Pathophys 4 Disorders Of Bone- Alterations In Growth/dvlpmnt

Front 1

What are the major factors that affect growth?

Back 1

Trauma-separation of epiphysis
Nutrition- vit c,d, ca xu
Hormones- GH, Thyroid

Front 2

The inactive form of vit d is ___
the active form is ___
it is converted by ____

Back 2

25 Cholicalciferol
1,25 Dihydrocholicalciferol
converted by KD

Front 3

in the embryonic stage the
ectoderm forms the ___
the mesoderm forms the ___
the endoderm forms the ____

Back 3

Skin/nervous sys
skeleton, muscles, ht, kd
Gi, respiratory sys

Front 4

bone starts budding the what time during gestation?
when does ossification begin?

Back 4

4th week
9th week

Front 5

What is the pathology of Osteogenesis Imperfecta?
what causes this?

Back 5

defective synth of connective tissue and bone matrix
caused by autosomal dominant or recessive gene

Front 6

how does osteogenesis imperfecta manifest in the recessive type?
dominant type?

Back 6

recessive type: stillbirth, iu multiple fractures usually during 3rd trimester

dominant: onset during childhood when child becomes active- mistaken as child abuse

Front 7

what is the pathology of developmental dysplasia of the hip?

this is best to manage if detected during ____. how is it treated?

Back 7

congenital dislocation of the hip causing a delay in maturation, size and dvlpment of the femoral head and acetabulum

best management if detected in the first 6 months (most growth)
immobilize the hip in abduction to manage

Front 8

list the manifestations and warning signs of dvlpmntl hip dysplasia

Back 8

Asymentry of hip/gluteal fold
shortening of thigh- 1 knee higher than other
ltd abduction of affected hip-inability to open
+Barlow/Ortolani Sign
Baby sleeps with a straight leg

Front 9

Toeing-in occurs during ___dvlpmnt
and it is due to ______

Explain Toeing-out

Back 9

Caused during normal devlpmnt
it is inversion of the foot/leg usually due to uneven dvlpmnt of muscles in the lower leg

eversion of foot/leg, external femoral roation

Front 10

Toeing-in/out can or cannot be fixed?

Back 10

can be fixed

Front 11

What is Genu-valgum
What causes this?

Back 11

deformity causing decreased space btwn the knees

Lax medial collateral ligament of the knee

Front 12

what are the warning signs of osteoporosis?

Back 12

there are no warning signs unless you fracture a vertebrae/hip/distal radius causing pain
vertebrae may collapse causing height loss and/or kyphosis

Front 13

explain the difference between osteoporosis and osteomalacia

Back 13

porosis: increase porosity of bones due to a loss of bone mass the rate of resorption is great than rate of formation

malacia: bone softening due to a mineral xu

Front 14

what are the pathologic changes that occur with osteoporosis?

Back 14

marrow canal widens making cortical bone thinner
more porous/spongy bone due to loss of trabeculae

Front 15

what pathologic change occurs with osteomalacia?

Back 15

demineralization of bone causes softening

Front 16

what are the manifestations of osteomalacia?

Back 16

bone PAIN!
muscle weakness
bone deformitites (kyphosis, bowleg)
secondary hyperthyroidism (result of osteomalacia- increase blood Ca)
pathologic fracture

Front 17

what are the pathologic changes of Pagets Disease?

Back 17

rapid bone resorption(osteoclasts-too fast)) followed by production of abnormal bone that is rough and pitted- often precursor to osteosarcoma

Front 18

what are the manifestations of Pagets Disease?

Back 18

nerve pasly/compression
cardiovascular disorder-tachycardia causing death
ventilation failure

Front 19

what are the test results needed that will diagnos pagets disease?

Back 19

xrays
blood test- increased alkaline phosphatase
urine test- increased hydroxyproline

Front 20

what is the tx for Pagets Disease?

Back 20

anti-inflammatory drugs
Calcitonin- antagonist to osteoclast function
Mithramycin- anti-metabolite cancer drug

Front 21

How can Osteoporosis be prevented?

