orthopedic pathology (bone pathologies)

Question 1

common issues of bone pathologies

Answer 1

bones too soft

bones too brittle

bones not right shape (mineral content)

tumours

Question 2

SSx of bone pathologies

Answer 2

bone pain

visible deformity

easily fractured

Question 3

diagnostic methods for bone pathologies

Answer 3

imaging:
X-ray

Bone scan (nuclear radiography)

**

genetic testing

Question 4

bone scan (nuclear radiography)

Answer 4

A whole-body bone scan is a nuclear medicine test to check your bones for issues or changes.

You receive an injection of a substance called a radiotracer. The radiotracer collects in areas of irregular activity and highlights these areas on an imaging scan.

It’s painless and safe for most people.

A bone scan is a type of nuclear radiology procedure.

Question 5

treatments (bone pathologies)

Answer 5

medication
E.g.
Bisphosphonates slow bone density loss
(decrease osteoclast activity; increase osteoblast activity –> esp after menopause)

other Treatment:
Surgery
(removing tumours?
surgically fixing fractures/weak areas?)

Question 6

osteoporosis

Answer 6

Progressive and systemic metabolic disease of decreasing bone mass/density

Bone breaks down over time and becomes brittle, thin, and breaks easily

Question 7

osteopenia

Answer 7

Osteopenia
Low bone mass
Precursor to osteoporosis

Question 8

osteoporosis classifications (primary/secondary)

Answer 8

Primary osteoporosis unrelated to any underlying disease or condition (80-95%)

–> primary = idiopathic / age-related

–> secondary = Secondary osteoporosis due to medication or other conditions

Question 9

osteoporosis risk factors

Answer 9

Hormonal status (e.g. menopause)

Age (decrease estrogen in women with age)

Ethnicity (caucasian females)

Sedentary Lifestyle

Smoking (decreases estrogen)

Alcohol

Family history

Diet

Question 10

osteoporosis other risk factors

Answer 10

Depression (hormones)

Weight (hormones)

Medications (steroids, chemotherapy)

Female

High caffeine intake

Malnutrition
Malabsorption (vtitamin d, c, calcium, etc.)

Endocrine disorders (hormones)

Question 11

osteoporosis SSx

Answer 11

Asymptomatic

Height loss
(compressed vertebrae –> thoracic kyphosis, lumbar hypolordosis, protracted head/neck)
–> note dowager’s hump

Postural changes
–> “

Compression fractures
(compressed vertebrae)

Back pain (sharp with no cause)
–> lumbar vertebrae compression, nerve compression (??)

Fractures

Muscular pain and spasm
–> reflex muscle guarding (?)

Question 12

osteoporosis Dx

Answer 12

History, physical assessment

Dual-energy X-ray absorptiometry (DEXA):

—> Low levels of x-rays used to measure mineral density

—> Standard x-rays cannot detect small decreases of bone mass

Lab tests
Blood tests:
can help determine levels of minerals and hormones

useful to determine WHY bone density is low
—> WHICH component is affecting bone density

Question 13

DXA test vs standard X-ray

Answer 13

A DXA scan (bone density test) is a quick, painless way to check your bone health.

It’s similar to a regular X-ray, but measures the strength and mineral content of your bones instead of just taking pictures of them.

“The DXA scanner on the other hand is designed to measure the density of body tissue but does not produce a high-quality picture.”

Question 14

osteoporosis Tx

Answer 14

Prevention
Critical age between 10 and 30 years

Lifestyle
Decrease alcohol, tobacco, caffeine intake
Increase weight bearing activities

Question 15

which ages are important to develop good habits for maintaining good bone density throughout life

Answer 15

between 10 and 30 years

Question 16

osteoporosis medication for treatment

Answer 16

Medication:

Estrogen (hormone therapy)

Calcitonin – inhibits osteoclasts

Bisphosphonates (decrease osteoclast activity, increase osteoblast activity)

Calcium and vitamin D supplements

Question 17

other important factors

Answer 17

Adequate sunshine (vitamin d)

Diet high calcium, vitamin D and protein

Question 18

bone tumour types

Answer 18

Tumours can be osteoblastic
—> Excessive bone is laid down

Tumours can be osteolytic
—> Bone is destroyed

Question 19

benign bone tumours

Answer 19

can be via
bone cells,
cartilage cells,
and fibroblasts

Can cause pathological fracture

Can cause neurological symptoms ( via MASS EFFECT)

Question 20

pathological fracture define

Answer 20

A broken bone caused by disease, often by the spread of cancer to the bone.

