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Pathology > 4th Exam: Bone & Joint Disease > Flashcards

4th Exam: Bone & Joint Disease Flashcards

1
Q

Shaft of bone:

A

diaphesis

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2
Q

Center of long bone:

A

spicules of bone, aka cancellous bone

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3
Q

Outer shell of long bone:

A

compact bone, cortex

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4
Q

Smoothest part of long bone:

A

articulating ends

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5
Q

Bone building molecules, etc.:

A

Vit D, Ca2+, Calcitonin, PTH

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6
Q

What is the bone covered by:

A

periosteum

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7
Q

Are there blood vessels in the periosteum?

A

yes

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8
Q

Osteoblast progenitors give rise to:

A

-blasts, -cytes, -oclasts

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9
Q

Mineralized osteoblast:

A

Osteocyte

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10
Q

These make osteoid:

A

osteoblasts

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11
Q

Osteoblasts have ____ receptors, secrete osteoclasts stimulating factor, bone break down.

A

PTH

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12
Q

Histology of -blasts:

A

blue stain: calcified bone, red stain: in bw osteoblast, mineralization front

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13
Q

Where is the inorganic material found?

A

ECM

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14
Q

What inorganic material is found in the ECM?

A

Hydroxyapatite crystals (calcium phosphate)

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15
Q

Organic material found in matrix:

A

collagen, proteoglycan, glycoprotein

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16
Q

What stimulates glycoprotein synthesis?

A

Vit D

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17
Q

How many days after matrix deposition does mineralization occur?

A

12-15d

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18
Q

Where is the mineralization front?

A

At osteoid-mineralization bone interface

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19
Q

What controls the mineralization front?

A

under osteoblast/osteocyte influence

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20
Q

When does mineralization occur?

A

if Ca2+ and PO4 adequate (need to crystalize), they displace H2 → Ca-OH apatite crystals

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21
Q

Lamellar:

A

mature, strong bone, parallel lines

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22
Q

Woven bone:

A

weaker than lamellar, fibers don’t look parallel

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23
Q

The osteon is part of what type of bone?

A

compact bone

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24
Q

Cancellous bone viewed thru polarized light:

A

bone breaks into spicules, not as dense, bone marrow in space

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25
Q

Osteoclasts:

A

multinucleated, form from macs

-

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26
Q

How do -clasts break up bone?

A

Burrow into calcified bone (blue), liberate calcium, demineralization

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27
Q

How do -Blasts signal -clasts:

A

RANK-RANK ligand receptors. Receptor on -clast precursor, -blast binds -clast receptor to tell it to break bone down, PTH: stimulates -blasts via its receptors, calcitonin: turns off -clasts

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28
Q

PTH, turns on or off -clasts?

A

turns off, stimulates -blasts via its receptors, calcitonin:

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29
Q

-clasts are derived from:

A

monocyte/mac system

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30
Q

-clasts secrete:

A

carbonic anhydrase → carbonic acid

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31
Q

TF? Exercise can stimulate new bone formation

A

T.

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32
Q

Types of fractures:

A

simple, displaced, comminuted, open (compound), compression, pathologic

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33
Q

Simple fracture:

A

unsially transvers, bone still aligned

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34
Q

Displaced fracture:

A

bone not aligned

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35
Q

Comminuted fracutre:

A

splintered, multiple pieces, crushing injury, longer to heal, bring pieces together surgically

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36
Q

Open fracture:

A

through skin

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37
Q

Compression fracture:

A

ex: mainly vertebra, and pt looses height- osteoporosis

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38
Q

Pathologic fracture:

A

pre-existing disease- bone wouldn’t fracture otherwise

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39
Q

Fracture complications

A

Infection, delayed union and nonunion, avascular necrosis

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40
Q

Fracture type most prone to infection:

A

compound

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41
Q

Most common cause of delayed healing:

A

Infection

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42
Q

What causes avascular necrosis?

