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58 Cards in this Set
- Front
- Back
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What are the 5 functions of bone?
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1) support & shape
2) movement 3) protection 4) storage of minerals 5) hematopoiesis |
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What kind of bone is haphazart in appearance and forms the medullary cavity?
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Trabecular/cancellous/spongy bone
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What's the difference b/t cortical and trabecular bone?
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1) cortical bone
-lamellar bone ONLY -slow, orderlly deposition of collagen fibers -outer covering 2) trabecular bone -lamellar AND woven bone -rapid, haphazard deposition of collagen fibers -in medullary cavity |
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What is responsible for the growth in width of bone?
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Periosteum
=called appositoinal growth |
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What is the function of the periosteum?
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1) osteoblastic/osteoclastic activity, in the inner cambium layer
2) growth/repair/nutrition |
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What is the function of the endosteum?
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-osteoblastic/osteoclastic activity
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Explain what the metaphysis has to do with neoplasms.
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It is the most metabollically active anatomical division of bone which creates a higher probability that it could have an abnormal proliferation of cells (neoplasms).
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What are the 4 anatomical divisions of bone?
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1) Epiphysis
2) Physis 3) Metaphysis 4) Diaphysis |
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What is the secondary growth center of bone?
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epiphysis
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What is the growth plate of bone?
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physis
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What is the remodelling area and most metabolically active part of bone?
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metaphysis
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What is the shaft of bone and has bone marrow?
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diaphysis
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What pathologies is the epiphysis vulnerable to?
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"DINA"
Dysplasias Ischemia Neoplasms Arthritis |
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What pathologies is the physis vulnerable to?
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abnormal growth
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What pathologies is the metaphysis vulnerable to?
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1) neoplasms (metabolically active)
2) ischemia (venous pooling & stasis) |
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What types of pathologies is the diaphysis vulnerable to?
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"MEL"
Multiple Myeloma Ewing's Sarcoma Leukemia |
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Osteoclasts ___________ to operate than osteoblastas.
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Require more energy and oxygen
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The cytoplasm of what blood cell contains the enzyme alkaline phophatase?
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Osteoblasts
-anytime bone is being built there are high levels of the enzyme in the blood. |
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Ischemia leads to __________ osteoblastic activity.
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Increased
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What are the 3 types of bone cells?
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1) osteoblasts
2) osteocytes 3) osteoclasts |
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What is the function of osteoblasts?
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-secrete & synthesize osteoid
-initiate bony mineralization |
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What is the function of osteocytes?
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-transport fluid thru canniliculi
-regulate cell environment (mediators of Wolff's Law) |
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What is the function of osteoclasts?
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-multinucleate cells responsible for bone resorption
-function only if matrix is mineralized |
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What type of bone formation uses a preexisting cartilage model?
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Endochondral bone formation
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What are the 2 methods of bone formation?
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1) intramembranous bone formation
2) endochondral bone formation |
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Give a simple definition of intramembranous bone formation.
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-bones form directly from osteoblasts clustered within a fibrous membrane
-there is no preexisting cartilage model -predominates in skull and facial bones where greater flexibility is needed |
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Give a simple definition of endochondral bone formation.
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-preexisting cartilage model calficies and is replaced by bone
-primarily in paired structures where a predetermined outcome is needed |
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What process can lead to bone infection?
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venous stasis & pooling
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Why is a metaphysis subject to ischemis in developing bone?
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vasculature is restricted from crossing the cartilage growth plate prior to skeletal maturity so it is isolated and subject to ischemia.
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Based on blood supply, which part of a bone in a child is most vulnerable to infection?
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-the metaphysis is supplied by systemic vessels
-prior to skeletal maturity, the area is subject to venous stasis and pooling. -thish could cause infections at bone ends |
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Based on blood supply, which part of a bone in a child is most vulnerable to ischemia?