Question 21

Mass effect define

Answer 21

“It can be used to describe any lesion in the body if it exerts displacement of adjacent structures”

(E.g. benign bone tumours on nerves)

Question 22

differentiating myositis ossificans vs. bone tumour

Answer 22

Differentiating between myositis ossificans and extraskeletal osteosarcoma is critical.

The zoning pattern of growth in myositis ossificans is an important diagnostic point.

Osteosarcoma displays disorderly growth of atypical hyperchromatic and pleomorphic tumor cells.

Question 23

benign bone tumours treatment?

Answer 23

Treatment is dependent on symptoms
—> If tumour is compressing adjacent structures, surgery is performed

Question 24

osteoma (type of benign bone tumour)

Answer 24

Slow growing

Usually asymptomatic

Usually occur on the skull or mandible, but can sometimes be found in the cervical region

Question 25

osteoma risk factors

Answer 25

Most osteomas have no identifiable cause. A small percentage are present or develop soon after birth. Others are believed to result from inflammation or trauma. In rare cases osteomas may be a component of an underlying hereditary disorder.

Question 26

osteochondroma

Answer 26

Bone tumor with cartilage (chondro) cap MOST COMMON benign bone tumor Found in children because they tend to grow at growth plates (cartilage) Usually asymptomatic Often an INCIDENTAL FINDING

Question 27

what is the most common benign bone tumour?

Answer 27

OSTEOCHONDROMA

Question 28

what population is osteochondroma found in? Why?

Answer 28

children @ growth plate (cartilage)

Question 29

why is osteochondroma generally via "INCIDENTAL FINDING"

Answer 29

Because many osteochondromas do not cause any discomfort or other symptoms, they are often discovered by accident when an X-ray is done for an unrelated reason, such as a traumatic injury. This is called an incidental finding.

Question 30

incidental finding define

Answer 30

Incidental medical findings are previously undiagnosed medical or psychiatric conditions that are discovered unintentionally and during evaluation for a medical or psychiatric condition.

Question 31

enchondroma

Answer 31

Cartilaginous tumor Arise from growth plate/chondrocytes abnormalities Usually found in children or young adults 10 – 30 years of age (?) Fairly common Usually asymptomatic ---> Found incidentally "Osteochondromas most commonly occur in the hands and feet, and enchondromas typically involve the iliac crests and metaphyses of long bones."

Question 32

osteoid osteoma

Answer 32

Bone tumor Usually found in children and adolescents

Question 33

osteoid osteoma clinical presentation

Answer 33

Clinical presentation ---> Classically cause night pain which is relieved by aspirin* ---> Mass effect ---> Risk factor for Fx

Question 34

osteoma vs osteoid osteoma

Answer 34

"An osteoid osteoma is a benign (noncancerous) bone tumor that usually develops in the long bones of the body such as the thighbone and shinbone." osteoma? "Usually occur on the skull or mandible, but can sometimes be found in the cervical region"

Question 35

osteoma vs osteoid osteoma (histology)

Answer 35

Different histology than osteoma

Question 36

Giant cell tumour (aka OSTEOCLASTOMA)

Answer 36

Thought to be via overproliferation of osteoclasts Occurs when growth plate is closed; therefore typically seen in early adulthood (20-30 years of age) Osteolytic bone tumour

Question 37

osteoclastoma surgical treatment (?)

Answer 37

Traditional surgical treatments have mostly employed intra-lesioned resection and bone cement reconstruction; however, these may cause unexpected damage around neurovascular structures.

Question 38

resection define

Answer 38

the process of cutting out tissue or part of an organ.

Question 39

bone cement?

