deposition of monosodium urate (MSU) crystals → acute inflammation
(due to excessive nucleotide turnover or decreased excretion)
3
Risk factor for gout?
Show answer
male sex, genetic predisposition, diet, hypertension, diabetes, kidney disease and medications like thiazide diuretics and aspirin
4
What process is initiated by MSU crystals in the synovial fluid?
Show answer
inflammatory process
5
What are the primary symptoms of the condition described?
Show answer
Inflammation, pain and joint swelling
6
What is the diagnostic method for gout
Show answer
Identification of MSU crystals
7
Treatment for acute flare of gout
Show answer
NSAIDs and steroids to control inflammation
8
What is the long-term treatment approach for this condition?
Show answer
urate lowering therapy like allopurinol
9
What is the most common form of age-related joint disease?
Show answer
Osteoarthritis
10
Which joints are commonly affected by osteoarthritis?
Show answer
Synovial joints
Knee, hip, hand, and spine joints
11
Cause of osteoarthritis
Show answer
destruction of the articular cartilage → joint damage
12
What are the primary risk factors for osteoarthritis?
Show answer
Female, older age (>60), obesity, and joint trauma
13
What are the primary symptoms of osteoarthritis?
Show answer
• Pain and burning, worse with activity
• morning stiffness
• Motor restriction
• Joint noises or grinding sounds
14
Treatment options for osteoarthritis?
Show answer
NSAIDs, intra-articular glucocorticoids, lifestyle and surgery
15
What is the most common type of inherited dwarfism?
Show answer
Achondroplasia
16
Etiology of achondroplasia
Show answer
Gain of function mutation
17
What does the gain of function mutation in FGFR3 inhibit?
Show answer
Cartilage synthesis at the epiphyseal growth plate
18
Characteristics of achondroplasia
Show answer
• Disproportionate dwarfism
• Bowed lower legs, and trident hand
• Flat bones (skull, trunk) are usually normal leading to relatively large head and trunk.
• Crowded/misaligned teeth, and maxillary hypoplasia
19
What is the medical term for short and thick extremities?
Show answer
Disproportionate dwarfism
20
What condition is characterized by extra space between the middle and ring fingers?
Show answer
Trident hand
21
What is the medical condition known as 'Marble bone disease'?
• Hereditary
• decreased osteoclast function and decreased bone resorption
• dense, thickened but defective bones (stone bones) that can fracture easily
24
What is the genetic cause of the autosomal recessive 'infantile' condition?
Show answer
mutations in carbonic anhydrase 2 (CA2) gene
impairs the ability of osteoclasts to generate acidic environment
What is the genetic cause of the autosomal dominant 'Adult benign type' condition?
Show answer
mutations in chloride channel 7 (CLCN7) gene
27
What are the symptoms of the autosomal dominant 'Adult benign type' condition?
Show answer
ranging from asymptomatic to pathological fractures, vision/hearing loss
28
Management options for the congenital form of osteopetrosis?
Show answer
Bone marrow transplant and Supportive: calcium, vit. D supplementation, erythropoietin
29
Management of Osteopetrosis Tarda
Show answer
supportive to repair fractures, physical therapy
30
What causes Osteogenesis Imperfecta?
Show answer
autosomal dominant mutations
• genes encoding α1 and α2 chains of type I collagen
• (example: COL1A1 and COL1A2)
• leading to defective collagen type I synthesis
31
What are the types of Osteogenesis Imperfecta?
Show answer
Nine subtypes with different severity
• type I is the mildest, type II fatal, III-IX variable symptoms
32
What are common symptoms of Osteogenesis Imperfecta?
Show answer
Brittle bone, blue discoloration for the sclera, hearing loss
33
Dentinogenesis imperfecta results in...
Show answer
small, fragile, and discolored teeth due to dentin deficiency
34
Treatment of osteogenesis imperfecta
Show answer
bisphosphonates, surgical, physical therapy
35
What is Paget's Disease?
Show answer
Increased bone remodeling of undetermined cause
affects adults over 50 years old
36
What happens in the lytic phase of Paget's disease
What happens in the mixed phase of Paget's disease
Show answer
• OC activity with highly increased OB activity
• produces a disorganized bone → deformed bone
38
What happens in the Osteosclerotic phase of Paget's disease
Show answer
OB activity is predominant → disorganized, thicker and weaker bone
39
What is the predominant activity in the osteosclerotic phase of Paget's Disease?
