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Flashcards in XXI - Musculoskeletal System Deck (134)
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This is a group of hereditary disorders caused by defective synthesis of type I collagen. Classic finding of a "blue sclerae" is seen in one type of this disorder. SEE SLIDE 21.1.

Osteogenesis Imperfecta, or brittle bone disease (TOPNOTCH)Robbins Basic Pathology,8th ed., p802


Characterized by , disproportionate shortening of the proximal extremities, bowing of the legs, and a lordotic (sway-backed) posture. SEE SLIDE 21.2.

Achrondroplasia (TOPNOTCH)Robbins Basic Pathology,8th ed., p802


A group of rare genetic disorders characterized by reduced osteoclast-mediated bone resorption and therefore defective bone remodelling. Literally means "stone bone".

Osteopetrosis(TOPNOTCH)Robbins Basic Pathology,8th ed., p802


The hallmark of this disease is loss of bone cortices are thinned and trabeculae are reduced in thickness. Osteoclastic activity is present but not dramatically increased. Mineral content of the bone tissue is normal.

Osteoporosis (TOPNOTCH)Robbins Basic Pathology,8th ed., p804


Characterized by repetitive episodes of frenzied, regional osteoclastic activity and bone resorption, followed by exuberant bone formation, and finally by an apparent exhaustion of cellular activity. Pathognomonic feature is a "mosaic pattern" of lamellar bone. SEE SLIDE 21.3.

Paget Disease (Osteitis Deformans) (TOPNOTCH)Robbins Basic Pathology,8th ed., p806


The hallmark of this disease is increased osteoclastic activity, with bone resorption. This leads to characteristic radiographic changes best seen along the radial aspect of the middle phalanges of the second and third fingers. SEE SLIDE 21.4.

Hyperparathyroidism (TOPNOTCH)Robbins Basic Pathology,8th ed., p808


Characterized by dead bone with empty lacunae is interspersed with areas of fat necrosis and insoluble calcium soaps. The cortex is usually not affected because of collateral blood supply. SEE SLIDE 21.5.

Osteonecrosis (avascular necrosis)(TOPNOTCH)Robbins Basic Pathology,8th ed., p809


Inflammation of the bone and marrow cavity.

Osteomyelitis(TOPNOTCH)Robbins Basic Pathology,8th ed., p809


What do you call the dead entrapped bone seen in infected sites of bones affected with osteomyelitis?

Sequestrum(TOPNOTCH)Robbins Basic Pathology,8th ed., p809


What do you call the shell of living tissue around a segment of devitalized bone?

Involucrum (TOPNOTCH)Robbins Basic Pathology,8th ed., p809


Benign bone tumor characterized as exophytic growths attached to bone surface of the face and skull, which may histologically resemble normal bone.

Osteoma(TOPNOTCH)Robbins Basic Pathology,8th ed., p811


Benign bone tumor that are cortical tumors, histologically described as interlacing trabeculae of woven bone. Characteristic symptom is pain. Common locations include the metaphyses of the femur and tibia. SEE SLIDE 21.6.

Osteoid osteoma(TOPNOTCH)Robbins Basic Pathology,8th ed., p811


These bone-forming lesions arise in vertebral transverse and spinous processes of the VERTEBRAL COLUMN, which may be histologically similar to osteoid osteoma.

Osteoblastoma(TOPNOTCH)Robbins Basic Pathology,8th ed., p811


A bone-producing malignant mesenchymal tumor, characterized as gritty, gray-white tumors, often exhibiting hemorrhage and cystic degeneration. The production of mineralized or unmineralized bone (osteoid) by malignant cells is essential for diagnosis. SEE SLIDE 21.7

Osteosarcomas(TOPNOTCH)Robbins Basic Pathology,8th ed., p811


These are relatively common benign hyaline cartilage-capped outgrowths attached by a bony stalk to the underlying skeleton.

Osteochondromas (TOPNOTCH)Robbins Basic Pathology,8th ed., p814


These are benign tumors of hyaline cartilage, described as gray-blue, translucent well-circumscribed nodules. May be seen in metaphyseal regions of tubular bones of the hands and feet. On x-ray, the unmineralized nodules of cartilage produce well-circumscribed oval lucencies surrounded by thin rims of radiodense bone (O-ring sign). SEE SLIDE 21.8.

