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4 - radiology > bone pathology > Flashcards

bone pathology Flashcards

1
Q

Describe the histological layout of compact bone?

A

Units are called osteons or a Haversian system
Between these are interstitial lamellae
Blood vessels are found in the Haversian canals
Osteons have concentric lamellae which contain osteocytes

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2
Q

What 3 systemic hormones are involved in bone remodelling?

A

PTH
Vitamin D3
Oestrogen

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3
Q

What role does PTH play in bone remodelling?

A

Produced in response to low blood calcium
It acts to increase blood calcium by stimulating bone resorption, releasing calcium and phosphate from bone matrix into the bloodstream

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4
Q

What role forms Vitamin D3 play in bone remodelling?

A

Enhances the absorption of calcium and phosphate from the diet
Also promotes mineralisation of newly formed bone by stimulating activity of osteoblasts

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5
Q

What role does oestrogen play in bone remodelling?

A

Inhibits bone resorption by regulating the activity of osteoclasts
It suppresses the production and activity of osteoclasts

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6
Q

What special tests can be carried out for bone biochemistry?

A

Blood calcium
Osteoblast activity
Osteoclast activity
PTH
Vitamin D assays

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7
Q

What are tori and give examples and clinical relevance?

A

Developmental exostosis that give problems with fitting dentures
Torus palatinus - midline of palate
Torus/tori - mandibularis

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8
Q

What is osteogenesis imperfecta, what are the clinical features and what is is associated with?

A

Type 1 collagen defect
Inheritance varied - 4 main types
Clinical features include weak bones and multiple fractures
Sometimes associated with dentinogenesis imperfecta

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9
Q

What is achondroplasia?

A

An autosomal dominant condition causing poor endochondral ossification
Causes Dwarfism

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10
Q

What is osteopetrosis?

A

A lack of osteoclast activity causing failure of resorption and marrow obliteration

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11
Q

What is fibrous dysplasia and who is affected?

A

An uncommon gene defect
Causes a slow growing, asymptomatic bony swelling - bone is replaced by fibrous tissue
Active in those under 20, stops growing after growth period usually

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12
Q

How does fibrous dysplasia present clinically?

A

Can be monostotic single bone) or polyostotic (many bones)
More commonly monostotic
Affects maxilla more than mandible
Causes facial asymmetry

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13
Q

What are 2 names for the appearance of fibrous dysplasia?

A

Ground glass appearance
Orange peel appearance

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14
Q

How does fibrous dysplasia appear radiographically?

A

Margins often blend into adjacent bone
Bone maintains approximate shape (initially)
Becomes more radiopaque as lesions matures

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15
Q

Describe the histology of active fibrous dysplasia

A

Fibro-osseous
Fibrous replacement of bone - cellular fibrous tissue
Bone is metaplastic or woven but will remodel and increase in density

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16
Q

What is rarefying osteitis and what should be considered as differential diagnoses?

A

Localised loss of bone in response to inflammation
Always occurs secondary to another form of pathology
If at apex of tooth - consider apical periodontitis, periapical granuloma or periapical abscess

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17
Q

What is sclerosing osteitis, where is it most common and how may it progress?

A

Localised increase in bone density in response to low-grade inflammation
Most common around the apex of a tooth with a necrotic pulp
May lead to external resorption if chronic

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18
Q

What is idiopathic osteosclerosis, where is it most common and how does it present?

A

Localised increase in bone density of unknown cause
Also known as dense bone island
Most common in premolar-molar region of mandible
Always asymptomatic
No bony expansion and no effect on adjacent teeth/structures

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19
Q

How can you identify idiopathic osteosclerosis from sclerosing osteitis?

A

Sensibility test the tooth involved - if no response then Sclerosing osteitis

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20
Q

What is alveolar osteitis and how does it present?

A

Dry socket
A complication of extraction, particularly difficult lower molars
Severe pain, loss of clot and bone sequestra
Has varied and unknown aetiology

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21
Q

What is osteomyelitis?

A

A rare endogenous infection that can be acute or chronic
Endogenous - arises from microorganisms present within the body

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22
Q

How does osteomyelitis present clinically and what infections are often seen?

A

Sequestrum
Actinomycosis - post extraction infection caused by Actinomyces
Chronic diffuse sclerosing osteomyelitis
Periostitis productive (Garre’s sclerosing osteomyelitis) - found in children
Suppuration is rare

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23
Q

Describe the aetiology of bone necrosis

A

Osteomyelitis - acute or chronic
Avascular necrosis:
- age related ischaemia
- anti-resorptive medication
Irradiation:
- osteoradionecrosis - prone to infections

24
Q

Give 3 examples of metabolic bone diseases

A

Osteoporosis
Rickets and osteomalacia
Hyperparathyroidism

25
Q

What conditions are osteoclast inhibitors used for?

