Muscoskeletal Pathology Flashcards

Question

Dentinogenesis Imperfecta

Answer 1

No pulp | - Radiographically, see no pulp!

Answer 2

Osteopenia — decreased bone mass, bone density lower than normal Osteoporosis — decrease sufficient to increase risk of fracture - Presence of atraumatic or vertebral compression

Answer 3

- Idiopathic - Senile - Postmenopausal — decreased estrogen o Type 1/postmenopausal — increased osteoclast activity o Type 2/senile (after age of 70) — decreased osteoblast activity

Answer 4

- Endocrine disorders o Type 1 diabetes, Hyperparathyroidism,Hyperthyroidism, Hypothyroidism, Addison disease treatment (from cortisol use), Cushing syndrome, Pituitary tumors, Multiple myeloma (from treatment) - Gastrointestinal o Hepatic insufficiency, Malabsorption, Malnutrition, Vitamin C and D deficiencies - Drugs o Anticoagulants, Anticonvulsants, Chemotherapy, Corticosteroids Everything happens after peak in bone mass

Answer 5

cystic fibrosis, Ehlers-Danlos (stretchy skin), Gaucher’s disease (problems with coagulation), hemochromatosis, endocrine disorders (mostly associated with the pituitary, from excess)

Answer 6

hip; vertebral (compression and 8:1 female to male)

Answer 7

- Genetic factors - Cigarette smoking — correlated with an increased incidence of disease in women - Dietary calcium intake — role is controversial - Exercise — its role is controversial in preventing disease

Answer 8

COTTON WOOL APPEARANCE Three sequential phases - 1. Initial OSTEOLYTIC stage - 2. Mixed OSTEOBLASTIC-OSTEOCLASTIC stage, with predominance of osteoblastic activity - 3. Final burned-out quiescent OSTEOSCLEROTIC stage ``` If you touch the bone, it will feel warm Pain — not clear, may be due to microfractures Hearing loss — impingement of CN VIII Pathologic fractures High output cardiac failure Increased risk of osteosarcoma ``` Also get frontal bossing and prognathism Intraorally, see spacing (might be the CC they present for) Doesn’t affect the oral mucosa ``` Associated conditions - Arthritis - CVD — increase in cardiac output - Kidney stones - Nervous system - Enlargement of the mandible/loose teeth o From bone remodeling o More resorption than formation ```

Answer 9

- Vitamin D Deficiency or abnormal metabolism - Impairment of mineralization - Accumulation of un-mineralized matrix -Osteomalacia — disorder of adults characterized by inadequate mineralization of newly formed bone matrix -Rickets — disorder in children, interferes with the deposition of new bone in the growth plates CAUSES: - Dietary deficiency of vitamin D and inadequate exposure to sunlight - Biliary tract obstruction — no bile in intestine  no vitamin D absorption - Liver damage - Intestinal malabsorption like Crohn disease - Chronic pancreatic insufficiency/malabsorption (lipase) SYMPTOMS: - pain - muscle weakness - spinal tenderness - pseudo-fractures - skeletal deformities

Answer 10

Hyper-sescretion of PTH Osteoporosis Brown tumors Osteitis fibrosa cystica - Primary — issue with parathyroid gland - Secondary — mostly seen with renal failure, but also from vitamin D deficiency) o GROUND GLASS appearance of skull o Ectopic calcification in primary hyperparathyroidism

Answer 11

- Reparative fibrous tissue - Vascularity — hemorrhage - Hemosiderin deposition - Cystic degeneration

Answer 12

"salt and pepper appearance" to skull

Answer 13

- Transverse — perpendicular to long axis of bone - Compression/Linear — along/parallel to long axis of bone - Oblique - Oblique displaced - Torsional/Spiral — spiral fracture with combined tension and compression shear forces - Comminuted — broken into a number of pieces - Compound — bone projecting through skin - Greenstick — bending with incomplete fracture; common in children - Pathological — fracture of bone weakened by disease

Answer 14

- Bleeding - Extensive muscle necrosis - Tearing of tendons or ligament insertions - Osteomyelitis