Show answer
Osteoblast activity
40
Symptoms of Paget's disease
Show answer
depend on severity and stage
• initially asymptomatic
• bone pain
• increase risk of fractures
• bone deformation
• enlarged skull
• enlarged jaw bones.
41
Management approach for Paget's Disease
Show answer
bisphosphonates and calcitonin
42
What is Osteomalacia
Show answer
Rickets
Bone softening disease
43
What is the primary cause of osteomalacia in adults?
Show answer
defective mineralization of bone matrix or cartilaginous growth plates
• secondary to vit D deficiency
• Decreased vit D = ↓ serum calcium, ↑ PTH, ↓ phosphate level
44
Symptoms of osteomalacia - Children
Show answer
• softening of the bones
• impaired bone growth
• altered gait/bowlegs
45
Symptoms of osteomalacia - Adults
Show answer
bone fragility, increase risk of fracture or falls, bone/joint pain
46
What is the main treatment for osteomalacia?
Show answer
Vit D and correction of calcium intake
47
What is the most common bone disorder?
Show answer
Osteoporosis
48
What is osteoporosis?
Show answer
low bone density and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility
49
Osteoporosis characteristics
Show answer
– Loss of bone matrix
– Thinning of cortical bone
– Increased bone fractures
– Localized or generalized
50
Statistics on osteoporosis
Show answer
• Women (50+) = 19.5%
• 1.5 million fractures annually
• vertebral > hip + pelvic fractures
51
Which type of fracture is most commonly caused by osteoporosis?
Show answer
vertebral fractures
52
What is the term for the peak bone mass that occurs during early adulthood?
Show answer
Peak Bone Mass
53
Which hormone is associated with increased bone resorption during menopause?
Show answer
Estrogen
54
What is the primary factor leading to increased bone resorption in menopausal osteoporosis?
What type of tumors are associated with a higher risk of MRONJ?
Show answer
myeloma
101
What genetic factor is associated with a sixfold increase in MRONJ risk?
Show answer
polymorphisms in the RBMS3 gene
102
Comorbidities associated with a higher risk of MRONJ?
Show answer
anemia, diabetes mellitus, and renal failure
103
Why is the jawbone turnover significantly higher than many other bones?
Show answer
• Alveolar bone turnover significantly higher - incorporate more bisphos
• least-protected from infection - proximity to oral microflora
• mechanical stress
• Embryonic origin
104
Factors of MRONJ
Show answer
• inhibition of OC activity
• inhibition of angiogenesis
• inflammation/infection
• soft tissue toxicty
105
What is the primary factor leading to the inhibition of angiogenesis?
Show answer
Interruption of vascular supply
106
What is the primary cause of soft tissue toxicity?
Show answer
Increased apoptosis of multiple cell types (bisphosphonates)
107
What is the first step in the prevention process?
Show answer
Pretherapy: Dental exam and screening
108
What should be discussed during antiresorptive therapy?
Show answer
Patient education, OHI, follow up
109
What is a key technique used in emergency dental care?
Show answer
• coordination of care between providers
• surgical/conservative techniques
• drug holiday (controversial)
110
What is the description for patients in the 'At risk category'?
Show answer
• Asymptomatic patients treated with IV/oral antiresorptive therapy
• No apparent necrotic bone
111
Patients at Stage 1 of MRONJ
Show answer
• Exposed and necrotic bone/fistula probes to the bone
• asymptomatic patients
• no evidence of infection/inflammation
112
What is the description for Stage 2 patients?
Show answer
• Exposed, necrotic bone/fistula that probes to the bone
• patients are symptomatic
• clear signs of infection or inflammation
113
Stage 3 of MRONJ
Show answer
• Exposed and necrotic bone or fistulae that probes to the bone
• pain, infection, 1+ of:
• fracture, extra-oral fistula, osteolysis in inferior border of mandible or sinus floor
114
What is the MRONJ staging for patients with no clinical evidence of necrotic bone but non-specific clinical findings?
Show answer
Stage 0
115
Which stage involves exposed and necrotic bone or fistula that probes to bone, associated with infection as evidenced by pain and/or drainage?
Show answer
Stage 2
116
What is the recommended treatment for Stage 3 MRONJ?
Show answer
Surgical debridement/resection for longer term palliation of infection and pain