Enchondromas (TOPNOTCH)Robbins Basic Pathology,8th ed., p814


Chondromas seen on the bone surface.

Juxtacortical chondromas(TOPNOTCH)Robbins Basic Pathology,8th ed., p814


These lesions arise within the medullary cavity of the bone to form an expansile glistening mass that often erodes the cortex. They exhibit malignant hyaline and myxoid cartilage.

Conventional chondrosarcomas (TOPNOTCH)Robbins Basic Pathology,8th ed., p814


These tumors are characterized as viscous and gelatinous, with the matrix oozing from the cut surface. Spotty calcifications are typically present, with central necrosis creating cystic spaces.

Myxoid chondrosarcomas(TOPNOTCH)Robbins Basic Pathology,8th ed., p815


Presents as sharply demarcated radiolucencies surrounded by a thin zone of sclerosis. They are gray to yellow-brown, and microscopically are cellular lesions composed of cytologically benign fibroblasts and macrophages. The fibroblasts classically exhibit a "storiform (pinwheel) pattern".

Fibrous Cortical Defect and Nonossifying Fibroma (TOPNOTCH)Robbins Basic Pathology,8th ed., p815


A benign tumor of the bone wherein all components of normal bone are present, but they fail to differentiate into mature structures. Curved trabeculae of woven bone mimick "Chinese characters" histologically. SEE SLIDE 21.9.

Fibrous Dysplasia (TOPNOTCH)Robbins Basic Pathology,8th ed., p816


Primary malignant small round-cell tumor of bone and soft tissue, characterized by Sheets of small round cells with scant, cleared cytoplasm, circled about a central fibrillary space or "Homer-Wright rosettes". SEE SLIDE 21.10.

Ewing sarcoma (TOPNOTCH)Robbins Basic Pathology,8th ed., p817


A relatively uncommon benign tumor usually arising in individuals in their 20s to 40s. These are large and red-brown lesions with frequent cystic degeneration, composed of uniform oval mononuclear cells with frequent mitoses, with scattered osteoclast-type giant cells containing 100 or more nuclei. SEE SLIDE 21.11.

Giant-cell tumors (GCTs)/Osteoclastoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p.1204


These are the most common malignant tumor of bone.

Metastatic tumors (TOPNOTCH)Robbins Basic Pathology,8th ed., p818


Pathways of metastasis to the bone.

1) direct extension, (2) lymphatic or hematogenous dissemination, (3) intraspinal seeding(TOPNOTCH)Robbins Basic Pathology,8th ed., p818


Characterized by fibrillation and cracking of the articular cartilage matrix, bone eburnation, and bony outgrowths/spurs (osteophytes). Full-thickness portions of the cartilage are lost, and the subchondral bone plate is exposed. SEE SLIDE 21.12.

Osteoarthritis (TOPNOTCH)Robbins Basic Pathology,8th ed., p819


Characterized by a dense neutrophilic infiltrate permeating the synovium and synovial fluid. Long, slender, needle-shaped monosodium urate crystals are frequently found in the cytoplasm of the neutrophils as well as in small clusters in the synovium.

Acute gouty arthritis(TOPNOTCH)Robbins Basic Pathology,8th ed., p821


Results from repetitive precipitation of urate crystals during acute attacks. The synovium becomes hyperplastic, fibrotic, and thickened by inflammatory cells, forming a pannus that destroys the underlying cartilage.

Chronic tophaceous arthritis (TOPNOTCH)Robbins Basic Pathology,8th ed., p821


Formed by large aggregations of urate crystals surrounded by an intense inflammatory reaction of lymphocytes, macrophages, and foreign-body giant cells, attempting to engulf the masses of crystals. Pathognomonic feature of gout.

Tophi (TOPNOTCH)Robbins Basic Pathology,8th ed., p821


Refers to multiple different renal complications associated with urate deposition, variously forming medullary tophi, intratubular precipitations, or free uric acid crystals and renal calculi.