Answer 15

- In repair, anything other than formation of bone represents incomplete healing - Hallmark of dead bone is absence of osteocytes and empty, dead lacunae - Woven bone in adult skeleton always represents a pathologic condition (fracture; it is reactive bone) - Cortical bone, defining shape of bone, comprises 80% adult skeleton - Callus — granulation tissue and woven bone, first forms towards end of inflammatory phase

Answer 16

``` Death of bone and bone marrow from ischemia Many from fractures and chronic steroids Causes: - Trauma, Injury, Increased pressure inside the bone, Corticosteroid administration (prolonged), Alcoholism Risk factors - Radiation treatment - Chemotherapy - Kidney and other organ transplants Osteonecrosis is more common in people with: - Cancer - Lupus (autoimmune diseases) - HIV - Gout - Vasculitis — inflammation of blood vessels  decreased vascularization of the area that needs repair - Osteoporosis - Sickle cell disease — sickle cells cause obstruction Reduced blood flow to bones and joints Avascular necrosis Aseptic necrosis Ischemic necrosis ```

Answer 17

Infection in bone - Staphylococci, E. Coli, Neisseria gonorrhoeae, H. influenzae, Salmonella - Should use cultures to see what antibiotics to use Direct penetration of bacteria by wounds, fractures Hematogenous — from a focus of infection elsewhere in body - E.g. from a tooth to knee, ankle, or hip Arthroplasty — surgery - Another source of infection in bone

Answer 18

Benign tumors o Epiphysis — chrondoblastoma, Giant cell tumor o Metaphysis — Osteoblastoma, Osteochondroma, Non-ossifying fibroma, Osteoid osteoma, Chondromyxoid fibroma, Giant cell tumor o Diaphysis — Enchondroma, Fibrous dysplasia Malignant tumors o Diaphysis — Ewing sarcoma, Chondrosarcoma o Metaphysis — Osteosarcoma, Juxtacortical osteosarcoma

Answer 19

- Round/oval, sessile, subperiosteal/endosteal - Skull and facial bones - Produce woven and lamellar bone - Gardner syndrome — intestinal polyps identical to Familial Adenomatous Polyposis (FAP)  multiple osteomas (mandible, skull, and long bones), epidermal cysts, fibromatosis o More prone colon cancer with adenomatous polyposis - Slow-growing but may cause obstruction of sinus - Do not transform into osteosarcoma o Grow slow but don’t become malignant

Answer 20

- Identical histologically to osteoid osteoma - More frequently involves the spine - Pain is dull and achy/no relief with aspirin

Answer 21

- Highly malignant - Most common primary malignant tumor of bone - Adolescents 10-20 years old - Males: females — 2:1   - CAUSE — Paget disease, mutations in retinoblastoma gene (Rb), p53, radiation exposure - Location — near knee or proximal humerus o Most frequently in lower limbs but can occur in the mandible too! o Knee (60%), hip (15%), shoulder (10%), mandible (8%) - SUNBURST appearance - Metastasizes hematologically to lungs - Mitotic figures

Answer 22

Half as frequent as osteosarcoma - Second most common malignant matrix-producing tumor of bone - Produces a matrix of hyaline and myxoid cartilage - Usually 40 years and older - Clear cell in younger patients, teens and twenties - Men to women — 2:1 and no racial predilection - Most common locations — pelvis, shoulders, ribs - Clear variant — in epiphyses of long tubular bones (tibia) - Metastasize to lungs

Answer 23

Breast, prostate, lung, thyroid, and kidney

Answer 24

OSTEOLYTIC LESIONS/PUNCHED OUT RADIOLUCENCIES - Malignant tumors of plasma cells - Production of monoclonal antibodies - Bence-Jones protein in urine - Men > Women — 2:1 - Average age of 65 - Lesions in bone are exclusively lytic - Spine, ribs, pelvis, and femur - Pathologic fractures are common - Amyloid deposits in kidney (myeloma kidney) o Causes kidney disease

Answer 25

- Benign tumor o Slow growing and fibrotic, so bone won’t feel warm - All elements of bone present but development arrested - Monostotic — affects one bone o Femur, tibia, ribs, jawbones, calvarium, humerus - Polyostotic — affects multiple bones o Femur, skull, tibia, humerus, ribs, fibula, radius, ulna, mandible, and vertebrae Pathologically see a sea of CHINESE CHARACTERS

Muscoskeletal Pathology Flashcards

(49 cards)