Patho chapter 10

Cortical bone has a direct blood supply. Nutrient and Perforating arteries form an anastomosis (collateral circulation) that circulates through the bone through the Haversian and Volkmann canals. Cancellous bone does not have a direct blood supply. It receives its blood supply through diffusion from the endosteal bone surface extending outward through the canaliculi.

Compare and contrast the blood supply of cortical bone and cancellous bone.

C. 1000 mg. daily

What is the recommended calcium intake for premenopausal women? A. 2000 mg. daily B. 1500 mg. daily C. 1000 mg. daily

D. a. b. and c. are all true

Which of the following are true of articular cartilage? A. Proteoglycans of the extracellular matrix resist compression forces B. Polypeptide chains give form and tensile strength C. Interstitial osmotic pressure and available fluid contribute to joint lubrication D. a. b. and c. are all true E. a. b. and c. are all false

Her OPG levels would be low. Amenorrhea results in lower estrogen levels. Estrogen increases the production of OPG in turn decreasing osteoclast activity. If estrogen levels are low, OPG levels would also be low resulting in increased osteoclast activity.

A 22-year-old competitive gymnast has experienced amenorrhea for the past 5 years. Her PCP is suspecting that she may have premature osteoporosis. Would you expect her OPG levels to be high, normal, or low? Explain why her levels would be at this level.

She is a female over the age of 55; she is obese, and she is relatively sedentary which contributes to the decreased nourishment of the joint that comes with weight bearing and range of motion.

A 60-year-old, obese female works out of her home and rarely walks due to the sedentary nature of her job. Give 2 reasons why she is at increased risk for developing OA.

This T-score indicates osteoporosis. This patient should take a Calcium and Vitamin D supplement. In addition, she should be prescribed one of the following: Estrogen, SERMs, Bisphosphonates, or Calcitonin. She should also participate in regular weight bearing and resistive exercise being careful to choose activities that would not put her at increased risk for falling.

A 68-year-old, white Caucasian female has a DEXA scan at the recommendation of her PCP. Her scan yielded a T-score of -2.6. Interpret the results of her DEXA scan. Develop a treatment plan giving a pharmacologic recommendation if applicable (be specific with name of supplement and/or class of drug), and a non-pharmacologic recommendation.

Phase 2 of gout is acute gout arthritis. The goal of treatment in this phase is to control inflammation and pain. Colchicine is a prescription drug that could be used to treat his acute inflammation. NSAIDS can also be used to treat inflammation and manage pain. This patient should be encouraged to lose weight and decrease his alcohol consumption. He should also avoid purine rich foods such as fish, bacon, and liver.

A 72-year-old male is said to be in phase 2 of gout. He is obese and has a history of alcohol abuse. Develop a treatment plan including specific pharmacologic intervention and a non-pharmacologic recommendation to manage his disease.

A. Blood work to determine uric acid levels B. Analysis of synovial fluid C. 24-hour urine specimen

A diagnosis of gout is made through which of the following tests? (mark all that apply) A. Blood work to determine uric acid levels B. Analysis of synovial fluid C. 24-hour urine specimen D. MRI of affected joint

1. Do you experience stiffness in the morning? 2. If so, does it last less than or longer than 30 minutes? 3. Does prolonged movement aggravate or alleviate your symptoms? 4. Do you ever have periods of relief, or do you experience pain daily? 5. Did your pain start in both hands or did it start with one hand and develop in the other over time? 6. What is your profession? (occupations requiring repetitive movements often lead to OA) *Note - student only has to provide 3 questions.

A patient has a bilateral presentation of pain in the PIP joints of the hands. You believe this pain is due to arthritis but are unsure whether it is a result of RA or OA. What are 3 questions you could ask this patient to help you differentiate between RA and OA?

This patient is in phase 1 of gout or asymptomatic hyperuricemia. They have elevated serum uric acid levels, but they do not exhibit symptoms of an acute attack.