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-the epiphysis is supplied by vessels surrounding the joint
-the vasculature is unable to cross the cartilage growth plate prior to skeletal maturity, so it is isolated -children are therefore vulnerable to no growth or bone death = ischemic or avascular necrosis at bone ends |
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True or False:
Cervical referred symptoms are characteristic of Cervical Radiculopathy. |
False:
-it is characteristic of sclerogenic (discogenic) pain |
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True or False:
UMN involvement is characteristic of Cervical Radiculopathy. |
False:
-it is due to Cervical Myelopathy |
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Name the 4 different possible clinical presentations of DJD (Osteoarthritis).
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1) Asymptomatic
2) Sclerogenic (discogenic) pain 3) Cervical Radiculopathy 3) Cervical Myelopathy |
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Correlate radiographic changes with clinical finding of Asymptomatic DJD.
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May be little correlation b/t degree of x-ray changes and patient symptoms.
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Correlate radiographic changes with clinical finding of Sclerogenic (discogenic) pain of DJD.
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X-ray:
-damaged discs, ligaments, and joints Clinical Findings: -cervical referred pain *may refer to occiput, inrascapular region, shoulders, and arm |
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Correlate radiographic changes with clinical finding of Cervical Radiculopathy of DJD.
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X-ray:
-IVF encroachment Clinical Findings: -dermatomal patterns of referral, due to nerve root compromise -changes are predominantly sensory over motor due to location |
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Correlate radiographic changes with clinical finding of Cervical Myelopathy of DJD.
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X-ray:
-spinal canal stenosis -disc protrusion -osteophytes Clinical Findings: -UMN involvement -gradual onset of weakness & loss of motor control -radiating pain & numbness |
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On X-ray, how are DJD and DISH the same?
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-located in the spine
-new bone/ossification |
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On X-ray, how are DJD and DISH different?
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DJD
-loss of cartilage = decrease joint space -lipping & spurring (osteophytes) at jt. margins -subchondral sclerosis/ eburnation -radiolucent subchondral cysts DISH -preservation of jt. space -flowing calfication and ossification anterior aspect of at least 4 contiguous bodies -absence of ankylosis in apophyseal and SI jts. |
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Name the x-ray listing that will separate Charcot's joints (neurotrophic arthropathy) from RA or DJD.
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Dislocation (one of the 6 D's)
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What is the underlying pathology in neurotrophic arthropathy (Charcot's Joints)? List clinical findings and x-ray findings that may be seen with these patients.
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X-ray:
*in weight bearing joints =hypertrophic changes (the 6 D's) *in non-weight bearing joints =atrophic (deterioration) changes Clinical findings: -may start w/painless joint effusion (water in knee) -altered gait, loss of DTR, pain insensitivity -recurrent joint effusion, enlargement, instability, crepitus (crackling sound of jt) |
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Compare & contrast the X-ray findings of DJD and RA, list 5 finding for each.
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DJD
-both occur in hand (DIP/PIP) -non-uniform loss of jt space -lipping/spuring at jt margins (horizontal osteophyts) -asymmetric distribution -subchondral sclerosis -articular (cartilage) deformity RA -both occur in the hand (MCP/PIP) -uniform loss of jt space -erosions at jt margins -symmetric distribution -juxta-articular osteoporosis -jt deformity |
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Locate Heberden's nodes, Bouchard's nodes, and Haygarth's nodes with respect to DJD and RA.
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DJD
1) Heberden's nodes (DIP) 2) Bouchard's nodes (PIP) 3) Haygarth's nodes (none) RA 1) Heberden's nodes (none) 2) Bouchard's nodes (PIP) 3) Haygarth's nodes (MCP) |
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Describe the pathophysiological process of RA.
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-inflammatory autoimmune rxn of the synovial tissue causing synovitis
-an inflammatory exudate called Pannus overlies synovial cells & destroys cartilage & erodes bone causing: *loss of jt space at corner of bone that is bilateral & symmetrical *causes jt to become swollen, warm, and stiff which restricts & prevents use |
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Prior to inflammation of the joints', what clinical signs and symptoms maybe exhibited by an RA patient?