Gouty nephropathy(TOPNOTCH)Robbins Basic Pathology,8th ed., p821


Also known as chondrocalcinosis or-more formally-calcium pyrophosphate crystal deposition disease. The crystals are weakly birefringent, rhomboid in shape with blunted ends.

Pseudogout (TOPNOTCH)Robbins Basic Pathology,8th ed., p823


Main causative agent of suppurative arthritis in late adolescence and young adulthood.

Neisseria gonorrhea(TOPNOTCH)Robbins Basic Pathology,8th ed., p824


Individuals with sickle cell disease are prone to developing osteomyelitis and suppurative arthritis caused by this agent.

Salmonella(TOPNOTCH)Robbins Basic Pathology,8th ed., p824


Arthritis caused by infection with the spirochete Borrelia burgdorferi, transmitted by deer ticks of the Ixodes ricinus complex.

Lyme arthritis (TOPNOTCH)Robbins Basic Pathology,8th ed., p824


A small (

Ganglion cyst(TOPNOTCH)Robbins Basic Pathology,8th ed., p825


The most severe and the most common form of muscular dystrophy. Characterized by marked variation in muscle fiber size, caused by concomitant myofiber hypertrophy and atrophy. SEE SLIDE 21.14. The definitive diagnosis is based on the demonstration of abnormal staining for "dystrophin" in immunohistochemical preparations.

Duchenne muscular dystrophy (DMD) (TOPNOTCH)Robbins Basic Pathology,8th ed., p825


This can present as either acute or chronic proximal muscle weakness, and can precede the onset of other signs of thyroid dysfunction. Findings include myofiber necrosis, regeneration, and interstitial lymphocytes.

Thyrotoxic myopathy (TOPNOTCH)Robbins Basic Pathology,8th ed., p830


This can occur with binge drinking, where there is an acute toxic rhabdomyolysis with accompanying myoglobinuria that can cause renal failure. On histology, there is myocyte swelling and necrosis, myophagocytosis, and regeneration.

Ethanol myopathy (TOPNOTCH)Robbins Basic Pathology,8th ed., p830


An autoimmune disorder of the neuromuscular junction characterized by muscle weakness which first manifests in the extraocular muscles. Caused by circulating antibodies to the skeletal muscle acetylcholine receptors (AChRs).

Myasthenia gravis (TOPNOTCH)Robbins Basic Pathology,8th ed., p830


This syndrome characteristically develops as a paraneoplastic process most commonly in the setting of small-cell lung carcinoma. Presents with muscle weakness secondary to decreased vesicle release in response to presynaptic action potential.

Lambert-Eaton Myasthenic Syndrome (TOPNOTCH)Robbins Basic Pathology,8th ed., p830


Soft tissue tumor which presents as soft, gelatinous, grapelike masses on the surfaces of the bladder or vagina. SEE SLIDE 21.15.

Sarcoma botryoides(TOPNOTCH)Robbins Basic Pathology,8th ed., p830


It is the most common soft tissue sarcoma of childhood and adolescence, usually appearing before age 20.

Rhabdomyosarcoma (TOPNOTCH)Robbins Basic Pathology,8th ed., p831


Diagnostic cell in rhabdomyosarcoma, characterized as round or elongated cells that may contain cross-striations visible by light microscopy.

Tadpole or strap cells(TOPNOTCH)Robbins Basic Pathology,8th ed., p831


Soft, yellow, well-encapsulated masses of mature adipocytes; they can vary considerably in size. Histologically, they consist of mature white fat cells with no pleomorphism

Lipoma (TOPNOTCH)Robbins Basic Pathology,8th ed., p832


Malignant neoplasms of adipocytes, which usually present as relatively well-circumscribed lesions. Diagnostic feature are lipoblasta, similar to fetal fat cells, with cytoplasmic lipid vacuoles that scallop the nucleus.

Liposarcomas (TOPNOTCH)Robbins Basic Pathology,8th ed., p833


A self-limited, reactive fibroblastic proliferation that typically occurs in adults on the volar aspect of the forearm. Consists of plump, randomly arranged, immature-appearing fibroblasts in an abundant myxoid stroma. Not a true tumor.

