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Terms in this set (96)
Etiology of Osteomalacia
Vitamin D deficiency
What is vitamin D needed for?
To absorb calcium in the small intestine.
What are the 4 causes of Vitamin D deficiency in the body?
1) inadequate dietary intake
2) lack of sunlight
3) malabsorption of vitamin D
4) errors in Vitamin D synthesis
Two Signs and symptoms of Osteomalacia
1) skeletal deformation (particularly in bones with predominance of cancellous bone)
2) looser's zones (areas that may appear as fractures)
What is cancellous bone also known as?
Which bones are affected by osteomalacia?
All bones (however, it is first noticed in cancellous bone)
Bone is _____and is constantly being _____.
1) living tissue
2) constantly remodeled
Diagnosis of Osteomalacia
Low serum D3
Treatment of Osteomalacia
Vitamin D supplementation
When does the onset of RA take place?
In RA what triggers the genetic predisposition?
Many scientists believe RA to be what kind of disorder?
Pathophysiology of RA
1) Antibody complexes imbed
2)Inflammation of the synovial capsule (synovitis)
3) Later episodes will lead to the creation of pannus
4) Pannus releases enzymes and cytokines that destroy the cartilage
5) Erosion creates an unstable joint
1) Antibody complexes ______.
2) Inflammation of the _________.
3) Later episodes lead to the creation of _______.
4) Pannus releases _____ and ____ the destroy _______.
5) ______ creates ______.
2) synovial joint
3) a pannus
4) enzymes, cytokines, cartilage
5) Erosion, an unstable joint
What type of hypersensitivity reaction is Rheumatoid Arthritis?
Type III hypersensitivity reaction
Pannus is ____ tissue that has spread of the _____ ______.
granulation tissue, articular cartilage
Fibrosis is when a ____ becomes ____ and limits _____.
Pannus, fibrotic, movement
Ankylosis is ____ or ____ of the _____ due to _______ _____.
fixation or fusion of the joint due to calcified pannus
Six Signs and Symptoms of RA
1) Progressive joint inflammation in MCP and PIP Joints
3) joint tenderness
4)ulnar deviation of phalanges
5) periarticular pressure erosions of bone from soft tissue nodules
6) Rheumatoid pannus
What is a rheumatoid pannus?
inflamed synovial tissue
What are the MCP and PIP joints?
metacarpophalangeal joint and Proximal interphalageal joint
Diagnosis for Rheumatoid Arthritis
1) Morning stiffness >=1 hour
2) Arthritis of >=3 joints
3) Arthritis of hand joints
4) Symmetric Arthritis
5) Rheumatoid Nodules
6) Serum rheumatoid factor
7) Radiologic changes
(American College of Rheumatology says if a person has at least 4 out of 7 of these symptoms then they are positive for RA)
Treatment of Rheumatoid Arthritis
3) Physical therapy
Duchenne's Muscular Dystrophy
Caused by chromosome X-linked recessive disorder
X-linked recessive disorder leads to what?
Inability of muscle cells to repair the sarcolemma.
DMD usually affects who?
Boys ages 3-7
Signs and Symptoms of DMD
1) ____ weakness
3) difficulty ____ ____.
4) ____ girdle followed by ____ girdle
5) death by age ____.
6) _____ maneuver
1) Proximal muscle weakness
2) Waddling gait, toe-walking, lordosis
3) difficulty climbing stairs
4) Pelvic girdle followed by pectoral girdle
5) Death by age 20
6) Gowers maneuver
What is Gowers Maneuver?
Pushing to a stand using the hands to climb up the legs
Diagnosis of Duchenne's Muscular Dystropy
1) Clinical Findings
2) Family History
3) Biopsy (Usually not done because of cost)
Treatment of Duchenne's Muscular Dystrophy
1) No specific therapy
2) Exercise is encouraged
Duchenne's Muscular Dystrophy is a degenerative condition with no cure. What does this mean?
It will continue to get worse until it causes death
Is Duchenne's Muscular Dystrophy painful?
Vertebral disc herniation publicly known as "slipped disc" is the leakage of ____ _____ through the ____ _____ of the disc.