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-fatigue
-malaise -general muscle weakness -low grade fever -stiffness worse in morning -insidious onset of pain and stiffness |
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What other inflammatory arthropathies have a similar clinical presentation to RA?
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1) DJD
-stiffness worse in morning -insidious onset of pain and stiffness 2) DISH -stiffness worse in morning |
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What lab & x-ray findings could help you tell RA, DJD, and DISH apart?
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1) RA
-soft tissue swelling -juxta-articular osteoporosis -marginal erosion -symmetrical loss of jt space -only one with abnormal labs: *90% + RF *Rheumatoid nodule biopsy *90% elevated ESR *80% anemia 2) DJD -horizontal osteophytes -subchondral sclerosis -asymmetrical loss of jt space 3) DISH -vertical flowing calcification -preservation of jt space |
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How is JRA the same as, and different than adult RA?
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JRA
-fever (very common) -rash (very common) -chronic iridocyclitis (very common) -large jts most often affected -non-articular (soft tissue) - growth abnormalities common -Lab: Leukocytosis common -in people <16 years old Adult RA -fever (uncommon) -rash (uncommon) -chronic iridocyclitis (uncommon) -symmetrical jts most often affected -non-articular (soft tissues) subcutaneous nodules common -Lab: RF common -in people >16 years old |
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Both Systemic Lupus Erythematosis and Progressive Systemic Sclerosis represent inflammatory disorders of CT that affect multiple organ systems. What clinical findings, ie: pt hx, and exam, enable you to tell them apart?
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SLE
-most pts have jt pain because up to 90% have non-erosive synovitis -90% of women in childbearing age, 20's & 30's -skin can get a rash, generally in places exposed to sunlight -may have hairloss (alopecia) PSS (Scleroderma) -50% of pts have dysphagia -Women are 3X more likely but 30-50 years old -skin becomes hardened and scarred -skin looks tight & thick & is also darkened due to increase in melanin -70% of pts have pulmonary involvement |
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Compare the clinical findings of SLE and PSS.
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SLE
-CC: polyarthralgias (jt pain) in 40% of pts -initial S/S are: *fever *malaise *anorexia *wt. loss *rash -rash symmetrical over face, neck, elbows, dorsum of hand, brought on by sunlight -alopecia -chronic and characterized by exacerbations and remissions PSS -in general, see skin changes first -may begin with Raynaud's Phenomena (discoloration of fingers/toes due to vasospastic disorder) *maybe initiated by cold or stress -rheumatoid-like pain & stiffness in finger & knee jts -50% of pts have dysphagia |
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Compare the x-ray findings of SLE and PSS.
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SLE
-normal jt spaces -reversible deformities -generalized osteoporosis -spinal manifestations are unusual -soft tissue atrophy, calcium deposits PSS -usually normal jt spaces -resorption of soft tissues of fingers w/retraction of tips -resorption of terminal tufts of the distal phalanges, become sharp and tapered -maybe diffuse osteopenia -calcinosis of soft tissue in 20%of pts |
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What pathology is related to abnormal levels of ESL and C-Reactive protein?
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No pathology is able to be distinguished as these are both present with general inflammation, they are not distinguishing findings.
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What lab result is almost diagnostic for lupus?
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A positive FANA test
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C.R.E.S.T is associated with what pathology?
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Scleroderma
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What are the lab findings that would allow you to distinguish b/t RA annd SLE?
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SLE: a positive FANA test
RA: a positive rheumatoid factor test |
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What does C.R.E.S.T stand for?
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C = calcinosis
R = Raynaud's phenomena E = esophageal dysfunction S = scleroderma T = telangiectasia |
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What are the 6 D's (hypertrophic changes seen in weight bearing jts in Charcot's joints)?
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1) Distension
2) Density 3) Debris 4) Dislocatiion 5) Destruction 6) Disorganization |