Nodular Fasciitis(TOPNOTCH)Robbins Basic Pathology,8th ed., p833


This develops in the proximal muscles of the extremities in athletic adolescents and young adults after trauma. Distinguished from other fibroblastic proliferations by the presence of metaplastic bone. Excision is curative.

Myositis Ossificans (TOPNOTCH)Robbins Basic Pathology,8th ed., p833


Malignant neoplasms composed of fibroblasts. These are soft unencapsulated, infiltrative masses frequently with areas of hemorrhage and necrosis. Malignant spindle cells are arranged in a "herringbone pattern". SEE SLIDE 21.16.

Fibrosarcoma (TOPNOTCH)Robbins Basic Pathology,8th ed., p834


These are relatively common benign lesions in adults presenting as circumscribed, small (

Benign Fibrous Histiocytoma (Dermatofibroma) (TOPNOTCH)Robbins Basic Pathology,8th ed., p834


A variety of soft tissue sarcomas Characterized by considerable cytologic pleomorphism, the presence of bizarre multinucleate cells, and "storiform" architecture. SEE SLIDE 21.17.

Malignant fibrous histiocytoma (MFH) (TOPNOTCH)Robbins Basic Pathology,8th ed., p834


Benign smooth muscle tumors described as well-circumscribed neoplasms that can arise from smooth muscle cells anywhere in the body, but are encountered most commonly in the uterus.

Leiomyoma (TOPNOTCH)Robbins Basic Pathology,8th ed., p835


These commonly present as firm, painless masses of the skin, deep soft tissues of the extermities and retroperitoneum. Histologically, they show spindle cells with cigar-shaped nuclei arranged in interweaving fascicles. SLIDE 21.18.

Leiomyosarcoma (TOPNOTCH)Robbins Basic Pathology,8th ed., p835


What is the mineral that gives bone strength and hardness and is the storehouse for 99% of the body's calcium, 85% of the body's phosphorous, and 65% of the body's sodium and magnesium?

Calcium Hydroxyapatite (TOPNOTCH)


Of all the proteins in the bone matrix, which one is unique to the bone?

Osteocalcin (TOPNOTCH)


Identify the bone cell: responsible for bone resorption

Osteoclast (TOPNOTCH)


Identify the bone cell: most numerous than any other bone forming cell

Osteocytes (TOPNOTCH)


Identify the bone cell: initiate the process of mineralization and express cell surface receptors that bind many hormones

Osteoblasts (TOPNOTCH)


What is the functional unit of bone?

Osteoblast and Osteoclast act in coordination and are considered the functional unit of bone known as the Basic Multicellular Unit (TOPNOTCH)


In what part of the bone can you see the histological abnormalities seen in achondroplasia?

Growth plate (TOPNOTCH)


Gross appearance: lack a medullary canal and the end of long bones are bulbous (Erlenmeyer Flask Deformity) and misshapen. The neural foramina are small and compress exiting nerves. SEE SLIDE 21.19.

Osteopetrosis (TOPNOTCH)


What is the main defect in Osteopetrosis?

Deficient Osteoblastic Activity (TOPNOTCH)


Osteoporosis cannot be reliably detected in plain radiographs until how much of the bone mass is lost?

30-40% (TOPNOTCH)


What is the histologic hallmark of Paget Disease of the bone?

Mosaic pattern of lamellar bone (Jigsaw pattern). SEE SLIDE 21.3. (TOPNOTCH)


A variety of tumor and tumor like conditions develop in pagetic bone. However, what is the most dreaded complication of this condition?

Sarcoma (Osteosarcoma > Malignant Fibrous Histiocytoma, or chondrosarcoma) (TOPNOTCH)


80% of cases, what bone is involved in Paget DIsease?

Axial skeleton and proximal femur (TOPNOTCH)


What is the most common site of tuberculous osteomyelitis?

Spine (thoracic and lumbar) > knees and hips (TOPNOTCH)


Most cases of osteomyelitis reach the bone via what route?