The leakage of the nucleus pulposus through the annulus fibrosus of the disc
Why is the term slipped disc not accurate?
The Vertebral disks CANNOT actually slip at all they are fused together.
What is a nucleus pulposus
The inner core of the vertebral disc which is composed of a jelly-like material.
What is the annulus fibrosus of the disc?
The tough circular exterior of the intervertebral disc that surrounds the nucleus pulposus.
Etiology of Vertebral Disc Herniation (2)
Vertebral Disc Herniation
___ or ____ causes the ____ fibers of the _____ ___ to weaken allowing for the ___ ___ to leak through.
1) age or trama causes the collagen fibers of the annulus fibrosus to weaken allowing for the nucleus pulposus to leak through
Signs and Symptoms of Vertebral Disc Herniation
1) if the ____ impinges of the ___ ___ or ___ ___, it can produce ____ or a ____ pain through a ___ or in the ___ wall depending on the location of the ______.
2) If the ___ does not impinge on the ____ ___ the condition is often _____.
1) If the pulposus impinges on the spinal cord or spinal nerve, it can produce numbness or a shooting pain through a limb or in the body wall depending on the location of the herniation
2) If the herniation does not impinge on the spinal cord this condition is often asymptomatic
1) Patient history
2) Spinal X-ray
3) CT scan
Treatment of vertebral Disc Herniation (4)
2) Pain relievers
3) muscle relaxants
4) removal of disc and fusion of spine
With Vertebral Disc Herniations, why cant the patients body repair itself?
Because there is no blood supply to this area of the body.
Vertebral disc herniation is ____ and must be repaired via ____.
Bones are ___ and ___ due to decreased amount of ____ tissue.
Bones are brittle and porous due to decreased amount of calcified tissue
Etiology of Osteoporosis
Pathophysiology of Osteoporosis (2)
1) usually secondary to another disease (Cushing's disease) or menopause
2) Postmenopausal women do not absorb dietary calcium well causing calcium to be liberated from the bone in order to maintain a proper serum calcium level
Diagnosis of Osteoporosis (4)
1) X-ray (usually of the calcaneal this checks bone density most used diagnostic technique)
2) Bone Scan
4) Bone Biopsy
Treatment of osteoporosis (3)
1) Increased dietary intake of calcium
2) Resistance excersizes
3) Hormone therapy
Give an example of resistance therapy and why does this help with osteoporoses
Weight lifting. This causes skeletal muscles to contract thus putting stress on the bone and simulating it to become thicker or lay down new bone.
Give an example of hormone therapy
Estrogen and progestroene pills
Achondroplasia is what?
Etiology of Achondroplasia (2)
1) Autosomal dominant genetic defect
2) Mutation in FGFR3 gene
What is FGFR3
R3- receptor 3
Fibroblasts are ___ ___ cells that make ____
Connective tissue cells that make collagen
What does collagen do in bone growth?
Collagen forms the foundation for bone mineral crystals to attach to and begin growth
Pathophysiology of Achondroplasia
1) Defect produces irregular ______ masses without ____ structure in ____ cartilage.
2) A thin, horizontal plate of ____ tissue and ___ soon separates the cartilage from the ___ and its blood vessels halting further _____ growth.
1) Defect produces irregular chondrocyte masses without architectural structure in epiphseal cartilage
2) A thin, horizontal plate of fibrous tissue (where your hialine cartilage should be) and bone soon separates the cartilage from the epiphysis and its blood vessels, halting further extremity growth.
What type of bone growth is not affected?
Membranous bone growth
Signs and Symptoms of Achondroplasia (6)
1) Bulky forehead
2) Saddle nose
3) Lumbar lordosis
4) bow legs
5) arms and legs are disproportionately short
6) Head looks abnormally large (but is actually an illusion the head size is normal for age)
What causes lumbar lordosis and bow legs in achondroplasia patients?
There own body weight.
