Musculoskeletal System Flashcards
(126 cards)
1
Q
What is the brittle bone disease?
A
Osteogenesis Imperfecta
2
Q
What are the features of osteogenesis imperfecta due solely to?
A
Defective collagen synthesis
3
Q
What type of osteogenesis imperfecta is the most severe?
A
Type II
Usually lethal with 50% stillborn due to multiple fractures in the body
4
Q
What type of osteogenesis imperfecta is the most common? Is is severe or mild?
A
Type I
The most common and mildest
5
Q
What are some features of type I osteogenesis imperfecta?
A
- Variable inheritance
- Blue sclera, hearing defects
- Fractures at birth in 10%
- Mild long bone deformities
6
Q
What type of osteogenesis imperfecta is most common in children?
A
Type I
Note: not on slides but she said verbally
7
Q
What type of osteogenesis imperfecta occurs beyond the perinatal period?
A
Type III
8
Q
What are some features of type IV osteogenesis imperfecta?
A
Bone fragility only, without other classic features
9
Q
What are some features of type III osteogenesis imperfecta?
A
- Moderate to severe fractures
- Cardiopulmonary complications
10
Q
What are some classic features of osteogenesis imperfecta in general?
A
- Fragile bones
- Numerous fractures
- Blue sclera
- Lax ligaments
- Hearing loss
- Dentinogenesis imperfecta/Opalescent dentin
11
Q
What is the difference between dentinogenesis imperfecta and opalescent dentin?
A
When the oral manifestation is apparent WITHOUT other features of osteogenesis imperfecta = dentinogenesis imperfecta
When the oral manifestation is apparent WITH other features of osteogenesis imperfecta = opalescent dentin
12
Q
What are some oral manifestations of osteogenesis imperfecta?
A
- Teeth are fray-amber-yellow
- Enamel is normal, dentin is soft
- Severe attrition
- Bell shaped crowns with thin short roots
13
Q
Do people with osteogenesis imperfecta oral manifestations have an increased caries risk?
A
No increased susceptibility to caries
14
Q
Are oral manifestations more common in osteogenesis imperfecta patients on their primary teeth or their permanent teeth?
A
More common (about 80%) on primary teeth Only about 33% of patients show on their permanent teeth.
15
Q
What is another name for Osteopetrosis?
A
Marble Bone Disease or Albers-Schonberg Disease
16
Q
Is osteopetrosis acquired or inherited?
A
It is a rare hereditary condition
17
Q
What is the cause of osteopetrosis?
A
Osteoclasts don’t remodel properly
18
Q
What are some features of osteopetrosis?
A
- Bones are dense, brittle
- Fractures
- Growth retardation
19
Q
What is the name of the most common type of bacterial infection that develops in the type of bone formed by osteopetrosis?
A
Osteomyelitis
-poor vascularity
20
Q
What is the histology of osteopetrosis?
A
- Sclerotic bone
- Obliterated marrow spaces
21
Q
Is osteoporosis acquired or inherited?
A
Acquired bone disease
22
Q
What are some features of osteoporosis?
A
- Reduced bone mass
- Increased bone fragility
- Broken bones (mainly occurs in the hip)
- Localized OR a manifestation of a metabolic bone disease
23
Q
What two groups is osteoporosis commonly found in?
A
Senile - all aging individuals
Postmenopausal- only women, after menopause
24
Q
What causes osteoporosis in postmenopausal women?
A
Decreased serum estrogen.
Increased IL-1, IL-6, TNF levels with increased expression of RANK and RANKL.
INCREASED osteoclast activity.
25
What are some causes of osteoporosis in senile individuals?
- Decreased replicative ability of osteoprogenitor cells
- Decreased synthetic ability of the osteoblasts
- Decreased biologic ability of matrix-bound growth factors
- Reduced physical activity
26
What is osteomyelitis?
An acute or chronic inflammatory process of the bone
27
What is a possible drainage in osteomyelitis?