Back 21

exercise
1500mg Ca/day
400-800 IU Vit D
HRT
Calcitonin
Biphosphonates (prevent resorption of bone)

Front 22

what are tophi and when do they appear?

Back 22

=accumulation of uric acid in a joint/ear that manifests outward and is filled with a pasty/chalky white substance that is easy to rupture

occurs in cases of CHRONIC Gout

Front 23

Genu Varum vs Genu Valgum

Back 23

Varum=bowleg
Valgum=knock knees - lax medial collateral ligament

Front 24

what is the pathology of scoliosis?

Back 24

lateral deviation of the spinal clum

Front 25

what are the manifestations of scoliosis?

Back 25

high shoulder
prominent hip
projecting scapula
pain/sob

Front 26

what are the causes of structural classifications of scoliosis?

Back 26

congenital-strctrl anomolies during embyronic dvlpmnt
neuromuscular- neuropathic/myopathic diseases
idiopathic

Front 27

What is the pathology of Coxa PLana Leg-Calve-Perthes? what groups are most affected by this disease?

Back 27

avascular necrosis of bone and marrow of the epiphyseal growth center in the femoral head
affects mostly white boys between 2-13yrs

Front 28

what are the stages of Coxa PLana Leg-Calve-Perthes?

Back 28

Synovitis (1-3 weeks)
Avascular necrotic (months-year)
Re-vascularization-resorb necrotic
bone
Healing-mature cell replacement

Front 29

what are the manifestations of Coxa PLana Leg-Calve-Perthes?

Back 29

Pain in groin/thigh/hip- causing limping
Ltd Abduction/internal rotation
progressive onset and prolonged course

Front 30

What is the pathology of Osgood Schlatter disease?

what is the cause?

Back 30

tendonitis/tearing of the tibial tubercule due to pulling on tendon

caused by stress placed on the knee during critical growth period-quick growth

Front 31

what groups are most likely to experience Osgood Schlatter Disease?

Back 31

boys 11-15yrs ***
girls 8-13yrs

Front 32

what are the manifestions of Osgood Schlatter Disease?

Back 32

knee pain upon exercise
resolves after closure of tibial growth plate

Front 33

what is the pathology of gout?

Back 33

accumulation of uric acid in blood that precipitates in the joints/periphery causing uric a in the synovial fluid or in tophaceous deposits

Front 34

gout is more likely to occur in men-or-women? what age range?

Back 34

men >40yrs

Front 35

what causes gout?

Back 35

overproduction of uric acid- metabolic waste product of purine
underexcretion of uric acid by the KD

Front 36

what drugs can interfere with the excretion of uric acid?

Back 36

salicylate and thiazide drugs

Front 37

uric acid is excreted via the ____

Back 37

KDs

Front 38

describe the pathogenesis of Gout

Back 38

rise in uric acid-> precipitates in joints->chemotaxis of PN->phagocytosis of uric acid-> death of PN->lysosomes released-> destruction of cartilage and subchondral bone

Front 39

what are the cardinal s/s of acute gout?

Back 39

inflammation/severe pain in big toe for few days/weeks

Front 40

what is intercritical gout?

Back 40

similar to remission
clinical manifestations disappear and affected joints seem normal (however- uric acid levels in blood will still be hi)

Front 41

what is the principle behind treating gout?

Back 41

try to preserve joints - chronic inflammation will cause destruction

Front 42

T/F
hi uric acid levels in blood (hyperuricemia) = gout

Back 42

F
in order to be gout there must be swollen/tender joints in addition

Front 43

what drugs can be used to treat gout?

Back 43

NSAIDS, colchichine, corticosteroids- treat pain/inflammation

Allopurinol- treat hyperuricemia by blocking xanthine oxidase enzyme needed to convert xanthin/purine to uric acid

Front 44

what is the ezyme needed to convert purine to uric acid?

Back 44

xanthine oxidase

Front 45

what are some lifestyle and dietary options to help treat/prevent gout?

Back 45

maintain ideal weight
reduce alcohol
avoid LV, KD, Sardine, Anchoive