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Bone Pathology > Bone > Flashcards

Bone Flashcards

1
Q

Front

A

Back

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2
Q

What are the three zones of long bones?

A
  1. Epiphysis 2. Metaphysis 3. Diaphysis
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3
Q

What are the two types of gross bone structure?

A
  1. Compact bone 2. Cancellous bone
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4
Q

What are the two types of microscopic bone structure?

A
  1. Bone matrix 2. Bone cells
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5
Q

What is the mineralized type I collagen found in bone?

A

Bone matrix.

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6
Q

What are the four types of bone cells?

A
  1. Osteogenic cells 2. Osteoblasts 3. Osteocytes 4. Osteoclasts
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7
Q

What is the definition of woven bone?

A

Woven bone is formed during fetal development and fracture repair.

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8
Q

What is lamellar bone?

A

Lamellar bone is a mineralized matrix arranged in two different patterns: 1. Concentric cylindrical units (e.g. compact bone) 2. Branching anastomosing curved plates (e.g. cancellous bone).

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9
Q

What are osteogenic cells?

A

Osteogenic cells are stem cells that can differentiate into osteoblasts.

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10
Q

What do osteoblasts do?

A

Osteoblasts do not divide; they synthesize and secrete the collagen matrix and calcium salts.

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11
Q

What are osteocytes?

A

Osteocytes derive from osteoblasts and are essentially osteoblasts surrounded by the products they secreted.

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12
Q

What are osteoclasts?

A

Osteoclasts secrete collagenase and other proteolytic enzymes for bone resorption.

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13
Q

What is bone mineralization?

A

Bone mineralization is the process of laying down minerals on the bone matrix.

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14
Q

What is the normal composition of bone?

A

Normal bone is composed of 50-70% minerals (calcium phosphorus magnesium) 20-40% organic matrix (collagen) 5-10% water and 3% lipids.

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15
Q

What is the role of carbonic anhydrase in bone resorption?

A

Carbonic anhydrase creates an acidic environment to facilitate the removal of bone by osteoclasts.

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16
Q

What is the role of alkaline phosphatase in bone formation?

A

Alkaline phosphatase creates an alkaline environment to lay down bone by osteoblasts.

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17
Q

What are the five functions of bone?

A
  1. Structural support for the body. 2. Permit movement and locomotion. 3. Protect vital internal organs. 4. Provide maintenance of mineral homeostasis. 5. Provide the environment for hematopoiesis within the marrow spaces.
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18
Q

What are the main categories of bone pathology?

A
  1. Congenital lesions 2. Acquired disease 3. Infection 4. Tumors
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19
Q

What are some congenital lesions related to bone?

A
  1. Aplasia 2. Supernumerary 3. Congenital fusion 4. Dysplasia (including Osteogenesis imperfecta Achondroplasia Osteopetrosis)
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20
Q

What is aplasia?

A

Aplasia is the congenital absence of a digit or rib.

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21
Q

What is supernumerary in terms of congenital lesions?

A

Supernumerary refers to the formation of an extra digit or rib.

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22
Q

What is congenital fusion in bone pathology?

A

Congenital fusion refers to the fusion of bones such as ribs or vertebrae or premature closure of cranial sutures.

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23
Q

What is dysplasia in bone pathology?

A

Dysplasia is a mutation that interferes with bone or cartilage growth or maintenance of normal matrix components.

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24
Q

What is Osteogenesis imperfecta (OI)?

A

Osteogenesis imperfecta also known as Brittle bone disease is an autosomal dominant condition caused by defective synthesis of type I collagen leading to increased fracture tendency.

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25
Q

What are the clinical features of Osteogenesis imperfecta?

A
  1. Blue sclera due to low collagen increasing transparency to choroid. 2. Hearing loss due to conduction defect in the middle inner ear bones. 3. Misshaped teeth due to dentin deficiency.
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26
Q

What is Achondroplasia?

A

Achondroplasia is an autosomal dominant condition caused by a point mutation in fibroblast growth factor receptor 3 (FGFR3) leading to defective cartilage synthesis at the growth plate.

