Exam 1- Musculoskeletal Pathologies Flashcards
(145 cards)
1
Q
____ may induce a fracture in musculoskeletal pathologies.
A
Trauma
2
Q
Age, Genetics and Lifestyle choices are more likely to have an influence on the development of a condition like ________
A
Osteoporosis
3
Q
Disorder of bony development resulting in defective ossification of the skeletal system
Develops due to irregular mesenchymal cell migration, during embryogenesis
A
Dysostosis
4
Q
Examples of Dysostoses
A
Cleidocranial Dysostosis
Klippel-Feil Syndrome
Polydactyly/Syndactyly
Aplasia
5
Q
Musculoskeletal pathology
Interferes with body’s ability to perform normal growth or regulate normal musculoskeletal homeostasis
Primarily abnormal bone formation (isolated/widespread)
A
Dysplasia
6
Q
Examples of Dysplasias
A
Type 1 Spondylolisthesis
Osteogenesis Imperfecta
Osteoporosis
Achondroplasia
7
Q
Stunted Growth
Individuals does not achieve a mature height of at least 4 ft. 11 in.
A
Dwarfism
8
Q
Pathologies resulting in Dwarfism
A
Turner Syndrome Achondroplasia Osteogenesis Imperfecta Hypopituitarism Severe Malnutrition
9
Q
Form skeletal dysostosis that involves congenital abnormalities of the bones and teeth
A
Cleiodocranial Dysostosis (Cleidocranial Dysplasia)
10
Q
Characteristically, the ______ are either underdeveloped (hypoplastic) or absent and allows affected individuals to ______ their shoulders to an extreme degree
A
Clavicles
Adduct
11
Q
Enlarged fontanelles (“soft spots”)
Normal intelligence
Mutation in the RUNX2 gene
Autosomal Dominant
A
Cleidocranial Dysostosis
12
Q
Form of skeletal dysostosis Presence of 2+ cervical vertebrae w/ abnormal fusion Shortened neck height Low-appearing hairline Limited ROM in cervical spine
A
Klippel-Feil Syndrome
13
Q
Conditions associated with Klippel-Feil Syndrome
A
Renal Abnormalities
Cardiac Abnormalities
Hearing Problems
14
Q
Skeletal abnormality of the scapula
Failure of the scapula to descend during early embryogenesis
Characteristically associated with Klippel-Feil Syndrome
A
Sprengel’s Deformitiy
15
Q
MC form of skeletal dysplasia and develops following a single gene mutation that affects many different areas of the musculoskeletal system
Autosomal dominant
MC Sporadic Mutations
A
Achondroplasia
16
Q
What is the gene responsible for Achondroplasia?
A
FGFR3
17
Q
What part of the body is most affected in achondroplasia with growth suppression?
A
Long bone elongation of the extremity bones
18
Q
Sporadic mutations of Achondroplasia involve mutations in the FGFR3 gene within the
A
Father’s sperm
19
Q
Advanced ______ age increases the risk of father’s sperm developing these spontaneous FGFR3 mutations
A
Paternal
20
Q
Characteristics of Achondroplasia
A
Short Extremity Bones Trident Hand Appearance Frontal Bossing Stenosis of Foramen Magnum Midface Hypoplasia Lumbar Spinal Stenosis Bullet Vertebrae Lower Extremity Radiculopathy Normal Intelligence
21
Q
Most common form of lethal dwarfism
A
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
22
Q
Severely diminished chondrocyte activity resulting in severely inhibited endochondral ossification
A
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
23
Q
FGFR3 gene mutation that traditionally causes achondroplasia with potentially lethal tissue distortions
A
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
24
Q
Lethal in utero or shortly after birth
1 in 20,000 pregnancies
A
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
25
Greek for "death bearing"
Thanatophoric
26
Severely underdeveloped _____ does not provide enough space for normal heart and lung development
Thorax
27
Most common cause of death among individuals affected with thanatophoric dwarfism
Respiratory Failure
28
Also known as brittle bone disease or Type I Collagen Disease
Osteogenesis Imperfecta (OI)
29
Autosomal dominant mutation in the genes that code for the formation of α1 - or α2- chains of type I collagen, which causes premature breakdown of bone due to irregular formation
Osteogenesis Imperfecta (OI)
30
T/F. Only bones, teeth, eyes, skin and joints are affected by Osteogenesis Imperfecta.
False (all tissues throughout body containing Type I Collagen are impacted)
31
What tissues are prominently impacted by Osteogenesis Imperfecta?
Bones, teeth, eyes, skin and joints
32
What's the most characteristic feature of Osteogenesis Imperfecta?