Hematogenous (TOPNOTCH)


What do you call a small intraosseous abscess that frequently involves the cortex and is walled off by reactive bone?

Brodie abscess (TOPNOTCH)


What do you call the morphologic variant of osteomyelitis that typically develops in the jaw and is associated with extensive new bone formation that obscures much of the underlying osseous structures?

Sclerosing osteomyelitis of Garre (TOPNOTCH)


Morphology: Edematous granulation tissue containing numerous plasma cells and necrotic bone

Congenital Syphilitic Bone infection and Acquired syphillis (TOPNOTCH)


What is the most common primary malignant tumor of bone, exclusive of myeloma and lymphoma, and accounts for approximately 20% of primary bone cancers.

Osteosarcoma (TOPNOTCH)


What are the 3 conditions associated with the development of osteosarcoma?

1. Paget disease2. Bone infarcts3. Prior irradiation (TOPNOTCH)


What part of the bone do osteosarcomas usually arise?

Metaphyseal region of the long bone of the extremities, 60% occur about the knee. (TOPNOTCH)


Morphology: Coarse, lacelike pattern of neoplastic bone produced by anaplastic malignant tumor cells

Osteosarcoma. SEE SLIDE 21.7. (TOPNOTCH)


Morphology: Presence of Homer Write rosettes ( tumor cells are arranged in a circle about a central fibrillary space)

Ewing Sarcoma. SEE SLIDE 21.10. (TOPNOTCH)


The diagnostic cell of embryonal, alveolar, and pleomorphic variants of Rhabdomyosarcoma which contains eccentric eosinophilic granular cytoplasm rich in thick and thin filaments. Can be round or elongated in shape (tadpole or strap cells).

Rhabdomyoblast (TOPNOTCH)


Morphology: Histological hallmark is the dual line of differentiation (biphasic) of tumor cells, epithelial like cells and spindle cells

Synovial Sarcoma (TOPNOTCH)


Gross morphology: Unencapsulated, infiltrative, soft, fish flesh masses, often having areas of hemorrhage and necrosis

Fibrosarcoma (TOPNOTCH)


These cells mimic fetal fat cells and contain round clear cytoplasmic vacuoles of lipid that scallop the nucleus. Seen in liposarcoma.

Lipoblasts (TOPNOTCH)


Most common soft tissue tumor of adulthood.

Lipoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1220


What are the most common cutaneous lesions seen in RA?

Rheumatoid Nodules (TOPNOTCH)


The most important factors in the development of Osteoarthritis

Aging and mechanical effects (TOPNOTCH)


Bone eburnation and joint mice are seen in what disease entity?

Osteoarthritis (TOPNOTCH)


The most common cancers that metastasize to the bone are?

Prostate, breast, kidney, and lung (TOPNOTCH)


What bones are most commonly involved in skeletal metastasis?

In descending order: Axial skeleton ( vertebral column, pelvis, ribs, skull, and sternum), proximal femur, and humerus (TOPNOTCH)


Skeletal metastases are typically multifocal, however, what carcinomas that metastasize to the bone are notorious for producing solitary lesions?

Ca of Kidney and Thyroid (TOPNOTCH)


What is the primary characteristic of osteosarcoma?

The formation of bone by the tumor cells (TOPNOTCH)


The combined picture of increased bone cell activity, peritrabecular fibrosis, and cystic brown tumors is the hallmark of what disease of abnormal mineral homeostasis?

Hyperparathyroidism (Generalized osteitis fibrosa cystica or von Recklinghausen disease of the bone) (TOPNOTCH)


What is the most important prognostic feature of a bone sarcoma?

Histological grade (TOPNOTCH)


O ring sign is seen in what cartilage forming tumor?

Chondroma (TOPNOTCH)


Morphology: Chicken wire pattern of mineralizaton. SEE SLIDE 21.20.

Chondroblastoma (TOPNOTCH)


Myositis ossificans is distinguised from the other fibroblastic proliferations by the presence of what structure?