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27
Q

What are the clinical features of Achondroplasia?

A
  1. Marked shortening of proximal extremities with normal-sized head and chest. 2. Bowing of legs. 3. Lordotic picture. 4. Chest abnormalities leading to death from respiratory failure.
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28
Q

What is Osteopetrosis?

A

Osteopetrosis is a condition characterized by dense bone that fractures easily due to defective osteoclast-mediated bone remodeling.

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29
Q

What are the clinical features of Osteopetrosis?

A
  1. Fractures. 2. Cranial nerve compression causing vision and hearing problems. 3. Anemia recurrent infections and thrombocytopenia. 4. Hepatosplenomegaly due to extramedullary hematopoiesis.
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30
Q

What is the treatment for Osteopetrosis?

A

Bone marrow transplant to repopulate osteoclasts from monocyte precursors.

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31
Q

What are some acquired diseases of bone development?

A
  1. Nutritional deficiency (Vitamin C in scurvy Vitamin D in rickets/osteomalacia) 2. Endocrine disorders (primary and secondary hyperparathyroidism osteoporosis idiopathic Paget disease).
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32
Q

What is rickets?

A

Rickets is a condition due to defective bone mineralization resulting in overabundant non-mineralized osteoid seen in children.

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33
Q

What is osteomalacia?

A

Osteomalacia is the adult form of rickets characterized by defective bone mineralization.

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34
Q

What are the causes of rickets and osteomalacia?

A
  1. Vitamin D deficiency in diet. 2. Lack of sunlight leading to deficiency of Vitamin D metabolites. 3. Intestinal malabsorption. 4. Renal or liver disease. 5. Drugs like phenytoin.
35
Q

What is the function of Vitamin D?

A
  1. Stimulates intestinal calcium and phosphorus absorption. 2. Stimulates bone calcium mobilization. 3. Increases renal reabsorption of calcium in distal tubules.
36
Q

What are the clinical features of rickets?

A
  1. Growth retardation due to defective calcification of epiphyseal cartilage. 2. Bones are soft bent and deformed (bowing of long bones). 3. Swelling of costochondral junctions causing rachitic rosary. 4. Thorax deformities (pigeon breast). 5. Harrison sulcus or groove at lower rib cage. 6. Skull flattening or bossing. 7. Deformed pelvis leading to childbirth difficulty.
37
Q

What are the clinical features of osteomalacia?

A
  1. Long bones or pelvis show spontaneous incomplete microfractures of the cortical plate and trabecular bone that appear as looser zones on X-ray. 2. Limb proximal muscle pain and weakness producing waddling gait. 3. Pelvic deformities in females interferes with childbirth.
38
Q

What are the causes of hypoparathyroidism?

A
  1. Primary or secondary hyperparathyroidism. 2. Osteoporosis. 3. Idiopathic conditions.
39
Q

What is osteoporosis?

A

Osteoporosis is the reduction of bone mass to a level below that required for normal bone support while mineralization is normal.

40
Q

What are the localized causes of osteoporosis?

A

Prolonged immobilization.

41
Q

What are the generalized causes of osteoporosis?

A
  1. Primary causes: postmenopausal senile idiopathic. 2. Secondary causes: hyperparathyroidism hypo or hyperthyroidism Addison disease diabetes mellitus multiple myeloma malabsorption corticosteroid use chemotherapy and lack of physical activity.
42
Q

What are the two types of osteoporosis related to menopause and aging?

A

Menopause (Type 1) and Aging (Type 2).

43
Q

What are some pathophysiological factors in osteoporosis?

A
  1. Decreased serum estrogen. 2. Decreased replicative activity of osteoprogenitor cells. 3. Increased IL-1 IL-6 TNF levels. 4. Decreased synthetic activity of osteoblasts. 5. Increased expression of RANK and RANKL. 6. Decreased biological activity of matrix-bound growth factors. 7. Increased osteoclast activity. 8. Reduced physical activity.
44
Q

What is the morphology seen in osteoporosis?

A

More pronounced in the spine and femoral neck due to the higher proportion of cancellous trabecular bone.