Severely under-mineralized bony tissue (which are very prone to fracture)
33
The presence of "blue sclerae" is very specific to
Osteogenesis Imperfecta (OI)
34
What causes the blue shade in the sclerae with an individual with Osteogenesis Imperfecta?
Sclerae is most translucent due to irregular Type I collagen, this allows the vascular choroid layer of eye to show blue
35
Hearing loss occurs due to middle ear bones irregularly forming
Teeth are likely to be small and misshapen due to an inability to produce normal dentin
Osteogenesis Imperfecta (OI)
36
What type of Osteogenesis Imperfecta is compatible with life, MC recognized during childhood, bowing of lower extremity bones, dwarfism or scoliosis
Type I Osteogenesis Imperfecta
37
What type of Osteogenesis Imperfecta is a contraindication to high-velocity, low-amplitude (HVLA) adjusting?
Type I Osteogenesis Imperfecta
38
What type of Osteogenesis Imperfecta is incompatible with postnatal life due to extreme skeletal fragility, suffer multiple fractures in utero or during birthing process resulting in lethal intracranial hemorrhage?
Type II Osteogenesis Imperfecta
39
AKA Marble Bone Disease
Osteopetrosis
40
Reduced osteoclast formation or activity resulting in widespread skeletal sclerosis
Osteopetrosis
41
Abnormal hardening of a body tissue
Sclerosis
42
Increased skeletal density, via Osteopetrosis, causes bones to be more prone to ______
Fracture
43
What is the condition that is occuring if an individual suffers from a "chalk stick fracture"?
Osteopetrosis
44
Bone marrow of individuals with _____ will fill with mineralized bone, which displaces functional red bone marrow and causes reduced hematopoiesis
Osteopetrosis
45
Erlenmeyer flask deformity associated with long bone distortion
Various cranial nerve defects due to foraminal stenosis
Osteopetrosis
46
Serve reduction in bone mineral density
Osteoporosis
47
At least ____ standard deviations from normal mineralization
-2.5
48
What is the primary complication of osteporosis?
Fracture
49
With Osteoporosis, fractures are most common in areas that have abundant ______ bone.
Trabecular
50
When diagnosing for Osteoporosis, bone mineral density is best evaluated with a
DEXA Scanner
51
Determines how many SD the patient's bone mineralization is away from normal (average bone mineral density of a 25 y.o. of the same sex), with a T Score
DEXA Scanner
52
T/F. Plain film radiography is not sensitive enough to be used as a diagnostic test.
True
53
Bone mineralization is below normal, but not yet reaching a severity to be considered osteoporosis
Osteopenia
54
Osteopenia is considered to have a SD of bone mineralization of ___ and ___ SD's below normal
1 and 2.5
55
Bone mineralization peaks during young adulthood, around the ages of
25-30
56
About _____ of individuals bone mineralization is lost with each of the following years.
0.5-0.7%
57
Factors that influence bone mineral density include:
```
Lifestyle choices
Diet
Physical Activity
Muscle Strength
Age
Hormonal Factors
```
58
Osteo____ activity decreases with age
-blast
59
Age-related loss in bone mineralization
Senile Osteoporosis
60
____ have accelerated rates of osteoclast activity, due to estrogen levels.
Women
61
Screening for osteoporosis is recommended for all women over age ____
65
62
Asymptomatic until the development of a fracture
Osteopenia
| Osteoporosis
63
Most common locations for osteoporosis-related fractures are the
Femoral Neck
| Vertebral Bodies
64
Vertebral body osteoporosis-related fracture that is most likely to cause compression fractures within the ______ spine
Thoracolumbar
65
Loss of overall height and what other feature are observable features of advanced osteoporosis
Dowager's Hump
66
Complications from osteoporosis-related fractures include:
Immobility
Spinal Deformation
Pneumonia
Pulmonary Embolism
67
_______ are a group of medications that decrease osteoclast activity
Bisphosphonates
68
Metabolic bone diseases that develop following a deficiency in Vitamin D
Rickets and Osteomalacia
69
```
Develop in children
Deficient in Vitamin D
Reduced bones deposition at the epiphyseal region
Stunted growth
Bowing of lower extremities
Increased risk of fractures
Abnormal spinal curvatures
```
Rickets
70
```
Adults
"adult counterpart of rickets"
Skeletally mature
Bone is left under-mineralized
Less severe than rickets
Limited to increased fracture risk
Mimics Osteoporosis
```
Osteomalacia
71
Evaluating serum vitamin D levels is needed to establish diagnosis of
Osteomalacia
72
Elevated parathyroid hormones (PTH) levels
Hyperparathyroidism
73
Parathyroid hormone levels regulate blood calcium levels by stimulating _______ activity, which releases calcium into the serum
Osteoclast
74
```
Parathyroid glands overproducing PTH
Adenoma of the parathyroid gland.