Answer 39

Bone Cement Injection? This procedure is used to help fill open or weak spaces in bones.

Question 40

aneurismal bone cyst

Answer 40

aneurism = "widen out" / dilation/bulge cyst = "bladder" *** Expansile and osteolytic tumour Primarily seen in children and adolescents Idiopathic

Question 41

aneurismal bone cyst, primarily seen in

Answer 41

children and adolescents

Question 42

more about aneurysmal bone cysts

Answer 42

Aneurysmal bone cysts are non-malignant, tumor-like, vascular lesions comprised of blood-filled channels. Although they can occur in any bone, they are most common in the femur, tibia, and vertebrae. [1] Their expansile nature may result in pain and inflammation, and disruption of joints and growth plates

Question 43

Fibrous dysplasia

Answer 43

Congenital abnormality in osteoblastic differentiation and maturation Leads to progressive replacement of normal bone with fibrous tissue (scar-like tissue) Defect is usually localized to one bone

Question 44

MALIGNANT BONE TUMOURS

Answer 44

Have the capacity to metastasize Often do so aggressively by invading locally and destroying adjacent tissues Less common than benign tumours Usually associated with constant and severe pain or night pain

Question 45

Skeletal Metastasis

Answer 45

Most common malignant tumours of the skeleton (via metastasis from tumour located elsewhere in body) 70% of all malignant bone tumours ---> Breast, prostate, lung and kidney cancers account for 80% of osseous metastases 80% of malignant tumours are axial tumours

Question 46

what cancers account for 80% of all osseous metastases?

Answer 46

Breast, prostate, lung and kidney cancers

Question 47

what percentage of malignant tumours are axial tumours

Answer 47

80% of malignant tumours are axial tumours

Question 48

clinical presentations of malignant bone tumours

Answer 48

fractures, cachexia, bone pain

Question 49

cachexia

Answer 49

weakness and wasting of the body due to severe chronic illness. kakos = bad hexis = habit

Question 50

a typical pattern (not always the case) (where benign vs malignant tumours are)

Answer 50

generally malginant bone tumours are @ axial skeleton & benign bone tumours are @ appendicular skeleton

Question 51

multiple myeloma

Answer 51

Most common primary malignant bone tumor Characterized by proliferation of malignant plasma cells and a subsequent overabundance of abnormal proteins and infiltration of red bone marrow. Occurs in individuals over age 40. ---> 70% are between 50 – 70 years of age.

Question 52

primary vs secondary tumour

Answer 52

secondary = via metastasis primary = not via metastasis

Question 53

mutiple myeloma age

Answer 53

Occurs in individuals over age 40. ---> 70% are between 50 – 70 years of age.

Question 54

why called mutiple myeloma

Answer 54

A cancer cell or malignant plasma cell is called a myeloma cell. Myeloma is called “multiple” because there are frequently multiple patches or areas in bone marrow where it grows.

Question 55

multiple myeloma SSx

Answer 55

Bone pain Pathologic fractures Anemia (@ bone marrow) Recurrent infection (@ bone marrow, so WBC) Proteinuria Renal failure

Question 56

why renal failure and proteinuria in multiple myeloma?

Answer 56

Multiple myeloma (MM) is a type of blood cancer that affects white blood cells called plasma cells. These cells help to fight infection. In MM, the abnormal plasma cells produce abnormal proteins that can bind to other proteins in the kidneys. This can result in kidney damage.

Question 57

why proteinuria?

Answer 57

fenesterated capillaries in kidneys damaged proteins leak through

Question 58

osteosarcoma

Answer 58

Second most common primary malignant bone tumor Typically seen in young patients (10-20 years of age)

Question 59

most common vs second most common PRIMARY malignant bone tumour

Answer 59

multiple myeloma = most common osteosarcoma = second most common

Question 60

also considered a blood tumour?