Treatment of achondroplasia
Management of achondroplasia
1) Surgical intervention to repair malformed joints
2) organizations that provide social contact (for mental aspects)
Combination of enviromental and genetic, some suggest a viral cause
Signs and Symptoms of Paget's Disease
1) Bone pain
2) Cranial nerve dysfunction due to occlusion of foramen
3) Coarsely woven trabeculae are seen in X-ray
Pagets disease is most commonly found in who?
Patients over 60.
Pathophysiology of Paget's Disease
1) genetic defect creats a profound increase in ____ _____ and new bone ____, resulting in a mix of ___ and _____ processes
2) Defect over-activates ___ ____ that promotes ____ formation
1) Genetic defect creates a profound increase in bone resorption and new bone formation, resulting in a mix of lytic and sclerotic processes
2) Defect over-activates signaling pathway that promotes osteoclast formation.
Diagnosis of Paget's Disease (2)
1) Often accidentally through an X-ray taken for another reason
2) Radionucleotide bone scan will show increased uptake at pagetic sites
Treatment of Paget's Disease (3)
1) localized and asymptomatic requires no treatment
2) chemotherapy to suppress bone cell activity
3) Orthopedic surgery
2) age related
3) can be secondary to other conditions such as septic arthritis or trauma
4) Can also be caused by chronic overuse of a joint
1) degenerative condition resulting in destruction of articular cartilage and hypertrophy of marginal bone
Signs and Symptoms of Osteoarthritis (4)
1) Deep, aching joint pain
2) Crepitation may be herd in the joint
3) Narrowing of the joint space in X-Ray
4)Presence of osteophytes at joint margin
What is crepitation
Creaking of a joint
What are osteophytes?
What is the most common joint effected in osteoarthritis?
The knee joint although any joint can be infected.
Diagnosis of Osteoarthritis
1) symptoms confirmed through X-Ray
Treatment of Osteoarthritis (5)
1) Cannot be cured
2) Treat pain
3) modify activity
4) possible weight loss
5) joint replacement surgery
Chronic Disorder of uric acid metabolism
Gout Etiology (4)
may be metabolic (inherited), renal (caused by renal dysfunction), both or genetic defect
Crystals of uric acid compounds are deposited on synovial joint margins
Signs and Symptoms of Gout
1) Sudden onset of joint pain in the first metatarsophalangeal joint, although other joints may be involved
2) Pain reaches a peak and then subsides which may be accompanied by mild fever and chills
Diagnosis of Gout
1) identification of tophi in xray
2) Urinalysis to reveal hyperuricemia
What is tophi?
Treatment of Gout (4)
1) Bed rest
3) anti-inflammatory drugs
4) low-purine diet
Carpal tunnel syndrome
compression of median nerve between the flexor retinaculum and carpal bones
Pathophysiology of Carpal tunnel syndrome
Overuse causes swelling of the flexor tendon sheaths which presses on the median nerve
Signs and Symptoms of Carpal Tunnel (4)
4) burning in the hands
Diagnosis of carpal tunnel
1) patient history
2) positive Tinel's sign
What is Tinel's sign?
tingling in skin produced by pressing or tapping on damaged nerve trunk
Myasthenia Gravis is a ____ progressive _____ disease producing sporadic ____ and exhaustion of _____ muscles.
Chronic, progressive, neuromuscular disease producing sporadic weakness and exhaustion of skeletal muscles
When does Myasthenia Gravis Usually develope?
most often between the ages of 20 and 40 years old
Pathphysiology of Myasthenia Gravis
1) an ______ response to membrane receptors for ______. ____ are formed toward the receptors.
2) Prevents transmission of ___ ___ to ____ cells.
1) an autoimmune response to membrane receptors for acetylcholine, antibodies toward the receptors are formed
2) Prevents transmission of nerve impulses to muscle cell
Signs and Symptoms of Myasthenia Gravis (5)
1) Double Vision
2) Droopy eyelids
3) Blank esxpression
4) Difficulty swallowing
5) Head Bobbing
Diagnosis of Myasthenia Gravis
1) improvement of muscular function after injection with anticholinesterase drugs that prevent the breakdown of acetylcholine
2) Serum Antibodies
Treatment for Myasthenia Gravis
1) Supportive anticholinesterase drugs, corticosteroids
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