45
Q

What are the clinical features of osteoporosis?

A
  1. Asymptomatic until fractures occur. 2. Bone pain with fractures (e.g. wrist hip and spinal bones). 3. Pulmonary embolism or pneumonia are common complications causing 50000 deaths annually. 4. Skeletal deformities (e.g. kyphosis or scoliosis) leading to loss of height.
46
Q

What is the treatment for osteoporosis?

A
  1. Bisphosphonates cause apoptosis of osteoclasts. 2. Dietary calcium intake vitamin D and exercise at age 30 to maximize peak bone mass.
47
Q

What is Paget disease of bone?

A

Paget disease also called Osteitis Deformans is a disorder of normal bone remodeling that maintains normal calcium levels resulting in enlarged brittle bone that is prone to fractures.

48
Q

What are the stages of Paget disease?

A
  1. Osteolytic stage. 2. Mixed osteolytic-osteoblastic stage. 3. Osteosclerotic stage.
49
Q

What are the common complications of Paget disease?

A
  1. High-output congestive heart failure. 2. Cranial nerve compression. 3. Bone deformation leading to chalkstick fractures under stress. 4. Secondary osteosarcoma.
50
Q

What is osteomyelitis?

A

Osteomyelitis results from microbial invasion of the bone or bone marrow commonly caused by pyogenic bacteria or Mycobacterium tuberculosis.

51
Q

What are the routes of infection for osteomyelitis?

A
  1. Hematogenous route. 2. Local extension of infection. 3. Traumatic implantation after fracture.
52
Q

What causes pyogenic osteomyelitis in children?

A

Pyogenic osteomyelitis in children is primarily caused by Staphylococcus aureus or Salmonella in persons with sickle cell anemia.

53
Q

What clinical features are associated with osteomyelitis?

A
  1. Fever. 2. Leukocytosis. 3. Throbbing pain. 4. Treatment includes antibiotics and surgical drainage.
54
Q

What are the complications of osteomyelitis?

A
  1. Spread of sepsis. 2. Pathologic fractures. 3. Chronic infection. 4. Secondary amyloidosis. 5. Endocarditis from septic thrombophlebitis causing systemic pyemia.
55
Q

What are the types of bone tumors?

A
  1. Primary tumors: osteosarcoma chondrosarcoma Ewing sarcoma. 2. Secondary tumors: more common than primary usually result in osteolytic punched-out lesions.
56
Q

What are the characteristics of osteosarcoma?

A

Osteosarcoma commonly occurs around the knee at the metaphysis and is characterized by gray-white tumors with hemorrhage and soft tissue masses that destroy surrounding cortices.

57
Q

What are the risk factors for primary osteosarcoma?

A
  1. Retinoblastoma RB gene mutation (60-70% cases). 2. Mutation in P53 CDK CDK inhibitors.
58
Q

What are the clinical features of primary osteosarcoma?

A
  1. Painful large mass. 2. Pathological fractures. 3. Codman’s triangle on X-ray (triangular shadow between cortex and raised periosteum). 4. 10-20% of patients have pulmonary metastases.
59
Q

What is the prognosis of primary osteosarcoma after treatment?

A

60-70% survive after surgery and chemotherapy unlike secondary osteosarcoma.

60
Q

What is the morphology of osteosarcoma?

A

The diagnosis relies on the production of mineralized or unmineralized bone osteoid by malignant cells.

61
Q

What is osteosarcoma?

A

Osteosarcoma is a fatal local malignant tumor characterized by osteoclast-type giant cells typically occurring in individuals in their 20s to 40s.

62
Q

What are osteoclast-type giant cells?

A

Osteoclast-type giant cells are related to osteoblast precursor cells and express RANK ligands that stimulate the development of osteoclasts.

63
Q

What are the morphological characteristics of GCTs (Giant Cell Tumors)?

A

GCTs are large red-brown tumors with cystic degeneration arising in the epiphysis of long bones around the knee.

64
Q

What is the composition of GCTs?

A

GCTs are composed of uniform oval mononuclear cells scattered with osteoclast-type giant cells containing 100 or more nuclei with mitosis along with necrosis hemorrhage and reactive bone formation.