A

loss of blood supply

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43
Q

What typically causes kyphosis?

A

spine disease: osteoporosis, disc disease, osteoarthritis

44
Q

Metabolic bone diseases:

A

osteogenesis imperfect, osteoporosis, osteomalacia, Paget’s disease, Rickets

45
Q

primary osteoporosis:

A

classic disease, post-menopausal or senile

46
Q

secondary osteoporosis:

A

can cause or complicate primary osteoporosis

47
Q

Cause and tx for secondary osteoporosis:

A

iatrogenic, corticosteroid therapy

48
Q

Most cases found in this population:

A

post-menopausal elderly women

49
Q

First signs of osteoporosis after possibly remaining silent for yrs:

A

bone pain, gradual loss in heigh

50
Q

Most common fracture site due to osteoporosis:

A

hip

51
Q

Who are more affected by osteoporosis, white or black women?

A

white, 1:2, vs 1:5

52
Q

osteoprosis fractures are due to:

A

peak bone mass

53
Q

Osteoporotic hip fractures mortality:

A

25%, high

54
Q

Gross appearance of osteoporosis fracture:

A

a depression, dec bone density

55
Q

Osteoporosis risk factors:

A

Female, age, asian, white, early menopaus, low peak bone mass, inadequate Ca2+ intake, lack of exercise, alcohol, smoking, steroids

56
Q

There is low ___ activity and high ___ activity in osteoporosis:

A

blast, clast

57
Q

Which types of bone are thin in osteoporosis?

A

cortical and trabecular

58
Q

Common fracture sites:

A

Femoral neck, Colles’ fractures (distal radius) in the hand in the wrist

59
Q

At what age do women meet their peak bone mass?

A

35yo, demineralization thereafter

60
Q

Consequences of osteoporosis in the spine:

A

pain, compression fractures (fxs), loss of height, stooped posture, kyphosis

61
Q

Therapy for osteoporosis:

A

Regular exercise, diet, Ca2+, vit D, Limit alcohol, smoking, estrogen supplements, bisphosphonates inhibit -clast activity

62
Q

Cause of osteonecrosis of jaw:

A

bisphosphonate therapy, fewer -clasts interfere w bone remodellin

63
Q

Osteonecrosis could easily be misdiagnosed as:

A

neuralgia inducing cavitating osetonecrosis (NICO_

64
Q

NICO:

A

Due to avascular (ischemic) osteonecrosis (NOT bisphosphonate therapy), in any bone, more susceptible to fracture

65
Q

Case: 60yo white man, head enlarging for past 2 years, bowing of tibias, X-ray: thickening of skull

A

Paget’s Disease

66
Q

Paget’s Disease:

A

White, euro descent, < age 40, ocalized or generalized (85%), etiology – myxovirus particles in -clasts, cycles of bone resorption and reformation (Woven instead of lamellar bone formed), X-rays: lytic (more dense) & sclerotic (less dense) lesions, bones look thick, imbalance of breaking and creating bone

67
Q

osteolytic phase of Paget’s Disease:

A

high lesion, less bone, bone breaking

68
Q

Osteosclerotic phase of Paget’s diseases:

A

less lesions, more bone, looks thick, bone creation

69
Q

Paget’s diseases happens here:

A

Tibia, ilium, femur, vertebra, skull

70
Q

Symptoms of Paget’s disease:

A

Cranial nerve compression → VIII cranial nerve – deafness

71
Q

Bone thickening in Paget’s disease happens here:

A

from OUTER cortex, so bone is not compressing brain

72
Q

pattern of new bone

A

mosaic (woven)

73
Q

How to see new, mosaic, woven bone best:

A

under polarized light

74
Q

TF? lamellar bone is formed around mosaic bone:

A

F. not formed here

75
Q

mosaic bone:

A

• Weak, woven, prone to fracture

76
Q

Saber shin:

A

bowing of the tibia, the bone is soft

77
Q

Calvarium:

A

osteosclerosis of the skull

78
Q

Osteoarthritis:

A

Common in elderly, 90% > 60yo, morning stiffness, pain w use, improves w rest, related to physical stress, often weight bearing joints, exception is DIP (distal interphalangeal?) joints

79
Q

Degeneration of articular cartilage:

A

Superficial layer flaking, fissuring of cartilage, then loss of cartilage. Resulting bone on bone, loss of articular surface, “Naked” bone against “naked” bone, abnormal bone growth → Osteophytes: bony outgrowth due to new stress on different part of bone, bone grows sideways), bone spurs, Heberden’s nodes

80
Q

Diarthrodial joints involves:

A

synovial fluid

81
Q

osteoarthritis histo:

A

Flaking at surface → fissures in the cartilage → loss of cartilage → bone on bone, he result is throwing the joint out of alignment → different forces on different parts of the bone → new bone formation, creating outgrowths (osteophytes)

82
Q

Gray section of the gross view of a surface of a joint:

A

erosion of the articular cartilage, partial or total

83
Q

Locations of arthritis:

A

Hip, distal joints of fingers

84
Q

Arthridial knobs of fingers:

A

Heberden’s nodes

85
Q

Heberden’s nodes, more common in men or women?

A

women

86
Q

Case: 41 year old man in good health, awakes from sleep with pain in great toe, severe, pain, sudden onset, can’t tolerate bed covers on toe, on PE next day, MP joint very tender to touch, joint swollen, red

A

Gout-Acute Arthritis

87
Q

Gout of the great toe

A

Podagra

88
Q

Gout risk factors:

A

Middle age or older, male, obesity and “rich diet”, alcohol consumption, superior intelligence

89
Q

Why does alcohol consumption lead to gout?

A

alcohol interferes with excretion of urates, purine metabolism issue

90
Q

Hyperuricemia:

A

Excessive intake of purine – containing foods (beer, organ meats (liver), beans), Low renal urate excretion (24h urinary acid < 1000 gm (apparently don’t memorize this number)), Alcohol and other agents which retard excretion, makes disease worse

91
Q

Uric acid, solubility level:

A

marginally soluble even at normal levels

92
Q

Normal serum uric acid:

A

~ 7 mg/dl

93
Q

Serum uric acid:

A

Tends to rise w age, rises at earlier age and faster in males

94
Q

What causes gout, crystal formation or inflammatory reaction?

A

inflammatory reaction

95
Q

Elevated serum acid:

o

A

Crystal form in joint fluid (especially at low temp), engulfed by polys → release lysosomal enzymes, synovitis and ultimate destruction of articular cartilage due to release of cytokines, crystals deposit in surrounding tissues → tendinitis, tophus formation (nodule, in soft tissue)

96
Q

TF? Gout is an untreatable disease.

A

F.

97
Q

How are urate crystals in joint fluid aspirate seen?

A

under polarized light

98
Q

Histo of crystal-induced arthritis:

A

white deposits of urates below the articular cartilage

99
Q

Histo of gouty arthritis:

A

White gout precipitating on destroyed articular cartilage

100
Q

Histo of Tophi in soft tissue:

A

Common in the ear and adjacent to the involved joint, like in the toe

101
Q

Second most common cause of facial pain:

A

TMJ

102
Q

Causes of TMJ:

A

The joint, muscles, osteoarthritis, bruxism

103
Q

Symptoms of TMJ:

A

Pain in muscles of mastication, headache

104
Q

Benign bone tumor:

A

osteoma

105
Q

Malignant bone tumor:

A

primary, metastatic

106
Q

Osteoma:

-

A

Benign, slow growing, common locations sinuses, jaw, skull, mean age 35, often asymptomatic

107
Q

Histology of osteoma:

A

Looks like normal bone, seems to arise from bone surface

Pathology (23 decks)

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