bone infection. There is severe destruction and caseous granulomas
163
How is mycobacterial osteomyelitis aka skeletal tuberculosis spread?
Hematogenous (mc) or lymphatic
164
What part of the body does mycobacterial osteomyelitis affect?
Long bones and vertebrae
165
Path Disease is a possible neuro deficit of what?
Mycobacterial osteomyelitis
166
Which disease is a common risk factor for development of avascular necrosis of bone?
Disorders that increase the risk for clotting
167
_______ is the term used for the entrapped necrotic bone in a patient with pyogenic osteomyelitis
Sequestrum
168
What is arthritis?
Inflammation of a joint
169
What is osteoarthritis?
Degeneration of articular cartilage
170
What is the most common joint disorder?
Osteoarthritis
171
Is primary or secondary the most common form of osteoarthritis?
Primary
172
If a child has osteoarthritis, is it primary or secondary?
Secondary
173
What causes secondary osteoarthritis in adults?
Trauma, obesity, disease/deformity
174
What are the common locations of osteoarthritis?
Cervical and lumbar spine, knees, hips, DIP joint, 1st MCP joint, 1st TMT joint
175
What are 2 things we see in advanced osteoarthritis?
Subchondral cysts and sbudnagion
176
Define ankylosis
Fusing
177
Spinal osteoarthritis usually occurs with _______.
Degenerative disc disease
178
Define spondylosis
Spinal pain from degenerative changes
179
What is degenerative disc disease?
Facet degeneration stressing the discs > the degenerating discs stresses facets
