MSK Patho

Question 1

What is the most common pathogen causing osteomyelitis?

Answer 1

Staph. Aureus

Question 2

Other than being a child, what are some risk factors for osteomyelitis?

Answer 2

Debilitated older adults
Hemodialysis
Sickle Cell Disease
IV drug use

Question 3

Explain Direct Entry of osteomyelitis

Answer 3

-80% of cases
-due to locally spreading infection
-Mostly adults
-often multiple organisms

Question 4

Explain Indirect Entry of osteomyelitis

Answer 4

20% of cases
-via bloodstream
-mostly children
-Most common site: vertebrae
-Usually one pathogen

Question 5

How does diabetes contribute to osteomyelitis entry?

Answer 5

Diabetic Neuropathy: can’t feel feet, unaware of foreign body or open wound

Question 6

Explain the patho/process of osteomyelitis

Answer 6

Pathogen invades bone, increasing pressure leads to ischemia, allowing infection to spread and obstruct blood flow, causing necrosis

Question 7

What is a sequestrum?

Answer 7

Osteomyelitis process: necrotic bone separates from living bone, walling itself off into a Sequestrum

becomes a reservoir for microbes and causes purulent drainage

Question 8

What is an involucrum?

Answer 8

Osteomyelitis process: periosteum w/ blood supply forms new bone (involucrum) over infected area/sequestrum

Question 9

Explain manifestations of acute osteomyelitis

Answer 9

Constant pain, worse w/ activity
Unrelieved by rest
Swollen, tender, warm, limited ROM

Question 10

Does acute or chronic osteomyelitis show systemic manifestations like fever, chills, nausea, drainage?

Answer 10

Acute

Question 11

Explain the duration/classification of chronic osteomyelitis

Answer 11

Greater than 1 month OR failed to respond to initial ABX

Question 12

How do inflammatory markers relate to osteomyelitis?

Answer 12

Allow trend tracking of inflammation levels

ESR and C-RP

Question 13

What is the best way of diagnosing Osteomyelitis?

Answer 13

MRI

Question 14

Explain treatment of acute osteomyelitis

Answer 14

Culture/bone biopsy FIRST

Aggressive, long-term IV ABX
(4-6+ weeks)

Requires CVAD, typically broad-spectrum

Question 15

How is progress of osteomyelitis treatment tracked?

Answer 15

Bone scans or ESR testing

Question 16

Explain osteosarcoma

Answer 16

Aggressive, rapidly spreading primary bone cancer

Mostly kids/yuong adults

Gradual pain onset/swelling

Chemo decreases size, followed by surgery and more chemo

Question 17

How is muscular dystrophy treated?

Answer 17

Corticosteroids help slow progression

Question 18

How can back pain be prevented?

Answer 18

Increasing core strength

Question 19

How does disc disease pain often manifest?

Answer 19

Pain radiates down buttock or leg

Possible numbness/tingling of legs, feet, toes

Question 20

Explain a herniated disc

Answer 20

Bulges outward between vertebrae

Question 21

Explain osteomalacia

Answer 21

Rare in US
From Vitamin D deficiency
Children form: Ricketts
Fracture risks

Question 22

How can GI conditions like Celiac, Chron’s, and Dumping Syndrome cause osteomalacia?

Answer 22

Impaired absorption and chronic diarrhea can impact vitamin D and calcium absorption

Question 23

How is osteomalacia treated?

Answer 23

Correcting vitamin D deficiency
Sunlight exposure
Weight-bearing exercises

Question 24

What is known as the “silent thief” due to many people not knowing they have it?

Answer 24

Osteoporosis

Question 25

What are some risk factors for osteoporosis?

Answer 25

Women -pregnancy, menopause, breastfeeding, lower bone mass, lower Ca2+ intake

Question 26

Is obesity a risk factor for osteoporosis?

Answer 26

NO -low weight is a risk factor

Question 27

What is a major medicinal risk factor for osteoporosis?

Answer 27

Long-term corticosteroid use

Question 28

Explain osteoporosis screening guidelines

Answer 28

Initial bone density test in women over age 65, every 15 years if normal

Question 29

What are the 3 most commonly affected sites of osteoporosis?

Answer 29

Spine Hips Wrists

Question 30

Explain the BMD T-score test

Answer 30

Diagnostic test for osteoporosis Bone Mineral Density T-score -compared to ideal bone density of 30-year old

Question 31

What is the most common screening tool for osteoporosis that also assesses effectiveness of treatment?

Answer 31

DXA Test

Question 32

What are bisphosphonates? Give 2 examples, MOA

Answer 32

Meds for osteopororis -inhibit osteoclast resorption Alendronate Ibandronate

Question 33

What is a major adverse effect of bisphosphonates and how is it prevented?

Answer 33

Esophageal Burns! Take meds w/ full glass of water Take 30 min before/after food or other meds Remain upright for 30+ mins after taking

Question 34

List 3 contraindications for bisphosphonate meds

Answer 34

Hypocalcemia Esophageal dysfunction Inability to sit upright for 30 mins after meds

Question 35

Explain SERMs -what for? -MOA? -examples?

Answer 35

Selective Estrogen Receptor Modifiers -Osteoporosis meds -Stimulate estrogen receptors on bones- increases bone density Raloxifene Tamoxifene

Question 36

What are some AEs of SERMs?

Answer 36

hot flashes, leg cramps increased VTE risk

Question 37

What are 2 contraindications of SERMs?

Answer 37

Pregnancy History of blood clot