Women ~50
Removal of the Parathyroid adenoma
Asymptomatic
```
Primary Hyperparathyroidism
75
Cause the parathyroid glands to increase production of PTH
Chronic Kidney Disease --> causes Hypocalcemia
Parathyroid gland responds by elevating PTH production
Secondary Hyperparathyroidism
76
Less commonly, Secondary Hyperparathyroidism is caused by
Vitamin D deficiency
77
What is the most common symptom of Primary Hyperparathyroidism?
Symptomatic kidney stones
78
What is the most common sign of Primary Hyperparathyroidism?
Hypercalcemia
79
T/F. Hyperparathyroidism will not affect many areas of the body
False (it is an endocrine disorder- it affects many areas of the body)
80
Skeletal changes associated with hyperparathyroidism involve resorption of ______ and _____ bone throughout the entire skeleton
Cortical
| Trabecular
81
Hyperparathyroidism most characteristically affects the
```
Phalange
Vertebral Body
Calvaria
Femur
Tibia
```
82
Rugger Jersey Spine is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Vertebral Bodiers
83
Resorption of the cortex, primarily on the radial side of the middle and distal phalanges is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Phalanges
84
Salt and Pepper Skull is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Calvaria
85
Osteitis Fibrosa Cystica is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Long bones of the lower extremities
86
_____ ____ develop following localized osteolysis whereas the bone weakens, hemorrhage occurs, macrophages accumulate within the area, and fibrotic tissue fills the area
Brown Tumors
87
Localized areas of osteolysis may give rise to areas of "cystic degeneration" and produce what is known as
Osteitis Fibrosa Cystica
88
Three stages of Paget Disease are known as:
Osteolysis --> Mixed Osteoclastic-Osteoblastic Stage --> Osteosclerotic stage
89
Results in increased, but structurally weak, bone mass
Paget Disease of Bone
90
Caucasian males 70 y.o.
MC in North America, Australia and New Zealand
1% of general adult population affected
10% adults older than 80 y.o.
Paget Disease of Bone
91
T/F. Most patients with Paget disease are symptomatic
False (most (80%) are asymptomatic)
92
A sign of Paget disease involves elevated serum levels of _____ _____, which represents elevated osteoblastic activity
Alkaline Phosphatase
93
Symptoms of Paget Disease:
```
Back/Neck Paine
Bony Deformation
Increased fracture risk
Headache
Cranial Nerve Compression
```
94
_____ disease may cause an "ivory vertebra sign", discovered upon radiological examination.
Paget
95
Paget disease on x-ray's is usually referred to as a ______ appearance while histological exams of a site of the disease will manifest with an irregular _____ or jigsaw puzzle pattern
Shaggy
| Mosaic
96
Paget disease is most likely to develop within the ____ ______ and the proximal _____
Axial Skeleton
| Femurs
97
T/F. A large percentage (about 75% or less) of all cases of Paget disease will transition into an aggressive bone cancer known as Osteosarcoma
False (A small percentage [1% or less])
98
Osteosarcoma is associated with a very high _____ rate
Mortality
99
What is the cause of Paget disease?
Idiopathic
100
Complete or partial loss of bone integrity
Bone Fracture
101
T/F. Just as much force is needed to break a pathological bony tissue versus a normal bony tissue
False (smaller amount of force)
102
Fracture at the site of a bone-weakening pathology
Pathological Fracture
103
Completely separates what was previously a single bone
Separation of bone's cortex
MC site of a pathological fracture
Occurs in an adult or older adult
Complete Fracture
104
Fracture that does not separate the fragments of the fractured bone
MC occur in long bones
Occur in pediatric individuals
Incomplete Fracture
105
Skin overlying the fracture remains intact
| Reduces the risk that this fracture site will become infected
Closed (Simple) Fracture
106
Fracture is in communication with overlying skin
Exposes the fracture site to the external environment
Increases risk of infection at site
Compound (Open) Fracture
107
Fracture is splintered into multiple fragments.
| High-velocity forces cause the fracture
Comminuted Fracture
108
Ends of the bones at the fracture site are not in alignment
Displaced Fracture
109
Slowly-developing fracture
| Increased physical activity and repetitive loading
Stress Fracture
110
Fractures are typically painful because the fracture disrupts the sensitive ______
Periosteum
111
The fracture of a bone will induce an __1.__ inflammatory response that initiates the ___2.___ process while also inducing a painful response via ____3.___ and ____4._ ____ production
1. Acute
2. Reparative
3. Prostaglandin
4. Substance P
112
Normal fracture healing begins immediately after the fracture occurs with the development of a ______
Hematoma
113
The hematoma developed to initiate healing of a fracture will also prompt formation of a fibrin-rich clot and fibroblasts will form a ____ ___ by the end of the 1st week of healing.
