Benign Bone Disease

Question 1

Describe the histology of osteoporosis

Answer 1

Loss of cancellous bone

Question 2

Describe the histology of osteomalacia and rickets

Answer 2

Excess of unmineralised bone (osteoid)

Question 3

Describe the histology of bone disease associated with hyperparathyroidism

Answer 3

Osteitis fibrosa cystica - marrow fibrosis and cysts (Brown tumour)

Question 4

Describe the histology of Paget’s disease of bone

Answer 4

Huge osteoblasts with >100 nuclei. Mosaic pattern of lamellar bone

Question 5

Name at least 3 bone diseases seen in renal osteodystrophy

Answer 5

Osteitis fibrosa cystica, osteomalacia, osteosclerosis, adynamic bone disease, osteoporosis

Question 6

Describe the symptoms of osteomalacia

Answer 6

Bone pain, tenderness, proximal muscle weakness

Question 7

Describe the symptoms of rickets in children

Answer 7

Bone pain, bowing of tibia, rachitic rosary, frontal bossing, pigeon chest, delayed walking

Question 8

Describe the symptoms of primary hyperparathyroidism

Answer 8

Hypercalcaemia (abdominal moans including constipation and pancreatitis, renal stones, bone pain, psychiatric groans), polyuria, polydipsia

Question 9

Describe the symptoms of Paget’s disease of bone

Answer 9

Bone pain, microfractures, nerve compression, skull changes and increased head size, deafness, high-output cardiac failure

Question 10

Describe the x-ray appearance of bones in primary hyperparathyroidism

Answer 10

Brown’s tumours, salt and pepper skull, subperiosteal bone resorption in phalanges

Question 11

Describe the x-ray appearance of Paget’s disease of bone

Answer 11

Mixed lytic and sclerotic lesions. Skull shows osteoporosis circumscripta and cotton wool appearance. Vertebrae show ivory vertebrae. Pelvis shows sclerosis and lucency

Question 12

Describe the x-ray appearance of osteomalacia/ rickets

Answer 12

Looser’s zones (pseudo-fractures), splaying of metaphysis

Question 13

State at least 3 causes of gout

Answer 13

Increased dietary purine intake, alcohol, diuretics, inherited metabolic abnormalities

Question 14

What is podagra?

Answer 14

Gout affecting the metatarsophalangeal joint of the great toe

Question 15

Describe the clinical features of gout

Answer 15

Hot, swollen, red, exquisitely painful joint. Pathognomic sign is tophus, typically on pinna and hands

Question 16

Describe the crystals found in gout

Answer 16

Urate crystals, needle shaped, negatively birefringent

Question 17

State at least 3 causes of pseudogout

Answer 17

Idiopathic, hyperparathyroidism, diabetes mellitus, hypothyroidism, Wilson’s disease

Question 18

Describe the clinical features of pseudogout

Answer 18

Hot, swollen joint with effusion

Question 19

Describe the crystals found in pseudogout

Answer 19

Calcium pyrophosphate crystals, rhomboid shaped, positively birefringent

Question 20

Describe the management of gout

Answer 20

Acute attack: colchicine

Long term: allopurinol, decrease alcohol and purine intake (sardines, liver)

Question 21

Describe the management of pseudogout

Answer 21

NSAIDs or intra-articular steroids

Question 22

Name at least 4 types of fracture

Answer 22

Simple, compound, greenstick, comminuted, impacted

Question 23

Describe the process of fracture repair

Answer 23

Haematoma (pro-callus) forms. Fibrocartilaginous callus forms. Fibrocartilaginous callus is mineralised. Bone is remodelled along weight-bearing lines

Question 24

State at least 4 things which can influence fracture repair

Answer 24

Fracture type, neoplasm, metabolic disorder, drugs, vitamin deficiency, infection

Question 25

Name the 2 causes of osteomyelitis

Answer 25

Haematogenous spread of infection or local infection, e.g. post-trauma

Question 26

Name the most common causative agent of osteomyelitis in adults

Answer 26

Staphylococcus aureus

Question 27

State 3 common sites of osteomyelitis in adults

Answer 27

Vertebrae, jaw (after dental abscess), toes (after diabetic ulcer)

Question 28

State two causative agents of osteomyelitis in children

Answer 28

Haemophilus influenzae, group B Strep

Question 29

Describe the clinical features of osteomyelitis

Answer 29

Pain, swelling, tenderness, malaise, fever, chills, leucocytosis

Question 30

What are Heberden's nodes?

Answer 30

Distal interphalangeal joint lesions in osteoarthritis

Question 31

What are Bouchard's nodes?

Answer 31

Proximal interphalangeal joint lesions in osteoarthritis

Question 32

Describe the x-ray features of osteoarthritis

Answer 32

LOSS: loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts

Question 33

Describe the characteristic deformities of rheumatoid arthritis

Answer 33

Radial deviation of wrist and ulnar deviation of fingers, swan neck and Boutonniere deformities of fingers, Z shaped thumb