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Skin/MSk > Exam 6 Bone Pathology > Flashcards

Exam 6 Bone Pathology Flashcards

1
Q

List different non-neoplastic bone diseases

A

Fractures, osteoporosis, osteomalacia, osteomyelitis, avascular bone necrosis/infarction, Paget’s disease, congenital bone disorders

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2
Q

What is the differential diagnosis of osteopenia?

A

Osteoporosis, osteomalacia, malignancy, rare hereditary disorders

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3
Q

What are neoplasms involving bone?

A

Metastatic tumors to skeleton, hemic malignancies that usually infiltrate bone

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4
Q

What is a pathological fracture?

A

fracture through diseased bone- usually refers to fracture through tumorous or tumor-like bone

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5
Q

What does PTH do to osteoclasts?

A

Increases their activity resulting in increased calcemia

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6
Q

Where does vitamin D come from?

A

Diet and skin synthesis (from sun)

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7
Q

What stimulates the release of PTH and increased conversion of vitamin D into it’s active form in the kidneys?

A

Hypocalcemia, hypophosphatemia

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8
Q

What is needed for healthy bones in an adult?

A

Calcium and phosphorous, vitamin D, good absorption at gut, good vit D conversion in kidneys, parathyroid hormones

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9
Q

What is the first thing that happens at a fracture site?

A

Blood clot

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10
Q

What happens when the periosteum experiences stress?

A

In can differentiate into osteoblasts and lay down new bone

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11
Q

What are some complications of a fracture through healthy bone?

A

Mal-alignment, non-union/mal-union/pseudoarthritis, osteomyelitis, growth disturbances, arthritis, FAT embolism, immobilization complications

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12
Q

What is osteoporosis

A

osteopenia caused by an imbalance of the bone remodeling process

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13
Q

What usually happens to give a patient a diagnosis of osteoporosis?

A

Typically a fracture of a bone is the first clinical manifestation

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14
Q

What is the bone density level of people with osteoporosis?

A

2.5

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15
Q

What are different diseases associated with osteoporosis?

A

postemenopausal women, excess corticosteroids, hyperparathyroidism, hypertheyroidism, poor nutrition/malabsorption, immobilization, hypogonadism

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16
Q

What can osteoporosis of the spine lead to?

A

kyphosis

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17
Q

What is the best prevention of osteoporosis?

A

maximize peak bone mass, encourage weight-bearing exercises and calcium supplementation

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18
Q

What does primary hyperparathyroidism cause?

A

Hypercalcemia

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19
Q

What can cause hypercalcemia?

A

primary hyperplasia of parathyroid gland, or neoplastic enlargement

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20
Q

What causes secondary hyperparathyroidism?

A

renal disease

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21
Q

T/F: most hypercalcemia is caused by a malignancy?

A

TRUE

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22
Q

Define osteomalacia

A

decreased bone mineralization with excess osteoid

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23
Q

What is associated with osteomalacia?

A

environmental problems (rickets), instestinal malabsorption, liver or renal disease, rare congenital errors of metabolism

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24
Q

What is the biochemical profile of osteomalacia?

A

Increased serum alkaline phsophatase, low serum calcium, decreased urinary calcium, increased PTH, decreased vit D

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25
Q

What is the childhood version of osteomalacia? What causes it?

A

Rickets; poor diet

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26
Q

What is the classical presentation of rickets?

A

Widened/distorted growth plates, bowed legs due to softened bone, fractures

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27
Q

What causes renal osteodystrophy/osteomalacia?

A

Progressive destruction of second hydroxylation step of vit D, often secondary hyperparathyroidism and abnormal mineralization

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28
Q

Define osteomyelitis

A

infection of a bone

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29
Q

What is the primary, secondary, and direct ways of acquiring osteomyelitis?

A

Primary: spread from often occult source, Secondary: spread to bone from adjacent infection, direct: compound fractures

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30
Q

What is the most common bacteria that causes osteomyelitis? What are others?

A

Staphylococcous aureus, Streptococcus, salmonella in sickle cell patients

31
Q

Are xrays good at detecting early osteomyelitis?

A

NO, often not detectable before 10 days after initial infection

32
Q

what is the best way to detect early bone infection?

A

Bone scans and MRI

33
Q

Where do most osteomyelitis start?

A

Metaphyseal marrow space

34
Q

What are long term complications of suppurative (bacterial) osteomyelitis?

A

Suppurative arthritis in adjacent joints, sinus tracks to skin, growth disturbances (children), deformity, amyloidosis

35
Q

what is the most common cause of osteomyelitis in adults?

A

direct extension from adjacent infections, or injection of bugs

36
Q

What are associations of bone infection in adults?

A

Compound fractures, contamination during orthopedic surgical procedures,

37
Q

What is the treatment of suppurative osteomyelitis?

A

Need high index of suspicion for early/timely diagnosis, Aggressive abx treatment, surgical drain/debride, maybe amputation

38
Q

What are complications of a reactivation of tuberculosis?