A patient presents with serum uric acid levels of 7.2 mg/dL. They have no active inflammation or complaints of pain. Which phase of gout are they in? Explain how you came to this conclusion.

A. Diffusion through the endosteal surface of the bone and the canaliculi

Cortical bone receives its blood supply through the following means except? A. Diffusion through the endosteal surface of the bone and the canaliculi B. Arteries branching inward from the periosteal arteries C. Arteries branching from the medullary cavity

False, Hyperuricemia may be a result of an overproduction of purines.

T/F - if False, change the statement to make it True Hyperuricemia may be a result of an underproduction of purines.

C. A serum uric acid level greater than 6.8 mg/dL without symptoms leads to a diagnosis of gout

Each of the following are true of gout except: A. Tophi are a result of the accumulation of urate crystals B. Crystals are more likely to accumulate in the periphery C. A serum uric acid level greater than 6.8 mg/dL without symptoms leads to a diagnosis of gout D. Hyperuricemia may be a result of an overproduction of purines

Males achieve 8-10% greater peak BMD than females do; they do not go through a midlife decline of sex hormone production.

Give 2 reasons that males are at a decreased risk for developing osteoporosis than females.

The tendons and ligaments of joints serve in proprioception (the awareness of ones' position in space or movement of the body). When these structures undergo stretch or torsional strain, these proprioceptive nerve fibers will cause a reflexive response to adjust the tension on the muscles (to maintain balance and not fall over) that support the joint protecting the capsule and other joint structures.

If someone loses their balance when walking on uneven terrain, explain how tendons and ligaments work to protect the joint and structures within it.

A. 25-hydroxyvitamin D3

In the liver, the inactive form of Vitamin D is converted to which of the following? (mark all that apply) A. 25-hydroxyvitamin D3 B. 1,25-dihydroxyvitamin D3 C. 24,25-dihydroxyvitamin D3

False, Lacunae house osteocytes.

T/F - if False, change the statement to make it True Lamellae house osteocytes.

A. Often a result of chronic corticosteroid use B. Premature birth

Premature Osteoporosis is characterized by which of the following? (mark all that apply) A. Often a result of chronic corticosteroid use B. Premature birth C. An increase in intestinal calcium absorption

False, A T-score compares the bone of the patient to that of a healthy 30-year-old adult.

T/F - If False, change the statement to make it True A T-score compares the bone of the patient to that of a healthy 20-year-old adult.

False, a capsular pattern is limited range of motion in a pattern specific to a joint, indicative of a degenerative process.

T/F - if False, change the statement to make it True A capsular pattern is considered normal range of motion for a specific joint.

B. They allow no movement between them E. They are joined by dense connective tissue

Which of the following are true regarding synostoses? (mark all that apply) A. They allow limited movement between them B. They allow no movement between them C. They allow a small degree of movement between them D. They are separated by a fibrous disc E. They are joined by dense connective tissue

C. Osteoblasts

Which of the following cells regulate bone growth through the secretion of growth factors and tumor necrosis factor? A. Osteocytes B. Osteoclasts C. Osteoblasts D. Osteoprogenitor cells

C. Microfractures extend through the articular surface but not into the subchondral bone

Which of the following is false regarding structural changes in OA? A. Articular cartilage will erode over time leaving the subchondral bone exposed B. Chondrocytes enlarge and reorganize C. Microfractures extend through the articular surface but not into the subchondral bone D. Small fragments of cartilage will break off and become free-floating in the joint cavity

B. The synovium surrounds the margins of articulation and lines the articulating surfaces of the joint

Which of the following is false regarding the synovium? A. The inner membrane of the joint capsule is referred to as the synovium B. The synovium surrounds the margins of articulation and lines the articulating surfaces of the joint C. The synovium secretes fluid that facilitates movement between articulating surfaces

B. A capsular pattern C. Crepitus with movement D. Bilateral involvement

Which of the following would a patient likely exhibit on an initial physical exam if you suspect they have OA? (mark all that apply) A. A typical gait pattern B. A capsular pattern C. Crepitus with movement D. Bilateral involvement