Med Aspects Final

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Anonymous
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151337
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Med Aspects Final
Updated:
2012-05-01 01:00:10
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LBP Diabetes Osteoporosis
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Three chapter overview
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  1. Osteoporosis
    • Low bone mass
    • Structural deterioration of bone tissue leading to fragility
  2. How many males will have an osteoporotic fracture?
    1 in 8
  3. How many females will have an osteoporotic fracture?
    1 in 2
  4. Estrogen in osteoporosis
    • Estrogen levels drop postmenapaus, which leads to osteoporosis
    • Bone spairing
  5. Who has osteoporosis
    • 20% white women 50 and older
    • 5% black women 50 and older
    • 10% hispanic women 50 and older
  6. Osteopenia
    • Low bone mass
    • T score of -1 to -2.5
    • 68% fall w/in stan. dev
    • 95% w/in 2 stan. dev
    • 99% w/in 3 stan. dev
  7. Mesenchymal cell
    • leads to pre-osteoblast
    • eventually leading to mature osteoblast
  8. Increase in blood calcium leads to...
    • Increased secretion of calcitonin which stimulates osteoblasts
    • Osteoblasts decrease the calcium in blood
  9. Decreased blood calcium leads to...
    • Increased secretion of parathyroid hormone
    • This leads to increases in osteoclast activity and increase in blood calcium levels
  10. How does an osteoclast break down bone?
    • Suction to bone, creates acetic environment through proton pumping
    • Seals off by useing alphav-beta3 integrin
  11. RANKL'D
    • Stimulation of RANKL protein stimulates osteoclast production
    • Parathyroid is stimulated by low blood calcium levels
    • Osteoprotegrin blocks RANKL protein preventing stimulation of osteoclast activity
  12. Maintaining homeostasis in blood calcium levels
    • High levels of calcium stimulate thyroids release of calcitonin which is a powerful inhibitor of osteoclasts
    • Low levels of calcium stimulates parathyroid gland to secrete parathyroidhormone which stimulates osteoclasts
  13. Vit D and osteoporosis
    Vitamin D increases calcium absorption from GI tract
  14. Wolff's Law
    Overload principle applied to bone - A bone will respond to the load imposed on it
  15. BMD w/ resistance training
    BMD increases
  16. What activities increase BMD?
    Activities that require constant loading - plyometric type activities best
  17. Primary osteoporosis
    Associated with the process of normal aging (0.5-1.0% loss/yr after 30 y.o.
  18. Type I osteoporosis
    • Menopause related (post-menopausal)
    • -2 to -6.5% bone loss per year (trabecular bone)
  19. Type II osteoporosis
    • Age related (senile)
    • 50-70 y.o., trabecular loss, vertebrae, wrist, and femoral neck fractures
  20. Secondary osteoporosis
    • Caused by certain medical conditions and medications
    • Acromegaly, cushing's syndrome, hyperparathyroidism, intestinal malabsorption, Marfan's syndrome, scurvy
    • Also can be caused by antacids, cortisone therapy, heparin, lasix, methotrexate, and thyroid hormone
  21. Hypothalamic adenoma and osteoporosis
    May cause stimulation of GHRH which causes GH release of pituitary leading to acromegaly, and hypothalamus may also release CRH which stimulates release of cortisol which breaks down protein, which is found in the bone matrix
  22. Heparin and osteoporosis
    Heparin increases release of thyroid hormone which causes universal breakdown of tissue
