Musculoskeletal Pathology - Bikman

Question 1

Describe the differences between osteoblasts, osteoclasts, osteocytes

Answer 1

Osteoblasts- creates bone matrix and signals osteoclasts
Osteoclasts- degrades bone
Osteocytes- embedded osteoblasts

Question 2

What is the ligand that activates osteoclasts?

Answer 2

RANK

Question 3

What regulates RANK?

Answer 3

Osteoprotegerin (OPG)

Question 4

Osteogenesis Imperfecta

Answer 4

Congenital Disease 
Many types based on collagen
Blue Sclera
Dentinogenesis imperfecta 
Multiple fractures 
Hearing loss

Question 5

Achondroplasia

Answer 5

Congenital Disease
Dwarfism
Affects the long bones
Autosomal dominant

Question 6

Osteopetrosis

Answer 6

Congenital Disease
"stone bone" 
Bone cannot be reabsorbed 
Dense, but brittle bones 
Autosomal recessive and dominant 
Delayed erruption of teeth

Question 7

Fiberous Dysplasia

Answer 7

Congenital Disease
Replacing bone with soft tissue
Three types: monostotic, polystotic, McCune-Albright Syndrome

Question 8

Osteoporosis

Answer 8

Acquired Disorder
Loss of bone, but same ratio of minerals
Primary- from age
Secondary- from everything else

Question 9

Paget Disease

Answer 9

Acquired Disorder
Random excess bone formation
Can cause osteosarcoma, heart disease, deafness or blindness

Question 10

Ricketts / Osteomalacia

Answer 10

Acquired Disorder
Deficiency in Vitamin D
Ricketts- young
Osteomalacia- older 
Weak tooth enamel; higher risk for caries

Question 11

Hyperparathyroidism

Answer 11

Acquired Disorder
Primary- excess secretion of PTH from one or more parathyroid glands
Secondary- increase of PTH from a chronic disease
Can get loss of lamina dura

Question 12

Scurvy

Answer 12

Acquired Disorder
Too little vitamin C
Leads to impaired osteoid matrix formation
Manifestations include- osteoporosis, bleeding gums, subperiosteal hemmorraging (bleeding in bone)

Question 13

Langerhans’ cell histiocytosis

Answer 13

Acquired Disorder
Birbeck granules
Cause bone lesions

Question 14

Describe the repair process of a fracture

Answer 14

Blood vessel rupture
Platelet clotting
Bone progenitor cells cover fractured site

Question 15

Osteonecrosis

Answer 15

From ischemia (lack of blood and oxygen) 
Not from infection

Question 16

Bisphosphonate-associated necrosis (BON)

Answer 16

Comes from after a patient has taken Bisphosphonate for osteoporosis
Can interfere with formation of bone after surgery or injury
Can get phossy jaw

Question 17

Osteomyelitis

Answer 17

2 Types: pyogenic and tuberculous
Pyogenic- caused by bacteria infections
Tuberculous- caused by tuberculosis and affects the long bones and vertebrae

Question 18

What are the routes of spreading of osteomyelitis?

Answer 18

Hematogenous dissemination
Contiguous infection spread
Traumatic implantation

Question 19

Osteoma

Answer 19

Benign Bone forming tumor
Affects the face
Older people
Normal bone

Question 20

Osteoid Osteoma

Answer 20

Benign Bone forming tumor
Metaphysis of the femur and tibia
Woven bone
Younger people

Question 21

Osteoblastoma

Answer 21

Benign Bone forming tumor
Like osteoid osteoma
Vertebrae
Younger people

Question 22

Primary osteosarcoma

Answer 22

Malignant Bone forming tumor
Usually affects the femur
Younger people
“Sunburst pattern” on radiograph

Question 23

Secondary osteosarcoma

Answer 23

Malignant Bone forming tumor

Femur, humerus, pelvis

Question 24

Osteochondroma

Answer 24

Benign Cartilage forming tumor
10-30 years of age
Bone and cartilage as a cup

Question 25

Enchondroma

Answer 25

Benign Cartilage forming tumor 30-50 years of age Small bones of the hands and feet

Question 26

Chondrosarcoma

Answer 26

Malignant Cartilage forming tumor Older people Affects pelvis, humerus, femur

Question 27

Osteoarthritis

Answer 27

``` Degradation of the cartilage Most common joint disorder Affects older people Primary- age Secondary- younger people with no reason ```

Question 28

Rheumatoid Arthritis

Answer 28

Destruction of articular cartilage and underlying bone More common in women Bilateral Likely a combo of genetics and environment Type 4 autoimmune disease

Question 29

Seronegative Spondyloarthropathies

Answer 29

Inflammation of ligaments | HLA associated

Question 30

Gout

Answer 30

From urate crystal formation because of supersaturated fluids Primary- absence without any other disease Secondary- occurs along with another disease

Question 31

Suppurative Arthritis

Answer 31

Acquired from S. aureus in adults or haemaphilus influenza in kids pyogenic fluid in joints

Question 32

Lyme Arthritis

Answer 32

From Borrelia

Question 33

Ganglion cysts

Answer 33

Fluid filled usually near the wrist | "Bible therapy"

Question 34

Synovial cysts

Answer 34

Herniation of synovium though a joint capsule | Needs surgery

Question 35

Lipoma

Answer 35

Benign Fat forming tumor | most common soft tissue tumor

Question 36

Liposarcoma

Answer 36

Malignant fat forming tumor Prognosis depends on differentiation Affects older people