Sinus tracts may drain to the skin
28
What are 3 predisposing factors to osteomyelitis?
- Compromised blood supply (like in osteopetrosis)
- Lowered host resistance
- Virulent organisms (usually bacteria)
29
What are the "specific" predisposing factors to osteomyelitis that increases the susceptibility to develop?
- Tobacco/Alcohol
- Diabetes Mellitus
- AIDS
- Radiation therapy
- Osteopetrosis/ other bone disorders
30
How long are the signs and symptoms of acute osteomyelitis in duration for?
Typically less than 1 month
31
What are the signs and symptoms for acute osteomyelitis?
Fever
Sensitivity
Swelling
Lymphadenopathy
32
How does the X-ray look for acute osteomyelitis?
Unremarkable or an ill-defined radiolucency
33
What is a sequestrum?
A fragment of necrotic bone
34
What is rarely seen in acute osteomyelitis?
Paresthesia
Drainage
Exfoliation of fragments of necrotic bone
35
What does the histopathology for acute osteomyelitis contain?
Lots of NEUTROPHILS (acute = neutrophils)
| Empty lacunae
36
What will be viewed in chronic osteomyelitis?
Dead bone "islands"
Repair - fibrosis and new bone
Chronic inflammation
37
What is contained in dead bone islands?
Dead bone with formation of new vital bone around
***Dead bone = detached sequestrum
Live bone = Involucrum***
38
What is another name for Osteitis Deformans?
Paget's Disease of Bone
39
What is the reason for signs and symptoms of Paget's Disease of Bone?
Abnormal resorption and deposition of bone. Net effect is deposition. Distorts and weakens the bones.
40
Who is affected by Paget's Disease of Bone?
Affects older people. Rarely seen in people below 40
41
What is the cause of Paget's Disease of Bone?
Cause is unknown. Possibilities: Inflammatory, genetic, endocrine, viral factors
42
Are most cases of Paget's Disease of Bone monoostotic or polyostotic?
Most cases are polyostotic
43
What are some signs and symptoms of Paget's Disease of Bone?
- severe bone pain
- teeth may migrate and loosen
- jaw(s) may enlarge
- comments about needing a bigger hat or denture
44
How does Paget's Disease of Bone appear on radiographs initially?
Patchy sclerotic area- "Cotton wool" appearance because of the excess formation and resorption initially.
45
What happens to the cementum in Paget's Disease of Bone?
Hypercementosis- cementum gets bigger in size
46
Which arch is more likely to increase in size in Paget's Disease of Bone?
Maxilla
47
What happens to the alveolar ridges in Paget's Disease of Bone?
Alveolar ridges are grossly and symmetrically enlarged.
48
What will a lab test find in blood of patient with Paget's Disease of Bone?
Elevated alkaline phosphatase- indicates increased osteoblastic activity
49
What are some microscopic findings in Paget's Disease of Bone?
Mosaic bone
| Basophilic reversal lines
50
What is the treatment for Paget's Disease of Bone?
No treatment is usually required if there is limited involvement and no symptoms. The disease is usually chronic, slowly progressive and seldom causes death. Calcitonin can be used to stop remodelling.
51
What does Paget's Disease of Bone put the patient at increased risk for?
Osteosarcoma.
52
What is an osteoma composed of? Malignant or benign?
Benign tumors. Composed of mature compact or cancellous bone.
53
What are histologically identical to osteomas but not considered osteomas themselves?
Platal and mandibular tori and buccal exostoses.
54
What syndrome did we learn about that has multiple osteomas?
Gardner Syndrome
55
What is the most common area for an osteoma?
Head and neck area-craniofacial skeleton
56
Where is a periosteal osteoma?
Arises on surface of bone, as polypoid or sessile mass
57
Where is endosteal osteoma?
In medullary bone
58
What age range are osteoma more common?
Young adults
59
Are osteomas always symptomatic? How would you treat?
They can be asymptomatic and solitary. Larger osteomas can cause symptoms and/or cosmetic deformities, can be fixed with conservative surgical excision. Smaller osteomas are just left and periodically observed.