Metaplastic bone (TOPNOTCH)


Most common cause of skeletal dysplasia and a major cause of dwarfism

Achondroplasia(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1184


Most common inherited disorder of connective tissue

Osteogenesis Imperfecta(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 1185


Hyaline cartilage is composed of what type of collagen?

Type II collagen(TOPNOTCH)


Most common type of joint disease

Osteoarthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1208


Presents with deep, achy joint pain that worsens with use, morning stiffness, crepitus, and limitation of ROM, osteophytes(bony outgrowths), sparing of wrists, elbow, and shoulder.

Osteoarthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1209


Radiographic hallmark of this joint disease are joint effusions and juxta-articular osteopenia with erosion and narrowing of joint space and loss of articular cartilage.

Rheumatoid arthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1212


Presents with malaise, fatigue, and generalized musculoskeletal pain. After several weeks, may present with symmetric joint pain affecting metacarpophalangeal, PIP, wrists, ankles and knees. The lumbosacral region and hips are spared. Involved joints are swollen, warm, painful, stiif when rising in the morning or following inactivity. What is the most likely diagnosis?

Rheumatoid arthritis(TOPNOTCH)


It causes destruction of articular cartilage and bony ankylosis, especially of the sacroiliac and apophyseal joints. May present with lower back pain and spine immobility.

It causes destruction of articular cartilage and bony ankylosis, especially of the sacroiliac and apophyseal joints. May present with lower back pain and spine immobility.


Also known as rheumatoid spondylitis and Marie-Strumpell disease

Ankylosis spondylitis(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 1213


Triad of arthritis, non-gonococcal urethritis or cerviciis, and conjunctivitis

Reactive arthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 1213


Presents with asymmetric pain and stiffness of the ankle and knee joints several weeks of the inciting bout of urethritis or diarrhea. May present with sausage-finger or toe, calcaneal spurs and bony outgrowths.

Reactive arthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 1213


Chronic inflammatory arthropathy concurrently or following the onset of skin disease. Produc the characteristic "pencil in cup" deformity , due to involvement of DIP of the hands and feet in an assymetric distribution. SEE SLIDE 21.21.

Psoriatic arthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 1213


Main causative agent of infectious arthritis in children younger than 2 years old.

H. influenza(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1213


Main causative agent of infectious arthritis in older children and adults.

S. aureus(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1213


Main causative agent of infectious arthritis in patients with sickle cell disease.

Salmonella(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1213


Most common joint affected in nongonoccocal suppurative arthritis.

Knee(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1213


Presents with sudden development of acutely painful and swollen joint with decreased ROM, associated with fever, leukocytosis, and elevated ESR. Usually involves only a single joint.

Suppurative arthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1213


Most common joints affected in mycobacterial arthritis

In descending order: Hips, knees, and ankles.(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1215


Genetic disorder resulting from complete absence of HGPRT, produced by mutation in the HPRT gene causing hyeruricemia.

Lesch-Nyhan syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1215


Presents with joint pain associated with localized hyperemia, warmth, usually in the first metatasophalangeal joint. Associated with excessive alcohol intake. Radiographs of chronic condition show characteristic juxta-articular erosion and loss of joint space.

Gouty arthritis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1216


Cytokine that is mainly implicated in the pathogenesis of RA.

TNF(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1217


The fundamental abnormality in this disorder is too little bone resulting in extreme skeletal fragility. Other findings include blue sclerae, hearing loss, and dental imperfections.

Ostegenesis Impefecta(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1185


Also known as marble bone disease and Albers-Schonberg disease

Osteopetrosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1186


First genetic disease treated with hematopoietic stem cell transplantation.

Osteopetrosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1187


Effect of decreased estrogen level after menopause

Increase bone resorption (and formation)(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1189


Hallmark of osteoporosis

Histologically normal bone that is decreased in quantity(TOPNOTCH)Robbins Basic Pathology, 9th ed, p 1189


Presents with pain due to microfracture or bone overgrowth, and enlargement of craniofacial skeleton pproducing leontiasis ossea, inability to hold the head erect. May also cause chalk-stick type fractures and arteriovenous shunt. Xray: enlarged, coarsened cortices and cancelous bone.

