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Clin Med 3- Exam 2 COPY > MSK 2 > Flashcards

MSK 2 Flashcards

1
Q

What are 4 causes of arthritis?

A

(1) DJD (degenerative)
(2) Rheumatoid
(3) Post-traumatic
(4) Post-infection

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2
Q

What are 5 modifiable local risk factors of DJD/OA?

A

(1) Muscle strength
(2) Physical activity/occupation
(3) Joint injury
(4) Joint alignment
(5) Leg length inequality

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3
Q

What are 3 modifiable systemic risk factors of DJD/OA?

A

(1) Obesity
(2) Diet
(3) Bone metabolism

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4
Q

What are 4 non-modifiable systemic risk factors of DJD/OA?

A

(1) Age
(2) Sex
(3) Genetics
(4) Ethnicity

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5
Q

What is one of the strongest predictors of OA?

A

Age

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6
Q

Are men or women at a higher prevalence and severity of OA?

A

Women

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7
Q

What are 3 facts of the quadriceps femoris?

A

(1) primary antigravity muscle of the lower limb (2) absorbs limb loading (3) provides dynamic joint stability

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8
Q

___ rupture is one of the most important knee injuries seen in the context of OA.

A

ACL rupture is one of the most important knee injuries seen in the context of OA.

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9
Q

What is one of the strongest predictors of knee OA progression?

A

Knee malalignment

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10
Q

Medial progression of knee OA 4x more likely in individuals with ____ alignment, and lateral progression is 5x more likely in individuals with ____ alignment.

A

Medial progression of knee OA 4x more likely in individuals with varus alignment, and lateral progression is 5x more likely in individuals with valgus alignment.

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11
Q

In varus alignment, stress is on the ___ side.

A

In varus alignment, stress is on the medial side.

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12
Q

In valgus alignment, stress is on the ___ side.

A

In valgus alignment, stress is on the lateral side.

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13
Q

What are 6 tx options for arthritis?

A

(1) Pain control
(2) Physical therapy
(3) Assistive devices
(4) Viscosupplementation
(5) Surgery (arthroplasty, osteotomy, bracing)
(6) Risk factor modification (weight management, muscle strengthening)

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14
Q

What is the first line tx for mild or moderate pain?

A

Acetaminophen (+ topical analgesics PRN)

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15
Q

If conservative therapy and acetaminophen fail to control pain, or if there is inflammation, what are your next 2 tx options?

A

(1) NSAIDs

(2) viscosupplementation

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16
Q

What are the 2 topical analgesic used in arthritis tx?

A

(1) Diclofenac Gel

(2) Capsaicin

17
Q

What is the role of narcotics in arthritis tx?

A

Short term use in exacerbations (minimal role)

18
Q

Define osteoporosis.

A

skeletal disorder characterized by a loss of bone matrix that reduces bone integrity, resulting in an increased risk of fractures

19
Q

Differentiate osteoporosis from osteomalacia.

A

Osteoporosis: bone matrix and mineral both decreased
Osteomalacia: bone matrix intact, mineral decreased

20
Q

What are the 3 key cells of bone tissue and what do they each do?

A

(1) Osteoblasts: synthesize the bone matrix and are responsible for its mineralization *blasts build
(2) Osteocytes: inactive osteoblasts that have become trapped w/in the bone they have formed *structural support
(3) Osteoclasts: break down bone matrix through phagocytosis *clasts breakdown

21
Q

What are 8 etiologies of osteoporosis?

A

(1) Hormone deficiency (estrogen-W, androgen-M)
(2) Hormone excess (Cushing syndrome or corticosteroid admin, thyrotoxicosis, hyperparathyroidism)
(3) Genetic disorders (Aromatase deficiency, collagen disorders, Ehlers-Danlos syndrome, homocystinuria
(4) Alcoholism
(5) Immobilization and microgravity
(6) Inflammatory bowel disease
(7) Malignancy, especially multiple myeloma
(8) Tobacco

22
Q

What are 8 medications etiologies of osteoporosis and what is the effect of each?

A

(1) Heparin anticoags: reduces bone formation
(2) Anticonvulsants: increases bone turnover, decreasing bone density
(3) Glucocorticoids
(4) Chemotherapeutics: changes d/t chemo and radiation induced hypogonadism
(5) Psychotropics: inc fx risk
(6) Narcotics: inc fx risk
(7) Barbiturates: inc fx risk
(8) PPIs: dec Ca absorption

23
Q

Osteoporosis is often asymptomatic until _____.

A

Osteoporosis is often asymptomatic until fracture occurs w/relatively light activity.

24
Q

What type of fractures lead to thoracic kyphosis?

A

Successive vertebral compression fractures

25
Q

What is DXA used to determine?

A

Used to determine the bone density of the lumbar spine, hip, and distal radius

26
Q

What 3 groups of pts are at risk for osteoporosis?

A

(1) postmenopausal women (2) men over age 70

(3) younger pts w/pathologic fxs or radiographic evidence of diminished bone density

27
Q

What is a T score?

A

Pt’s bone mineral density as compared to gender and ethnicity matched young adult

28
Q

What T score is indicative of osteoporosis? Severe osteoporosis?

A

Osteoporosis =T score < -2.5

Severe= T score < -2.5 with fracture

29
Q

What is a Z score?

A

Pt’s bone mineral density as compared to age, gender, and ethnicity matched peer

Differ from T score by including age-match!

30
Q

What can DXA not distinguish b/w?

A

Cannot distinguish osteoporosis from osteomalacia

31
Q

DXA overestimates BMD in ____ pts, and underestimates BMD in ____ pts.

A

DXA overestimates BMD in taller pts, and underestimates BMD in smaller pts.

32
Q

What vitamin deficiency is common in osteoporosis?

A

Vitamin D

33
Q

What are 7 tx options of osteoporosis?

A

(1) Adequate dietary calcium and Vit D
(2) Weight-bearing exercise
(3) Calcium and Vit D supplements
(4) Bisphosphonates
(5) Calcitonin
(6) Estrogens
(7) Selective estrogen receptor modulators

34
Q

What level of calcium should be taken daily in osteoporosis tx?

A

> /=1,200 mg/day

35
Q

What level of Vit D should be taken daily in osteoporosis tx of pts 50+?

A

800-1,000 IU/day

36
Q

What is the first line pharm tx for osteoporosis?

A

Bisphosphonates

37
Q

What is the MOA of bisphosphonates, and what are you concerned about b/c of this?

A

They inhibit osteoclast activity, allowing osteoblasts to work more effectively; d/t inhibiting osteoclast activity, they are getting set up for stress fractures (bisphosphonate insufficiency fracture)

38
Q

What are the 2 tx options for bisphosphonate insufficiency fractures?

A

(1) protected WB

(2) prophylactic IM rodding

Clin Med 3- Exam 2 COPY (15 decks)

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