A

Osteomyelitis of the spine (Pott’s disease) and long bones

39
Q

What population is most likely to have Pott’s disease in the US?

A

Immigrants from third world countries

40
Q

Where does osteomyelitis often start?

A

In the lungs, spreads via blood stream

41
Q

What are the most common causes of avascular bone necrosis/infarction?

A

Fractures, corticosteroids, alcoholism

42
Q

What bone does avascular bone necrosis/infarction usually affect?

A

Femoral head (femoral neck fractures)

43
Q

What diseases/incidents are associated with avascular bone necrosis?

A

CORTICOSTEROID THERAPY, Fractures, Legg-calve-perthes disease (random osteonecrosis of femoral head), alcoholism, Gaucher’s disease, SLE, sickle cell anemia, Caisson’s disease

44
Q

What does avascular bone necrosis often present as clinically?

A

Subchondral infarcts (pain w/ activity), medullary infarcts (often silent), Multiple infarcts (corticosteroid therapy)

45
Q

What are complications of avascular bone necrosis?

A

Secondary degenerative joint disease, bone growth deformities (childhood), pathologic fracture

46
Q

What population most commonly gets Paget’s disease (osteitis deformans) of bone?

A

Middle-aged and elderly anglo-saxon adults

47
Q

What is the current theory of Paget’s disease (osteitis deformans)?

A

Due to latent viral infection of osteoclasts in genetically susceptible person

48
Q

What are the three phases of Paget’s disease?

A

Lytic (osteoclasts), Mixed (osteoclasts and osteoblasts), sclerotic (osteoblastic)

49
Q

What are clinical/imaging features of Paget’s disease?

A

Widening/bowing of long bones, distorted/widened pelvic bones, general weakening of affected bone causing fractures

50
Q

What are the symptoms of Paget’s disease?

A

Principally pain due to fractures, compression of spinal nerves, sometimes skin overlying affected bone is warm during lytic/vascularization

51
Q

What are the biochemical hallmarks of Paget’s disease?

A

Older person with increased alkaline phosphatase, normal serum calcium, no hepatobiliary disease

52
Q

What are hallmarks of congenital bone disorders?

A

Localized absence or duplications of bones, malformation of craniospinal axis, achondroplasia, osteogenesis imperfect, osteopetrosis

53
Q

What is the basis for osteogenesis imperfecta?

A

congenital disorders of type 1 collagen

54
Q

What information do x rays give for bone tumors?

A

likelihood of primary v metastatic lesion (w/ age), ability to subtype primary bone tumors by location and x-ray character, can separate benign and malignant

55
Q

What are the classifications of bone tumors x rays can give you?

A

osteolytic, osteoblastic, mixed

56
Q

What is a classic example of purely osteolytic malignancy?

A

myeloma

57
Q

What is a classic example of largely osteoblastic malignancy?

A

metastatic prostate cancer

58
Q

Where is the most common site for metastatic tumor to skeleton from?

A

Visceral cancers: lung, breast, prostate cancer

59
Q

T/F: Most bone cancers are caused by metastasis

A

True

60
Q

What are hemic malignancies affecting bone?

A

Classic myeloma, plasmacytoma of bone, lymphoma (non-hodgkin’s), Leukemia

61
Q

Where does leukemia always affect?

A

Bone marrow, can cause diffuse multifocal bone/joint pain

62
Q

Where do most primary tumors arise in bones?

A

Metaphyses

63
Q

What are most common benign tumors seen in bones?

A

Osteochondroma, giant cell tumor, chondroma, osteoid osteoma, fibroma

64
Q

What are most common malignant tumors seen in bone?

A

Osteosarcoma, chondrosarcoma, lymphoma, Ewing’s sarcoma, chordoma

65
Q

What is the most common primary malignant tumor in children/young adults?

A

Osteosarcoma

66
Q

What is the most common malignancy in middle-age/older adults?

A

Chondrosarcoma

67
Q

What is the treatment for primary bone tumors?

A

Pre-surgical chemotherapy, surgery, chemotherapy and radiation post surgery

68
Q

T/F: giant cell tumors are malignant?

A

False but some can be… it’s a gray area

69
Q

What is the most common bone lesion?

A

Metaphyseal fibrous defect (fibroma, fibrous cortical defect)

70
Q

What can osteosarcoma be secondary to?

A

Paget’s, prior irradiation, old bone infarcts

71
Q

What are the most lethal variants of chondrosarcoma?

A

Dedifferentiated and mesenchymal

72
Q

Where is chondrosarcoma often found?

A

Long bones and central skeleton (pelvis)

73
Q

what is the most aggressive and lethal bone tumors?

A

Ewing’s sarcoma

74
Q

What age group is typically affected by Ewing’s sarcoma?

A

peripubertal ages

Skin/MSk (31 decks)

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