Paget Disease (Osteitis Deformans) (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1191


Most dreaded complication of Paget disease

Sarcoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 11911


The fundamental defect in these disorders is an impairment of mineralization and a resultant accumulation of unmineralized matrix due to vitamin D deficiency or its abnormal metabolism.

Rickets(children) and Osteomalacia(adult)(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1191


Most common cause of osteomyelitis.

S. aureus(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1195


Most common cause of osteomyelitis in individuals with sickle cell disease.

Salmonella(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1195


Characteristic radiographic findings of a lytic focus of bone destrucrion surrounded by a zone of sclerosis

Osteomyelitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1196


Presents with painful, progressively enlarging masses usually in the metaphyseal region of the extremities; sudden fracture; Xray: large destructive, mixed lytic and blastic mass with infiltrative margins, Codman triangle

Osteosarcoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1198


The most common benign bone tumor

Osteochondroma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1200


A 17 year old presents with a painfull swelling of the right knee. Radiographs show a lytic and blastic mass in the distal femur, with lifting of the surrounding periosteum. Which of the following is consistent with the diagnosis of osteosarcoma? (A) malignant mesenchymal cells in a chondromyxoid stroma (B) round, blue cells in sheets, with scant clear cytoplasm (C) multinucleated giant cells and a background of mononuclear cells (D) malignant mesenchymal cells with osteoid formation

Malignant mesenchymal cells with osteoid formation (TOPNOTCH)Robbins Basic Pathology,8th ed., p 813


A 42 year old male has repeated bouts of inflammation of his big toe, associated with drinking alcohol and cold weather. There is a knobby, nodular swelling around the involved joint. There are similar nodules in some of his fingertips and on his earlobe. If one of these nodules is biopsied, it would likely show (A) curved trabeculae of woven bone and surrounding fibrous tissue (B) marked proliferation of the synovium with underlying dense lymphoplasmacytic infiltrate (C) aggregate of amorphous material surrounded by reactive fibroblasts, lymphocytes, macrophages, and foreign-body giant cells (D) granulomas with epithelioid macrophages, giant cells with nuclei in a horeshoe configuration, and central necrosis

aggregate of amorphous material surrounded by reactive fibroblasts, lymphocytes, macrophages, and foreign-body giant cells (TOPNOTCH)Robbins Basic Pathology,8th ed., p 820-821


A 7 year old female is observed to have a fleshy, grape-like mass protruding from her vagina. SEE SLIDE 21.15. A biopsy showed large round cells with abundant granular eosinophilic cytoplasm. Some of the cells are elongated. The tumor (A) is commonly associated with chromosomal translocations (B) common in childhood and adolescence (C) may be positive for desmin and muscle-specific actin (D) all of the above

All of the above (TOPNOTCH)Robbins Basic Pathology,8th ed., p831


How does one differentiate between postmenopausal and senile osteoporosis?

Postmenopausal - trabecular bone loss severe (vertebral compression fracture); Senile - cortical bone loss (weight-bearing bone fractures, like femoral neck) (TOPNOTCH)Robbins Basic Pathology, 9th ed., p768


Halmark is increased osteoclastic activity, causing dissecting osteitis (boring into centers of bony trabeculae) and brown tumor formation (collection of osteoclasts, reactive giant cells, and hemorrhagic debris).

Hyperparathyroidism (TOPNOTCH)Robbins Basic Pathology, 9th ed., p772


A process seen in bone necrosis wherein with time, osteoclasts resorb necrotic bony trabeculae, and dead bone fragments act as scaffolding for new bone formation.

Creeping substitution. SEE SLIDE 21.5. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p773


Most specific antibody seen in rheumatoid arthritis

Anti-cyclic citrullinated peptides (TOPNOTCH)Robbins Basic Pathology, 9th ed., p784


Affected joints show CHRONIC PAPILLARY SYNOVITIS (synovial cell hyperplasia, dense perivascular inflammatory infiltrates, increased vascularity, increased osteoclast activity in the underlying bone), eventually leading to a pannus formation.

Rheumatoid arthritis (TOPNOTCH)Robbins Basic Pathology, 9th ed., p785

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