Thursday 2 - Witrak - Bone pathology

Question 1

Osteoporosis

Answer 1

Post menopausal (usually) bone resorption

Question 2

Osteomalacia

Answer 2

osteois matrix insufficient from G.I mal-absorption

Question 3

Osteomyelitis

Answer 3

Staph A. usually, subtle, nonspecific and hard to eradicate.

Question 4

Paget's disease
what is it 
Who does it effect and to what extent?
symptoms?
lab findings?

Answer 4

excessive breakdown and reformation of bone possibly from virus in osteoclasts. (widens bones, long bones)
up to 10-15 % in older patients usually ango-saxon
pain due to fractures
^ alkaline phosphatase, normal serum Ca, no hepatobiliary disease

Question 5

Osteopenia

3 types

Answer 5

Generalized decrease in bone mineralization

can be:
Osteoporosis
Osteomalacia
Malignancy

Question 6

Hyperparathyroidism can do what to bone?

Answer 6

increase the resorption of the bone, increasing serum Ca

Question 7

Pathological fracture

Answer 7

fracture through deseased bone – usually refers to fracture through tumorous or tumor-like bone

Question 8

What type of bone tissue cell produces alkaline phosphotase?

Answer 8

active osteoblasts, signals that there is active bone formation going on.

Question 9

What event coincides with the fusing of the epiphyseal plate during puberty?

Answer 9

blood vessels entering into the epiphyseal plate

Question 10

How do you get the active form of vit D

Answer 10

Vit D —-liver—-> Vid D (OH)1

Vit D (OH)1 —-PTH (kidney)—-> Vit D (OH)2

Question 11

synth of active vit d inhibited by what

Answer 11

Phosphate and Vit D (OH)2 (that IS the active form)

Question 12

Three things parathyroid hormone (PTH) does to bones and calcium

Answer 12

synthesizes the last step in activating Vit D (1 OH to 2 OHs)

stimulates osteoblasts to release osteoclast stimulating factor, which resorbs bone calcium.

stimulates uptake of calcium from the intestine to the blood.

Question 13

Steps in forming new bone in a fracture?

Answer 13

Fibroblasts come in and morph into osteocartilagenous matrix, which goes on to form bone

Question 14

Heterotopic ossification

Answer 14

ossification happening where it is not supposed to.

Question 15

This is a joint that is formed from a break in bone

Answer 15

pseudoarthrosis

Question 16

This fracture of the spine is usually painless and can cause kyphosis

Answer 16

wedge fracture

Question 17

What doesn’t make sense about PTH with regards to osteoporosis?

Answer 17

there is a dimineshed PTH secretion, but still too much bone resorption.

Question 18

Best prevention of osteoporosis

Answer 18

maximize peak bone mass in young adult hood

weight-bearing exercise and Ca supplementation

Question 19

Hypercalcemia.

differential?

Answer 19

hyperparathyroidism or cancer until proven otherwise

Question 20

What is in excess in rickets?

Answer 20

osteoid. not enough Ca co calcify the bone

Question 21

Four examples of ways to get osteomalacia

Answer 21

Environmental
intestinal malabsorption (common in US)
liver or renal disease (impaired Vit D hydroxylation(second step in synth))
Rare congenital

Question 22

Main lab finding for osteomalacia

Answer 22

^serum alkaline phosphatase

Question 23

Patients with sickle cell tend to get what type of bacteria that causes osteomyelitis?

Answer 23

Salmonella

Question 24

Where does most of pyogenic osteomyelitis begin?

Answer 24

metaphyseal marow space

Question 25

Treatment for suppurative (purulent) osteomyelitis?

Answer 25

Early, aggressive IV antibiotics surgical drainage amputation in chronic cases

Question 26

Pott's disease

Answer 26

tuberculous osteomyelitis of the spine

Question 27

Blastomycosis and coccidioidomycosis

Answer 27

Fungal forms of osteomyelitis

Question 28

Avascular bone necrosis/infarction causes? What usually causes multiple infarcts? best way to image?

Answer 28

Fractures, corticosteroids, alcoholism corticosteroids MRI

Question 29

Unilateral hip hypercalcification. main thought in differential?

Answer 29

Paget's

Question 30

Osteogenesis imperfecta clinical findings congenital disorder of what

Answer 30

Smaller, bent bones | type 1 collagen

Question 31

Classic example of purely osteolytic malignancy

Answer 31

Myeloma (cancer of plasma cells, effector B cells)

Question 32

Classic example of purely osteoblastic malignancy

Answer 32

prostate cancer

Question 33

Most common sources of metastatic tumor that involve the skeleton

Answer 33

Lung, Breast, Prostate

Question 34

What is usually the first clinical finding of bone malignancy

Answer 34

Pathological fracture

Question 35

Most common malignancy involving bone?

Answer 35

METASTATIC TUMORS i.e. cancer that came from a different type of tissue.

Question 36

Most common type of bone tumors for kids? | for adults?

Answer 36

Kids: osteosarcoma Adults: Chondrosarcoma

Question 37

Osteochondroma. mostlikely benign or malignant?

Answer 37

benign

Question 38

3 common malignant bone tumors

Answer 38

osteosarcoma chondrosarcoma ewing's sarcoma

Question 39

Common bone lesion in children (1 in 3) that looks like a mushroom Where is it most common in the body?

Answer 39

metaphyseal fibrous defect (a non-ossifying fibroma) Knees

Question 40

Pain at night, Throbbing finger, bone deformity, young. Asprin releaves pain top of differential?

Answer 40

osteoid osteoma**

Question 41

Soft, jello crud in epyphysis of bone. Inbetween tumor, might be malignant might not be

Answer 41

Giant cell tumor.

Question 42

Shepard's crypt deformaty

Answer 42

congenital focal bone disorder of the trochantor of the femur

Question 43

Characteristics of a bone x-ray that would make you think malignancy

Answer 43

not well circuscribed. cortex is lytically destroyed elevated pariostium (irregular osteoblastic change) calcification in soft tissue. only other thing in differential is severe osteomyelitis

Question 44

Most feared primary bone cancer in young people. Where does it usually occur?

Answer 44

osteogenic sarcoma. sporatic, loves the knee

Question 45

histology of osteosarcoma

Answer 45

some nuclii bigger than others, osteoblastic tumor cells making too much pink osteoid. (H&E stain)

Question 46

Where can osteosarcoma metastasize in the example from class?

Answer 46

Lung

Question 47

This type of tumor is often one of the largest

Answer 47

Chondrosarcoma.

Question 48

Most aggressive and lethal primary bone tumors often found where? Histology? who? metastases?

Answer 48

Ewing's sarcoma Shafts of long bone Wall to wall nucleii young often lung

Question 49

Metaphyseal refers to what?

Answer 49

metaphysis of the bone, between the epiphysis and diaphysis

Question 50

Myeloma age group?

Answer 50

cancer of plasma cells (b cells) older people

Question 51

Osteiod osteoma gender ratio

Answer 51

M:F 3:1