Soft Callus
114
By the end of the 2nd week of healing, a ___ ____ will have formed and woven bone will rise to endochondral ossification
Bony Callus
115
Woven bone will forming through endochondral ossification will result in mature _____ bone at the end of the healing process.
Lamellar
116
How long does bone take to heal after a normal fracture?
6-8 weeks
117
What aspect of the healing process of a fractured bone will be remodeled over that persons lifetime?
Bony Callus
118
T/F. Bony callus' will become more noticeable as that individual ages.
False (less noticeable over time)
119
What may delay fracture healing?
Fracture...
- Fragments remain displaced
- Splintered
- Not immobilized
- Becomes infected
- Malnourished (Calcium, Vitamin D, Phosphorus or Magnesium)
- Occurs in an older adult
120
Place the healing process of bone fracture in order:
Bony Callus, Hematoma,
Soft Callus, Lamellar Bone, Woven Bone
1st. Hematoma
2. Soft Callus
3. Bony Callus
4. Woven Bone
5. Lamellar Bone
121
Fractures that involve the epiphyseal growth plate
Salter-Harris Fractures (SHF)
122
Salter-Harris Fractures (SHF) only apply to individuals who have open or active ____ ____.
Growth Plates
123
Salter-Harris Fractures (SHF) are limited to ____ who have not reached skeletal maturity
Pediatrics
124
Occur in about 15% of all pediatric long bone fractures
Salter-Harris Fractures (SHF)
125
Fracture that extends through the entire growth plate (physis)
5% of all SHF's
Favorable Prognosis
Type I
126
Fracture extends from the growth plate into the metaphysis
75% of all SHF's
Favorable Prognosis
Type II
127
Fracture extends from the growth plate into the epiphysis
10% of all SHF's
Limited prognosis, due to joint involvement
Type III
128
Fracture extends through the growth plate, metaphysis and epiphysis
10% of all SHF's
Poor Prognosis
Type IV
129
Compression fracture of the growth plate
<1% of all SHF's
Poor Prognosis
Type V
130
Site of necrosis, due to reduced blood supply (ischemia).
Avascular Necrosis (AVN)
131
___ dislocations may also cause vascular damage that result in an AVN.
Joint
132
Other causes of AVN:
Autoimmune Vasculitis (Type III Hypersensitivity reaction)
Prolonged use of Corticosteroids
Ionizing Radiation
Blood Clots
Blood Disorders (that increase clotting risk i.e. Sickle Cell Disease)
Idiopathic (about 25% of all cases)
133
What is the healing process called for AVN's?
Creeping Substitution
134
Is healing of AVN's managed?
No
135
_____ AVN's may collapse and cause acute pain and surface irregularities at the joint, accelerating osteoarthritis. This is known as
Secondary Osteoarthritis
136
Term given to an AVN that develops at the subchondral area of a joint.
Originates from an ischemic injury and causes pain
Due to death of osseous and cartilaginous tissues
Osteochondritis Dissecans
137
What are the most common locations for Osteochondritis Dissecans to develop?
Knee and Hip Joints
138
Most AVN cases occur around age
30-50
139
Site of bone marrow inflammation, due to an infection
Osteomyelitis
140
Osteomyelitis is more commonly a feature of a localized bacterial infection with ______ ____ or _____
Pyogenic Bacteria or Mycobacteria
141
The site of an infected bone will die and this is refereed to as the ______, which is surrounded by irregular bone known as the _____ and the pus draining location is the ______
Sequestrum
Involucurm
Draining Sinus
142
Involves a bone marrow infection that reaches the marrow via hematogenous spread
Extension from nearby infection
Direct Implantation from trauma or a compound fracture
Occur at any age
Long bones of extremities tend to be MC site
Pyogenic Osteomyelitis
143
What bacteria, of Pyogenic Osteomyelitis, is the microbial origin of up to 90% of all cases?
Staph. Aureus
144
May develop in patients with pulmonary TB (about 3% of all Pulm. TB cases)
Invades the local mediastinal lymph nodes and spreads to the blood
MC among individuals with a suppressed immune sytstem
Result of chronic infection
Less likely to manifest with acute features
Mycobacterial Osteomyelitis
145
Mycobacterial Osteomyelitis will cause ____ ____ to form at the area of infection and tends to involve the long bones of extremities and the ___ ____.
Caseous Granulomas
| Vertebral Bodies