A

Osteoporosis
Paget’s disease
Bone metastasis

26
Q

Where is osteonecrosis most found?

A

Affects the mandible more than the maxilla
60% are related to a dental procedure

27
Q

How is osteonecrosis managed?

A

Conservative - extract as a last resort
If established then supportive care

28
Q

What is osteoporosis?

A

Bone atrophy - where resorption exceeds formation
An endo steal net bone loss
A quantitative deficiency (bone formed is normal)

29
Q

What are the clinical features of osteoporosis?

A

Symptomless
Weak bone
Antrum enlarged

30
Q

What is the radiographic feature of osteoporosis?

A

Loss of normal bone markings

31
Q

What are the aetiological factors for osteoporosis?

A

Oestrogen deficiency
Age
Calcium status
Physical activity

32
Q

What is secondary osteoporosis and give 4 causes of it

A

Caused by an underlying medical condition:
- hyperparathyroidism
- Cushing’s syndrome
- diabetes mellitus
- thyrotoxicosis

33
Q

What is rickets and osteomalacia?

A

Vitamin D deficiency - lack of sunlight, poor diet, malabsorption, renal causes
Osteoid forms but fails to calcify
Poor endochondral bone formation
Low calcium
Raised alkaline phosphatase

34
Q

What is hyperparathyroidism?

A

Calcium mobilised from bones
Generalised osteoporosis

35
Q

What are the types of hyperparathyroidism?

A

Primary - neoplasia/hyperplasia
Secondary - hypocalcaemia (due to vitamin D deficiency)
Tertiary - hyperplasia as a result of prolonged secondary

36
Q

What is the incidence of primary hyperparathyroidism?

A

Affects 1 in 1,000
Mainly post-menopausal woman
Affects females over males in 3:1 ratio
90% of these have increased PTH - hypercalcaemia and increased bone turnover

37
Q

What is osteitis fibrosa cystica?

A

Generalised osteoporosis
Focal osteopathic lesions
Giant cell lesions (brown tumours)

38
Q

Give 2 examples of giant cell lesions of the jaws

A

Peripheral giant cell epulis
Central giant cell granuloma

39
Q

What is the incidence of giant cell lesions of the jaws?

A

Age 10-25
Affects mandible > maxilla

40
Q

What are the 3 differential diagnoses of giant cell lesions of the jaws?

A

Osteitis fibrosa cystica
Aneurysmal bone cyst
Giant cell tumours (very rare)

41
Q

What is cherubism?

A

A rare autosomal dominant inherited condition
Multicystic/multilocular lesions seen in multiple quadrants
Grow before about 7 years then regress after puberty

42
Q

What is seen histologically in cherubism?

A

Vascular giant cell lesions

43
Q

How does Paget’s disease of bone present clinically?

A

Bone swelling
Pain
Nerve compression

44
Q

What is Paget’s disease?

A

Abnormal bone remodelling leading to enlarged and weakened bone

45
Q

What is the incidence of Paget’s?

A

Mostly in age >40
Affects males more than females

46
Q

How does Paget’s present radiographically?

A

Loss of lamina dura
Hypercementosis
Migration (due to bone enlargement)
Can be monoatomic or polystotic

47
Q

Describe the histology of Paget’s

A

Increased bone turnover
Osteoclastic and osteoblastic activity

48
Q

What are the complications of Paget’s?

A

Infection
Tumour

49
Q

Give 2 examples of bone tumours?

A

Osteoma
Osteoblastoma

50
Q

Describe an osteoma?

A

Solitary
Mostly affects cortical bone
Slow growing
If multiple then consider Gardner’s syndrome

51
Q

How do ossifying fibromas present clinically?

A

Slow growing
Affects a wide age range
Mainly found in the mandible
Radiologically - well-defined
Histologically - celllular fibrous tissue
Acellular calcifications

52
Q

Give 2 examples of cementum lesions

A

Cementoblastoma
Cemento-osseous dysplasias

53
Q

What is a cementoblastoma?

A

Neoplasm attached to the root
Histology the same as Osteoblastoma

54
Q

What is a cemento-osseous dysplasia and name the different types?

A

A radiolucency which turns into calcification
Types:
- periapical COD
- focal COD
- florid COD

55
Q

Describe osteosarcomas

A

Rare
Most common in age 30s - if in elderly then likely Paget’s
Affects mandible > maxilla
Varied clinical and radiographic presentation
Causes local destruction
High recurrence and metastasis

4 - radiology (8 decks)

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