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HistoPath > Histopathology 15: Bone Pathology > Flashcards

Histopathology 15: Bone Pathology Flashcards

1
Q

What part of long bones encompasses the growth plates ?

A

Metaphysis

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2
Q

What are some of the main differences between cancellous and cortical bone ?

A

Cortical

  • Occurs in the long bones
  • 80% of skeleton
  • Appendicular component
  • 80-90% calcified
  • Mainly mechanical and protective

Cancellous

  • Found in the vertebrae and pelvis
  • 20% of skeleton
  • Axial component
  • 15-25% calcified
  • Mainly metabolic function
  • Large surface
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3
Q

How do osteoblasts inhibit osteoclast formation ?

A
  • Osteoblasts release osteoprotegrin (OPG)
  • which inhibits RANKL from binding to the RANKL receptor on osteoclast precursors
  • This blocks differentiation into mature osteoclasts.
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4
Q

List fractures commonly seen in patients with osteoporosis ? (4)

A
  • Colle’s fracture of the wrist
  • neck of femure and intertrochanteric fractures of the hip
  • Pelvic
  • Vertebra
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5
Q

What are the biochemistry findings in a patient with osteoporosis ?

What is best Ix?

A

Normal calcium, phosphate, ALP

Ix: Bone Densitometry

  • -1 to -2.5 = osteopaenia
  • < - 2.5= osteoporosis
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6
Q

What are the histological findings in osteoporosis ?

A

Loss of cancellous bone

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7
Q

List 2 ty typical X-ray findings suggestive of Osteomalacia ?

A

Bowing of the legs in Rickets
Horizontal pseudofractures in looser’s zones

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8
Q

List signs and symptoms of Rickets in children ?

A

Bone pain
Bowing tibia
Rachitic rosary
frontal bossing
Pigeon chest
Delayed walking

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9
Q

What is a histological feature of Osteomalacia ?

A

reduced mineralised bone relative to the osteoid (less mineralisation)

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10
Q

List symptoms of hyperparathyroidism?

A

Basically Sx of hypercalcaemia:

  • Moans - depression, confusion
  • Stones- calcium oxalate renal calculi
  • Bones- bone pain
  • Groans- constipation, pancreatitis, polyuria
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11
Q

Which metabolic bone disease shows histological bone changes of osteitis fibrosa cystica ?

A

Hyperparathyroidism

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12
Q

List 3 x-ray findings suggestive of hyperparathyroidism ?

A
  • Brown’s tumours (osteitis fibrosa cystica)
  • Salt and pepper skull
  • Subperiosteal bone resorption in phalanges
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13
Q

What is renal osteodystrophy ?

A

A term that describes all skeletal changes associated with chronic renal disease

  • Increased bone resorption (osteitis fibrosa cystica)
  • Osteomalacia
  • Osteosclerosis
  • Growth retardation
  • Osteoporosis
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14
Q

What is the most common causative organism for osteomyelitis in adults ?

A

S.Aureus

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15
Q

List 2 histological findings in Paget’s disease ?

A

Huge Osteoclasts with >100 nuclei
Mosaic/jigsaw pattern of lamellar bone (due to line between areas of new bone formation)

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16
Q

List the x-ray features of osteoarthritis ?

A

L- loss of joint space
O- osteophytes
S- subchondral sclerosis
S- subchondral cysts

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17
Q

List 2 features of osteoarthritis in the hands ?

A

Heberden’s nodes (DIP joints)
Bouchard’s nodes (PIP joints)

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18
Q

List 6 features of rheumatoid arthritis in the hands and wrist?

A

Sparring of the DIP joints
Radial deviation of the wrist
Ulnar deviation of the fingers
Swan neck deformity of the fingers
Boutonniere’s deformity of the fingers
“Z” shaped thumb

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19
Q

Joint spared in rheumatoid arthritis

A

DIP (distal interphalangeal joint)

20
Q

List 3 histological features of rheumatoid arthritis ?

