METABOLIC DISORDERS/GENETIC INF DISEASES

Question 1

Metabolic disorders occur from abnormal physiological processes of the ____ and ____ system

Answer 1

nervous and endocrine system

Question 2

True or false: the skeleton is a metabolically active organ that finishes remodeling at 25-35 years

Answer 2

false: undergoes continuous remodeling throughout life
*resorption and formation

Question 3

Bone mass reaches peak levels between ages __and ____

Answer 3

25-35 years
after this time, rate of resorption begins to exceed rate of formation

Question 4

metabolic bone diseases are characterized by loss of bone ____and ___

Answer 4

density and strength

Question 5

What is the most serious, potentially life threatening, costly complication of metabolic bone disease

Answer 5

fracture

Question 6

kyphosis due to metabolic bone disease could affect what

Answer 6

cardiopulmonary function

Question 7

what is osteomalacia

Answer 7

softening of bones

Question 8

what is osteopenia

Answer 8

low bone mass

Question 9

osteopetrosis

Answer 9

increased bone density

Question 10

osteoporosis

Answer 10

systemic disease decreases bone density

Question 11

Secondary osteoporosis is due to

Answer 11

(Metabolic) Diseases, meds (increase bone reabsorption), other conditions

Question 12

Osteoporosis is defined as what?

Answer 12

Chronic, progressive disease with low bone mass, impaired bone quality, decreased bone strength, enhanced risk of fractures

Question 13

Primary osteoporosis is due to what?

Answer 13

Age related physiological changes!
-long term calcium deficiency
-declining gonadal/adrenal function
-progressive estrogen deficiency
-sedentary lifestyle

Question 14

Is primary or secondary osteoporosis more common?

Answer 14

Primary osteoporosis

Question 15

Risk factors for osteoporosis

Answer 15

Hormonal status
Genetics
Sedentary
Tobacco, alcohol
Meds
Depression (sedentary?)
Diet/nutrition

Question 16

Bone strength is based on what two factors?

Answer 16

Bone density
Bone quality

Question 17

Without weight bearing/mechanical stimuli, you pee out more ____ and bone density _____

Answer 17

Calcium (calcium excretion increases)
Bone density decreases

Question 18

What are the most common presenting features of osteoporosis?

Answer 18

Loss of height
Postural changes
Back pain
Fractures

Question 19

Where is muscular pain/trigger points in people with osteoporosis?

Answer 19

Lower back para spinals
Rhomboid muscles

Question 20

What is an unrecognized early sign of osteoporosis?

Answer 20

Stress fractures
VERTEBRAL COMPRESSION FRACTURES ARE MOST COMMON OSTEOPOROSIS RELATED SPINAL FRACTURES

Question 21

What are the most common spinal fractures in osteoporosis?

Answer 21

Vertebral compression fractures

Question 22

MEDICAL MANAGEMENT SLIDE: STUDY

Question 23

Osteomalacia is what?

Answer 23

Soft bone (lack of mineralization without loss of bone matrix)
Due to lack of calcium, vitamin D, phosphate

*known as adult rickets

Question 24

What is paget disease?

Answer 24

Increased bone resorption (by osteoclasts)
Excessive, unorganized new bone formation (by osteoblasts)

Normal bone marrow replaced by vascular and fibrous tissue

Question 25

What is the second most common metabolic bone disease?

Answer 25

Osteitis deformans/pagets disease (Big bones that are weak)

Question 26

What is developmental dysplasia of the hip?

Answer 26

A genetic/developmental disorder Affects infants/kids *developmental hip disorder happening DYNAMICALLY in utero and 1st year of life

Question 27

Developmental dysplasia of the hip can be

Answer 27

Unilateral Bilateral Occur in 3 forms of varying severity

Question 28

1. Unstable hip dysplasia is what?

Answer 28

Hip positioned normally, can be dislocated with manipulation

Question 29

Subluxation or incomplete dislocation DDH is what?

Answer 29

Femoral head is in contact with acetabulum, but head of femur is partially displaced/uncovered

Question 30

complete dislocation in DDH is what?

Answer 30

Femoral head is totally outside acetabulum

Question 31

What does DDH look like in newborns-1 year old

Answer 31

Ortolani/Barlow signs Positive Galeazzie sign in asymmetric cases Physical asymmetry in ROM (as limitation of hip abduction) Asymmetry in butt fold (higher on affected side) Extra skin folds Leg length discrepancy

Question 32

In ambulating kids, what does DDH look like?

Answer 32

Bilateral dysplasia-compensated trendelenburg (Lean to weight bearing side, compensate for weak glute med)

Question 33

Osteogenesis imperfecta is what?

Answer 33

Brittle bone disease Generalized connective tissue disorder: skeletal fragility Growth deficiency (Growth retardation, long bone and spinal deformities)

Question 34

Osteogenesis imperfecta may be evident at birth in severe forms because

Answer 34

fractures/deformities in utero (long bone and spinal deformities)

Question 35

when do less severe forms of OI become evident?

Answer 35

when child begins to walk and fractures happen

Question 36

what is common in children with osteogenesis imperfecta?

Answer 36

short stature (abnorm epiphysial growth plates, deformity after fx, osteoporosis, vertebral collapse)

Question 37

what are other clinical features of OI?

Answer 37

LE more than UE bruise easily lax ligmanets thin skin hypermobility hearing impairments scoliosis deformed teeth and pectus cardiovascular complications

Question 38

What is osteomyelitis caused by?

Answer 38

inflammation of bone by infectious organism (bacteria, also fungi, parasites, viruses)

Question 39

what areas are most affected with osteomyelitis?

Answer 39

arms, legs, spine, pelvis

Question 40

acute osteomyelitis is usually seen in

Answer 40

children, older adults, IV drug abusers (new infection, rapid destructive pyogenic infection through open wound or GI...leads to speticemia/septic infectious joint)

Question 41

subacute/chronic osteomyelitis is usually seen in

Answer 41

adults secondary to open injury to bone/soft tissue around it

Question 42

chronic osteomyelitis is result from

Answer 42

persistent bone infection or acute disease undiagnosed

Question 43

what is the primary cause of prosthetic failure?

Answer 43

Implant infection (acutely in 1st month post op or months/years after)

Question 44

nearly 80% of prosthetic infections are due to what bacteria?

Answer 44

staphylococcus

Question 45

______ infections occur around the time of surgery and are probably caused by contaminated instruments at the surgical site

Answer 45

perioperative infections

Question 46

hematogenous infections are due to

Answer 46

primary infection elsewhere in body

Question 47

continguous infections occur secondary to

Answer 47

nearby infections

Question 48

Other types of prostheses or implants susceptible to infection include

Answer 48

internal fixation of the spine, breast implants, penile implants, dental implants, cardiac implants, other orthopedic devices and hardware, shunts, and even contact lenses.

Question 49

what may be the only symptom of prosthetic/implant infection?

Answer 49

persistent joint pain acute symptoms: could be fever, joint pain, warmth, redness

Question 50

what is spondylodiscitis?

Answer 50

infection affecting vertebral spine

Question 51

what is the most common site for spinal infection?

Answer 51

intervertebral disk

Question 52

classic signs in children of spondylodiscitis

Answer 52

fever and spinal pain *young children: back pain, refusal to walk, pain with hip extension *abdominal pain and weight loss, maybe can't flex lower back

Question 53

in adults, what would spondylodiscitis look like?

Answer 53

spinal pain, radiating into lower extremities involving multiple nerve levels *worse with activity, rest does not relieve pain *unusual postures and movement patterns in adults