65
Q

What are the clinical features of GCTs?

A

Clinical features include pain and pathological fractures with X-rays showing large solitary lytic eccentric tumors destroying the cortex and producing a soft tissue mass.

66
Q

What is the recurrence rate for GCTs after simple curettage?

A

The recurrence rate after simple curettage is 50% with 2% likely to spread to the lungs.

67
Q

What is Ewing sarcoma?

A

Ewing sarcoma is a malignant tumor commonly found in male children characterized by a 11;22 chromosome translocation and an ‘onion-skin’ or sunburst appearance on X-ray.

68
Q

What are the microscopic features of Ewing sarcoma?

A

Microscopic features include small round blue cells forming rosettes that resemble lymphocytes and it can be confused with lymphoma or chronic osteomyelitis.

69
Q

What is the treatment response for Ewing sarcoma?

A

Ewing sarcoma often presents with metastasis but has a good response to chemotherapy.

70
Q

What is osteoarthritis?

A

Osteoarthritis is the most common degenerative joint disorder affecting the elderly over 65 years and is more common in females.

71
Q

What are the types of osteoarthritis?

A

The types of osteoarthritis include primary osteoarthritis (idiopathic with genetic factors) and secondary osteoarthritis (due to age wear and tear occupational factors obesity trauma or systemic diseases).

72
Q

What is the pathogenesis of osteoarthritis?

A

The pathogenesis involves normal chondrocytes maintaining cartilage synthesis and degradation; an imbalance leads to degeneration. Chondrocytes produce proteoglycans and type II collagen. The breakdown of the matrix through metalloproteinases results in cartilage degradation.

73
Q

What morphological changes occur in osteoarthritis?

A

Morphological changes include monoarticular or oligoarticular involvement soft granular-appearing cartilage (chondromalacia) full-thickness cartilage loss exposed smoothened subchondral bone (eburnation) and development of osteophytes.

74
Q

What are the clinical features of osteoarthritis?

A

Clinical features include morning stiffness lasting less than 30 minutes deep pain that increases with use crepitus and limitations in joint movement.

75
Q

What are the differences between rheumatoid arthritis (RA) and osteoarthritis (OA)?

A

RA is a systemic chronic inflammatory autoimmune disease affecting small joints symmetrically whereas OA is a degenerative condition affecting large weight-bearing joints asymmetrically.

76
Q

What genetic factors are associated with rheumatoid arthritis?

A

Genetic risk factors include HLA-DRB1 associated with immune tolerance breakdown leading to citrullination.

77
Q

What is the role of cytokines in rheumatoid arthritis?

A

Cytokines such as TNF IL-1 and IL-6 are secreted by activated T cells and macrophages contributing to tissue injury and increased osteoclast activity.

78
Q

What are rheumatoid nodules?

A

Rheumatoid nodules are subcutaneous masses formed by fibrinoid necrosis surrounded by lymphocytes and macrophages typically located at extensor surfaces.

79
Q

What is gout?

A

Gout is caused by excessive uric acid leading to monosodium urate crystals that induce acute inflammation.

80
Q

What are tophi in gout?

A

Tophi are large crystalline aggregates formed by urate crystals and are pathognomonic for gout.

81
Q

What are the clinical features of acute gouty arthritis?

A

Clinical features include pain and erythema in the great toe particularly in the first metatarsophalangeal joint which may remit in days to weeks.

82
Q

What are the possible renal complications associated with gout?

A

Renal complications include gouty nephropathy which may involve medullary tophi intratubular precipitations or renal calculi.

83
Q

What is myasthenia gravis?

A

Myasthenia gravis is an autoimmune condition where autoantibodies attack the postsynaptic acetylcholine receptor at the neuromuscular junction more commonly seen in women.

84
Q

What is Lambert-Eaton syndrome?

A

Lambert-Eaton syndrome involves antibodies against presynaptic calcium channels at the neuromuscular junction and is often a paraneoplastic syndrome associated with small cell carcinoma of the lung.

Bone Pathology (1 decks)

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