A

Proliferative synovitis
Pannus formation
Grimley sokoloff cells- multinucleate giant cells

21
Q

Which infectious organism causes osteomyelitis with Langerhans-type giant cells on histology ?

A

Tuberculosis

22
Q

Name of lesion in gout (pathogenic)

A

Tophus

23
Q

Which shape Chrystal are seen in gout and pseudogout?

A 
Gout = needle shaped 
Pseudogout = rhomboid shaped
24
Q

Which syndrome has the following features: Blue sclera, hearing loss, miss shaped teeth and recurrent fractures ?

A

Oesteogenesis imperfecta (autosomal dominant)

25
Q

Describe the 4 stages of fracture repair ?

A
  1. Organisation of haematoma
  2. fibrocartilaginous callus formation
  3. Mineralisation of fibrocartilaginous callus
  4. remodelling of bone along weight bearing lines
26
Q

Brown cell tumours are a histological feature of which condition?

A

hyperparathyroidism

27
Q

Main joint in gout

Main joint in pseudogout

A

Great toe

Knee

28
Q

Type of cell seen on histology in Ewing’s sarcoma

A

small round blue cells

Also see onion-skinning of the periosteum

29
Q

Most common primary bone sarcoma and where it mainly occurs

Key feature on X-ray

A

Osteosarcoma - knee

Codman’s triangle

30
Q

5 tumours that metastasise to bone in children

A
  • neuroblastoma
  • Wilm’s tumour
  • osteosarcoma
  • Ewing’s sarcoma
  • Rhabdomyosarcoma
31
Q

2 main bones affected in Paget’s disease

A

Lumbar spine

Skull

32
Q

Which mechanism regulates osteoclast formation and function

A

Paracrine molecular mechanisms

33
Q

Name for reduced bone mass

A

Osteopaenia

34
Q

How to study Bone mineralisation

A

Using osteoid parameters

35
Q

Drug that increases R of osteoporosis

A

Steroids

Affect ALL THREE types of cell (Osteoclasts, -blasts and -cytes)

36
Q

Main Primary cause of hyperpPTH

3 causes of secondary

A
  • Parathyroid adenoma (85-90%)
  • Chronic renal insufficiency
  • Vitamin D deficiency
  • Malabsorption
37
Q

Main bones affected in osteomyelitis (4)

A
  • Vertebrae
  • Jaw (secondary to dental abscesses)
  • Toe (secondary to diabetic skin ulcers or vascular ulcers, > 3mm)
  • Long bones (usually metaphysis)
38
Q

Where can you get an abscess in TB?

A

Psoas

39
Q

X-ray changes in osteomyelitis

A
  • Usually appear 10 days after the onset of osteomyelitis
  • Mottled rarefaction and lifting of periosteum
  • > 1 week: irregular sub-periosteal new bone formation is seen which is called involucrum (layer of new bone that forms around dead bone)
  • Later: irregular lytic destruction (takes 10-14 days)
  • Some areas of the necrotic cortex may become detached. This is called sequestra (takes 3-6 weeks)
40
Q

Organism in syphilis

A

Treponema pallidum

NB a rare cause of osteomyelitis

41
Q

Organism causing lyme disease

A

Borrelia burgdorferi

42
Q

Late presentation of Lyme disease

A

arthritis

NB earlier presentation = the classic rash that looks like target sign (erythema migricans)

43
Q

Aetiology of osteoarthritis

A
  • degenerative joint disease - mainly age-related
  • synovium becomes very chronically inflamed with infiltration of inflammatory cells
44
Q

HLA associated with rheumatoid arthritis

A

HLA-DR4 and DR1

45
Q

Histology of rheumatoid arthritis

A
  • Proliferative synovitis (Thickening of synovial membrane)
  • Pannus formation with exuberant inflamed synovium
  • Grimley-Sokoloff cells

HistoPath (21 decks)

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