  23. Methetrexate and osteoporosis
    chemo drug which inhibits bone growth
  24. Which bone goes first in osteoporosis
    Trabecular bone
  25. Risk factors for osteoporosis
    • Female
    • Advancing age
    • Caucasian race
    • Low body mass
    • premature menopause or prolonged premature amenorrhea
    • Low calcium intake
    • Chronic smoking and/or excessive alcohol
    • Chronic corticosteroid
  26. Fractures
    • >70% in people > 70 y.o
    • Each 1 SD decrease in bone mass increases fracture risk by 15%
  27. When should BMD be tested?
    • Women over the age of 65
    • Women with post menopause bone fracture
    • Women on HRT for prolonged periods
    • Men with low testosterone levels
  28. Antacids and osteoporosis
    Large antacid use leads to low BMD
  29. HRT
    hormone replacing therapy is associated with increase risk of cancer
  30. Osteoporotic symptoms
    • Collapsed vertebrae
    • Kyphosis posture
  31. Wedge fracture
    Kyphosis can cause decreased space in the anterior component of the disk
  32. Which sites are most common for fracture
    • Wrist
    • Vertebrae
    • Femoral neck
  33. What percent of hip fracture patients over the age of 50 die within a year
    25%
  34. Slipped disk
    Gel portion of disk is pushed thru cartilage and puts pressure on the spinal nerves
  35. Estrogen
    • inhibits bone remodeling behavior (osteoclast behavior)
    • Also endothelial protecting, decreasing risk of CAD
  36. Calcitonin
    • Reduces blood Ca++ levels
    • decreases Ca++ resoprtion
    • decreases osteoclast activity
    • decreases Ca++ reabsorption
  37. SERM (Selective estrogen receptor modulator)
    • Not estrogen, but binds to estrogen receptors
    • Increase BMD
    • Decrease risk of CAD
  38. Bisposphates
    Inhibit osteoclast activity
  39. Calcium supplementation
    • > 60 y.o. take 1200 mg/day
    • But remember, you can only absorb 500 mg/ingestion so spread the doses
    • Females > 50 y.o. take 1500 mg/day
  40. Lumbago
    Low back pain
  41. #1 complaint ages 25-60
    Low back pain
  42. Acute low back pain
    Less than three months of pain
  43. Chronic low back pain
    Greater than 3 months
  44. What causes low back pain?
    • Osteoporosis/arthritis
    • spinal stenosis
    • Nerve impingement
    • Trauma, sprain, strain
    • Muscle contracture
  45. Sciatica
    • Pain and impingement caused by impingement in the lumbosacral area
    • Often due to weak core
  46. Normal spinal curvature
    • Cervical lordosis
    • Thoracic kyphosis
    • Lumbar lordosis
    • Sacral kyphosis
  47. Sprain
    Ligament damage/tear
  48. Strain
    Muscle damage/tear
  49. Muscles causing posterior tilt
    • Abdominals
    • hamstrings
    • gluteals
    • illiacus, quads, sartorius, TFL
  50. Muscles causing anterior pelvic tilt
    • Erector spinae
    • Illiopsoas
  51. Tight iliopsoas
    Lumbar lordosis
  52. Weak abdomen
    anterior pelvic tilt
  53. Normal posture
    • ASIS line up with pubic symphysis
    • Femoral head should line up with lumbar L5
    • Ears and ASIS
  54. Anterior tilt
    • Hip flexors tight
    • Abdominals weak
  55. How should you sit in a chair?
    On your ischeal tuberosity, with knees at 90˚
  56. How should you lift objects?
    Close to your body to decrease the lever length
  57. Diabetes insipidous
    • Kidneys unable to hold water (lack of ADH)
    • Glucose in urine
  58. Gestational diabetes
    Occurs during the third trimester
  59. Type I diabetes
    Hypoinsulinemia
  60. Type II diabetes
    Hyperinsulinemia
  61. Phaeochromocytoma
    • Cancer in the adrenal medulla
    • Prevents release of insulin
  62. Roles of insulin
    • Increase glucose uptake, oxidation, and storage in cells
    • Increase TAG storage
    • Decrease TAG breakdown
    • Increase aa uptake and protein synthesis
    • Inhibit action and release of anti-insulin hormones
  63. Insulin insufficiency
    • Increased adipocyte lypolysis
    • Increased blood glucose
    • Increased FFA (increased LDL, VLDL)
    • Increased ketone production
    • acetone form ketone production causes fruity breath
  64. Symptoms of diabetes
    • Glycosuria
    • Polyuria
    • Polydipsia (thirsty)
    • Polyphagia (hungry)
    • Lethargic/fatigue
  65. Glycosylated hemoglobin
    • Eventually, glucose binds to hemoglobin. Since this process takes a while it gives a bit of history to how long you have been hyperglycemic
    • Normal < 6.5% of Hb
  66. Blood insulin
    7-20 uU/ml is normal
  67. C-peptide
    0.5 - 3.0 is normal
  68. Kussmaul respiration
    • Deep, labored, gasping
    • caused by ketoacidosis
  69. Diabetic ketoacidosis (diabetic coma)
    pH dropped too far
  70. Arteriosclerosis
    Calcification of fatty plaque causing artery to be stiff and hard
  71. Microvascular disease
    • Retinopathy
    • Nephropathy (40%-50% will have renal disease) 2/3 of these will have kidney faiure and need a transplant
  72. Diabetic neuropathy
    16-58% will eventually develop gangreen
  73. Diabetic management of diabetes
    • Decrease total kcals if obese (300-500 kcals/day to lose 1-2 lbs)
    • 55-70% CHO's
    • Cholesterol <300 mg
  74. IDDM feeding schedule
    3 meals + 3 snacks
  75. Insulin like effect of exercise
    • Muscle contractions stimulate glucose to go from blood to muscle
    • May last up to 48 hours
    • Prolonged exercise can increase HDL by 50% and drop triglycerides by 50%
    • Increase insulin receptors and glut-4 carriers in cell

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