Answer 60

multiple myeloma (b/c @ RBM -- related to blood)

Question 61

osteosarcoma clinical presentation

Answer 61

Clinical presentation: ---> Pain is common ---> Soft tissue mass and swelling ---> Pathological fracture

Question 62

chondrosarcoma

Answer 62

Cartilaginous tumor Typical age group is 30 – 50 years of age

Question 63

chondrosarcoma clinical presentation

Answer 63

Clinical presentation: ---> Pain ---> Palpable mass ---> Pathological fracture

Question 64

Ewing's Sarcoma

Answer 64

Composed of undifferentiated bone marrow cells Occurs in MALES aged 10-20 Found in the diaphysis of long bones ---> Poor prognosis (high mortality)

Question 65

Ewing's Sarcoma -- undifferentiated bone marrow cells?

Answer 65

Ewing sarcoma is a type of tumor that forms from a certain kind of cell in bone or soft tissue. Undifferentiated small round cell sarcoma may also form in the bone or soft tissue. A genetic condition may increase the risk of Ewing sarcoma and other sarcomas. "This biopsy shows an undifferentiated small round cell sarcoma involving bone with focal areas of necrosis"

Question 66

recall low level of differentiation =

Answer 66

recall low level of differentiation = high level of malignancy

Question 67

Fibrosarcoma

Answer 67

Rare malignant tumor of fibroblasts and collagen ---> Can be found in other soft tissues as well Occurs in people 30-60 years of age

Question 68

Fibrosarcoma presentation

Answer 68

Usually found around the knee Localized pain and swelling with long duration of symptoms

Question 69

Malignant Fibrous Histiocytoma

Answer 69

Composed of mesenchymal stem cells Very aggressive tumour ---> Commonly metastasizes Most commonly found in people 50-70 years old

Question 70

Hodgkin's Lymphoma

Answer 70

Type of lymphoma that typically spreads through predictable lymphatic pathways Note: Presence of Reed-Sternberg cells, which are abnormal B cells ---> Reed-Sternberg cells are pathognomonic

Question 71

Hodgkin's Lymphona -- clinical presentation

Answer 71

Painless lymphadenopathy Night sweats Weight loss/cachexia

Question 72

recall lymphadenopathy

Answer 72

Lymphadenopathy refers to the swelling of lymph nodes which can be secondary to bacterial, viral, or fungal infections, autoimmune disease, and malignancy.

Question 73

Hodgekin's lymphoma prognosis

Answer 73

90% curable if detected early late detection = worse prognosis (?)

Question 74

osteomyelitis

Answer 74

Inflammation of bone caused by infectious microorganism, usually bacteria (also could be fungus, parasite, virus) Acute – initial infection Chronic – delayed treatment, relapse, delayed healing, prolonged infection

Question 75

osteomyelitis etiology

Answer 75

Most common - staphylococcus aureus (RECALL ALSO MOST COMMON CAUSE FOR INFECTIOUS (septic) ARTHRITIS) Also streptococcus, pneumococcus, Haemophilus influenzae, E. coli, salmonella Often polymicrobial From infected wounds, blood, open wounds, surgery

Question 76

osteomyelitis, Risk factors (weakened IS)

Answer 76

Chronic illness (weaker IS) Steroids use or immunosuppressive drugs (weak IS) Age (weaker IS) Malignancy (weak IS) Malnutrition (weaker IS)

Question 77

osteomyelitis SSx

Answer 77

Varies depending on host age and health status and on organism involved Can include: ---> Fever, severe pain ---> Edema, erythema, tenderness ---> Low grade fever

Question 78

erythema vs hyperemia (??)

Answer 78

Hyperaemia – increased blood in a part, resulting in distension of the blood vessels. Erythema – a redness of the skin occurring in patches of variable size or shape.

Question 79

Osteomyelitis, Dx, Tx

Answer 79

Diagnosis: History X-ray Bone scan Cultures Treatment: Antibiotics Surgery

Question 80

bone marrow culture (test?)

Answer 80

Bone marrow culture is an examination of the soft, fatty tissue found inside certain bones. The bone marrow tissue produces blood cells. This test is done to look for an infection inside the bone marrow. It is often done to diagnose prolonged fever that remains unexplained after other tests.

Question 81

osteomyelitis why surgery?

Answer 81

Surgery. Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures: Drain the infected area. Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection.