Path: Bone: 1 Flashcards by Thomas Ems

Presence of woven bone in an adult indicative of?

always an abnormal process

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What is MC cz of disability

arthritis

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4 Non-inflammatory arthropathies

1. Osteoarthritis (DJD)
Secondary to ischemia
			2.  AVN
			3. Legg-calve-perthes dz
4. Neuropathic arthropathy/Charcot joint

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3 Inflammatory arthropathies

RA, Lyme, Psoriatic

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WHat is MC form of arthritis

Osteoarthritis (DJD)

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Risks for OA (3)

obesity, trauma, age (all “wear and tear”)

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OA: pain increases with

use

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cause of Neuropathic joint (charcot joint)

loss of sensation

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Rheumatoid Arthritis 
# of joints involved, laterality, symmetry, large vs small joints?

Polyarticular, bilateral, symmetrical (small > large)

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3 Risks for AVN:

steroids, SSD, trauma

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RA: pain increases with

rest

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MC joint affected in gout

1st MTP

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Gout histology (include birefringence color and property)

Needle shaped crystals, yellow under parallel light, blue under perpendicular = (-) birefringent

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Pseudogout what crystals

Calcium pyrophosphate crystals

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Diff between Endochondral and intramembranous formation

Endochondral formation: preformed cartilaginous model

Intramembranous formation: no cartilage model, bone laid directly on fibrous layer of mesenchyme

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Define Osteomyelitis

Definitioin: inlfammation of bone

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Etiology and MC cz of osteomyelitis + 2 other causes

Almost always dt infx

MC= S. aureus
Salmonella with SSD: if G(-)
Blastomycosis and Histoplasmosis –> fungal osteomyelitis

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CP of osteomyelitis

acute systemic illness. Symptoms may be overt or subtle

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radiology of osteomyelitis

Destructive focus surrounded by edema and sclerosis

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Dx of osteomyelitis

Blood: Cultures positive

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4 complications of osteomyelitis

○ pathologic fracture
○ Secondary amyloidosis (dt acute phase reactant ASS–> AA–> deposition)
○ Endocarditis
4. SqCC in sinus site, rarely osteosarcome

Define Sequestrum:

entrapped necrotic bone fragments (in osteomyelitis)

what is involucrum

Osteomyelitis some dead bone is left (sequestrum) with a shell of woven, viable bone around it (known as an involucrum)

pott dz aka

tuberculosis osteomyelitis

Elevated Alkaline phosphatase (ALP) indicates?

Increased when osteoblasts are active (alkaline environment is required to lay down bone)

bone cancer is ix by what levels of the following things: PTH Ca Phosphorus

PTH: Low level = bone cancer Ca: high level = bone cancer Phosphorus: low level = bone cancer

Osteopetrosis : dt? findings (3)

dt decreased marrow = anemia, thrombocytopenia, leukopenia

Mineralization normal or dysfunctional: osteoporosis, osteomalacia

``` osteoporosis = normal osteomalacia = defective (low vit D) ```

``` Levels in osteomalacia: Ca: PO4: ALP: PTH: ```

Ca: low PO4: low ALP: high PTH: high

``` Levels in osteoporosis: Ca: PO4: ALP: PTH: ```

all normal

``` Levels in Paget: Ca: PO4: ALP: PTH: ```

ALP is only high one

``` Levels in osteopetrosis: Ca: PO4: ALP: PTH: ```

all normal

pathology of osteoporosis

reduction in trabecular bone mass

2 radiologic findings (and hallmark) of OA

1) Loss of joint space = hallmark | 2) Marginal osteophytes (bone spurs)

"named" Joint findings in hands in OA (and joint(s) involved)

in OA BOTH DIP and PIP are involved: Heberden Nodes | Bouchard nodes

Hallmark gross finding on subchondral bone in OA

Eburnation = polished ivory appearance

gross finding in OA

pitting articular cart

What cuases a Subchondral cyst?

Synovial fluid accessing subchondral space through cracks in articular cartilage

Joint involved in charcot joint is related to underlying disease: which? 1) Ankle: ? 2. Knee, hip, spine: ?

1) Ankle: DM | 2. Knee, hip, spine: tertiary syphillis

Hallmark gross finding in RA

Pannus: inflammed synovium --> granulation tissue covering articular cartilage (destroys and fuses joint)

finger joint findings in RA and how differs from OA

PIP only affected in RA | PIP and DIP in OA

What causes joint destruction and deviation in a pannus

myofibroblast proliferation

What is a Rice body and where found?

fibrin with PMNs in the synovium

Subchondral formations in RA (and diff bt OA)

``` RA = Subchondral resorption OA/DJD = subchondral sclerosis (bone formation) ```

What is a rheumatoid nodule and where are they found

A Palisading granuloma: Macros, lymphos, plasma cells surrounding necrotic area Seen in GI tract, lungs, heart

Risk factors for AVN (4)

Chronic steroid use, SSD, fractures, barometric trauma ("the bends")

What 2 hallmark radiologic sign is seen in AVN

1. Crescent sign (hallmark)- separation between articular cart and underlying subchondral bone 2. wedge shaped infarct

What is Legg-Calve-Perthes Disease

AVN of femoral head in kids

What is gout

Monosodium-urate (MSU) crystal deposition in joints

Pseudogout/ Chondrocalcinosis/ Calcium pyrophosphate deposition disease presents how? findings? histo

findings: Calcification (CPPD) deposits in cartilage, menisci, synovium CP: arthritis Histo: Rhomboid-shaped, blue-purple crystals (Positive birefringence)