60
What is osteoblastoma? Malignant or benign?
Benign tumors arising from osteoblasts.
61
How do osteoblastomas and osteomas differ?
Osteoblastoma pain is not relived with aspirin, osteoid osteoma pain IS relived with aspirin.
Osteoblastoma size is greater than 2 cm. Osteoid osteoma size is less than 2 cm.`
62
Is osteosarcoma malignant or benign?
Bone malignancy.
63
What groups is osteosarcoma more common in?
More common in males and in teens to early 20s.
64
What is the number one site of osteosarcoma?
The knee: proximal tibia, distal femur.
65
What is the presenting symptom of osteosarcoma?
Pain and swelling
66
What is the difference between primary and secondary osteosarcoma?
Primary arises on its own. Secondary develops from another condition, making that condition a higher risk for developing osteosarcoma.
67
What are the 3 secondary causes of osteosarcoma?
- Paget's
- Radiation
- Fibrous dysplasia
68
What is the genetic predisposition to osteosarcoma?
Retinoblastoma p53 gene
69
Who has a worse prognosis for osteosarcoma?
Older patients
70
What is the radiographic appearance of osteosarcoma?
- Sunburst appearance
- Radiolucency and radiopacity
- Mottled borders
71
Can osteosarcoma occur in the jaw? Is there a mean age?
Yes, 7% occur in jaws. Mean age is 10-15 years older than the mean age for development in the long bones = 33
72
What periodontal changes occur in osteosarcoma?
- Resorption of roots of teeth
| - Early radiographic change symmetric widening of periodontal ligament space
73
What are the 3 microscopic types of osteosarcoma?**
**Fibroblastic
Chondroblastic
Osteoblastic**
74
What is common to all 3 types of osteosarcoma?
All contain malignant osteoid, just the amount differs
75
What does fibroblastic osteosarcoma produce?
Collagen
76
What does chondroblastic osteosarcoma produce?
Cartilage
77
What does osteoblastic osteosarcoma produce?
Osteoid or bone
78
What is chondrosarcoma?
Sarcoma of chondroblasts
79
Is the pain less or worse in chondrosarcoma compared to osteosarcoma?
Pain less often than osteosarcoma
80
What percentage of bone malignancies are chondrosarcoma?
20%
81
How does chondrosarcoma appear on a radiograph?
Radiolucent lesion with poorly defined borders, contain radiopaque foci
82
What groups is chondrosarcoma most common in? How does this compare to osteosarcoma?
More common in males (same as with osteosarcoma). Age range of 50-70 (older than in osteosarcoma).
83
Where is the #1 site of chondrosarcoma?
Pelvis
84
Where can chondrosarcoma be found orally?
Anterior jaws
| Condyle
85
What is the most common bone malignancy in children?**
Ewing's Sarcoma**
86
What is Ewing's Sarcoma?
Distinctive primary malignant tumour of bone of uncertain histogenesis.
87
How is Ewing's Sarcoma believed to be caused?
Neuroectodermal derivation. Translocation of chromosomes 11 and 22****
88
Is the jaw involved in Ewing's Sarcoma? Which arch is more common?
Uncommon. Mandible is more common than maxilla though.
89
Where are common sites of Ewing's Sarcoma?
Femur, pelvic bones
90
What is the characteristic reaction seen in Ewing's Sarcoma?
Characteristic onion-skin periosteal reaction of long bones
91
What is the survival rate like in Ewing's Sarcoma?
40-80%
92
What are some signs and symptoms of Ewing's Sarcoma?
Fever
Leukocytosis
Elevated erythrocyte sedimentation rate
Pain and swelling
93
What is fibrous dysplasia?
A developmental tumour-like lesion. Bone is replaced with fibrous tissue.
94
Is monostotic (involving one bone) or polystotic (multiple bones) fibrous dysplasia more common?
Monostotic disease in 80-85%
95
Where is monostotic fibrous dysplasia found?
Jaws
| Ribs
96
Where is polyostotic fibrous dysplasia found?
Long bones
97
Is fibrous dysplasia malignant?
There is a rare chance of malignant transformation
98
What are the 2 polyostotic fibrous dysplasia conditions?**
Jaffe-Lichenstein**
| McCune-Albright Syndrome**
99
How do the 2 polyostotic fibrous dysplasia conditions compare?
McCune-Albright is more severe and diffuse.
Both contain deformation of multiple bones (polyostotic) and both contain cafe au lait spots.
McCune-Albright has endocrine disturbances like precocious puberty and pituitary adenoma.
100
Is it better to diagnose fibrous dysplasia from biopsy or radiograph?
Radiograph
101
What is the X-ray appearance of fibrous dysplasia?
**Ground glass radiopacity***
Mottled lesion
Hard to see border
102
What are the 2 types of muscle atrophy and their cause?
Neurogenic Atropy- loss of nerve supply resulting from something like spinal cord trauma
Simple Disuse Atropy- prolonged bed rest, immobilization
103
What is Myasthenia Gravis? What does it target?
An autoimmune disorder of neuromuscular junction. Circulating antibodies that target/receptor of AChRs (acetylcholine)
104
What is the result of Myasthenia Gravis?
Muscle weakness. Skeletal muscle only.
105
What gender is Myasthenia Gravis more common in?
Females, like most autoimmune disorders
106
What is the #1 cause of Myasthenia Gravis that starts the production of the auto-antibodies?
90% thymic disorders of thymoma
107
What are some signs and symptoms of Myasthenia Gravis?
Abnormal muscle fatigue as the day goes on.
| Small muscles of head and neck will go first- eye focus, swallowing, slurred speech
108
What is muscular dystrophy?
Progressive degeneration of skeletal muscle. Nerves are intact. Muscle weakness and wasting.
109
What are the 2 most common muscular dystrophies? What gender is are they more common in?
Duchene
Becker
More common in males because X-linked
110
Is Becker or Duchene more common? Which is more severe?
Duchene is more common.
| Duchene is more severe.
111
What gene is affected in both Duchene and Becker?
Dystrophin gene on X chromosome. Responsible for the protein called dystrophin, which is needed for attachment of muscle to the skeleton.
112
Is heart involvement found in Duchene and/or Becker?
Heart involvement in Duchene.
| May of may not have hear involvement in Becker.
113
When is Duchene seen?
Early life, delay in walking. Will die in 20s from respiratory failure, pneumonia, CHF.
114
When is Becker seen?
Symptoms are seen later in life. Onset is usually in 20s and often dies in 50s.
115
What is a benign tumour of adipose tissue called?
Lipoma
116
Is lipoma common or rare?
Very common. Solitary and painless
117
What is liposarcoma?
Malignancy of adipose differentiation.
118
What age does liposarcoma peak? Where is it usually found?
Peak 50-60. Usually in legs.
119
What is fibromatosis?
Aggressive, but benign fibroblast proliferations.
120
Where can fibromatosis be found?
Superficial- hands, feet, penis, knuckles, neck
Deep- Called demoed tumours: abdomen, trunk, extremities.
Superficial are less aggressive than deep.
121
What is fibrosarcoma?
Fibroblastic malignancy
122
Age range for fibrosarcoma? Where is it common and how is the onset?
30-55 years
Thigh, trunk, forearm
Slow, painless onset
123
What is rhabdomyosarcoma?
Malignancy of skeletal muscle.
124
What is the most common soft tissue malignancy in children/young individuals?
Rhabdomyosarcoma
125
What are the 3 types of rhabdomyosarcoma and how are they classified?
Classified based on appearance histopathologically.
Embryonal: 0-15 years, botryoid subtype looks like grapes.
Alveolar: 10-25 years
Pleomorphic: Older adults, 45+ years
126
Which type of rhabdomyosarcoma has the worst prognosis?
Pleomorphic
