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Path - Histopath > Bone > Flashcards

Bone Flashcards

1
Q

which Bone Cells are of the macrophage family?

A

osteoclasts

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2
Q

what. is the process allowing bone resorption?

A

osteoblasts with RANK-L bind to RANK on surface of osteoclast precursors

osteoblasts also release macrophage colony-stimulating factor (M-CSF) which binds to MCSF receptor. on surface of osteoclasts p

these 2 together induce activation into osteoclasts

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3
Q

what is the process stopping bone resorption?

A

stromal cells / osteoblasts release Osteoprotegrin

OPG acts as a “decoy” receptor for RANKL, preventing it from binding the RANK receptor

Consequently, OPG prevents bone resorption by inhibiting osteoclast differentiation.

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4
Q

what is the downstream factor activated by RANK-RANK-L. binding?

A

NFKB

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5
Q

90% cases of osteoporosis is due to ??

A

insufficient Ca intake and post-menopausal oestrogen deficiency

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6
Q

what are the mechanisms. of. Glucocorticoid-Induced Bone Disease ?

A

excess steroids can lead to osteonecrosis and fractures through;

  1. Osteocytes - increased apoptosis
  2. Osteoblasts - less made = less bone formed
  3. Osteoclasts - less made, but temporary increased in bone breakdown
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7
Q

how. does. Osteoporosis typically present?

A

back pain and #

> 60% vertebral # are asymptomatic

compression sx

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8
Q

what are the 2 types of osteomalacia?

A
  1. Deficiency of vitamin D

2. Deficiency of PO4

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9
Q

Looser’s zone fracturesare seen in?

A

osteomalacia

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10
Q

what are the sx of Hyperparathyroidism?

A

Stones (Ca oxalate renal stones)
Bones (osteitis fibrosa cystica*, bone resorption)
Abdominal groans (acute pancreatitis)
Psychic moans (psychosis & depression)

  • Browns tumours - fibrovascular tissue and giant cells with abundant deposits hemorrhage and hemosiderin.
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11
Q

what does Renal Osteodystrophy involve?

A

Comprises all the skeletal changes of chronic renal disease

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12
Q

name. a disorder of bone turnover?

A

Pagets disease

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13
Q

what is the aetiology of Pagets disease?

A

Familial cases show autosomal pattern of inheritance with incomplete penetrance (mutation 5q35-qter - sequestosome 1 gene)

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14
Q

what is the. presentation of pagets?

A

pain
microfractures
nerve compression (incl. Spinal N and cord)

+/- haemodynamic changes, cardiac failure
Development of sarcoma in area of involvement 1%

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15
Q

what are the histological features of pagets?

A

cortex - thickened

trabeculae - coarse, irregular, thick

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16
Q

what are the stages of fracture repair?

A
  1. Organisation of haematoma at # site (pro-callus)
  2. Formation of fibrocartilaginous callus
  3. Mineralisation of fibrocartilaginous callus
  4. Remodelling of bone along weight-bearing lines
17
Q

what are the presenting sx of osteomyelitis?

A

General - malaise, fever , chills , leucocytosis

Local - pain, swelling and redness

18
Q

what are. common sites for osteomyelitis?

A

Vertebrae
Jaw (2º to dental abscess)
Toe (2º to diabetic skin ulcer) (>3mm)
Long bones (usually metaphysis)

19
Q

how might we ivx osteomyelitis?

A

60% positive blood cultures

X-ray - mixed picture; eventually lytic

20
Q

what is the most common organism in osteomyelitis?

A

Staph Aureus(90%)

21
Q

name some xray changes for osteomyelitis?

exam purpose only

A

Usually appear 10 days or so post onset
Mottled rarefaction and lifting of periosteum
>1week - irregular sub-periosteal new bone formation called involucrum

Later - irregular lytic destruction (takes 10-14days)
Some areas of necrotic cortex may become detached called sequestra (takes 3-6 weeks)

22
Q

psoas abscess and severe skeletal deformity (Pott’s disease) may present in the skeletal manifestation of which condition?

A

Tuberculosis

TB Osteomyelitis
since osteomyelitis only means infection n inflammation of bone

23
Q

list some rarer causes of Osteomyelitis?

A

TB

Syphilis

24
Q

name the most prevalent vector bone disease

A

Lyme disease

25
Q

aetiology of lyme disease?

A

Inflammatory arthropathy

Organism:-
Borrelia burgdorferi

Tick Species:-
Ixodes dammini

26
Q

erythema chronicum migrans rash is seen in?

A

lyme disease

27
Q

how does lyme disease present?

A

Characterised by rash (90%)
Often thigh, groin, axilla (earlobe in children)

Early - Disseminated disease:
Affects many organs, musculoskeletal, heart, nervous system.

Late, persistent: Dominated by arthritis

28
Q

what processes underline osteoarthiritis?

A

cartilage degeneration
fissuring
abnormal matrix calcification
osteophytes

29
Q

most common sites affected in osteoarthiritis?

A

Main sites vertebrae hips and knees

+/-DIPJ PIPJ of the hand

+/- carpometacarpal and metatarsophalangeal joints

30
Q

what clues can the synovium give us about osteoarthiritis?

A

Infiltration of mononuclear cells, thickening of the synovial lining layer and production of inflammatory cytokines

31
Q

the following are found in which condition:

Radial deviation of wrist
Ulnar deviation of fingers
‘Swan neck’ & ‘Boutonniere’ deformity of fingers
‘Z’ shaped thumb

A

Rheumatoid Arthritis

32
Q

what would be the histological features of Rheumatoid Arthritis?

A

Proliferative synovitis with

1. Thickening of synovial membranes ( villous)
2. Hyperplasia of surface synoviocytes
3. Intense inflammatory cell infiltrate
4. Fibrin deposition and necrosis

Pannus formation with exuberant inflamed synovium
overlying the articular surface

33
Q

what are Grimley-Sokoloff cells?

A

synovial giant cells found in Rheumatoid Arthritis

34
Q

what is the commonest malignant bone tumour ?

A

metastatic bone cancer

35
Q

list some Primary Bone Tumours - Malignant? most common?

A

Osteosarcoma - most common

Chondrosarcoma

Ewing’s sarcoma

36
Q

epidemiology of Osteosarcoma?

A

peak in adolescence

37
Q

what would be the histological n X-ray features of osteosarcoma?

A

malignant mesenchymal cells +/- bone and cartilage formation

xray: elevated periosteum (Codman’s Triangle)

38
Q

the following are consitent with which condition:

X-ray: lytic with fluffy calcification

Histo: malignant chondrocytes +/- chondroid matrix may dedifferentiate to high grade sarcoma

A

chondrosarcoma

because it is a cartilage producing tumour

39
Q

the following are consitent with which condition:

X-ray: onion skinning of periosteum, lytic +/- sclerosis
Histo: sheets of small round cells

A

Ewing’s Sarcoma/PPNET

- 80% -> reciprocal rearrangement of t(11;22)(q24;q12) resulting in an EWSR1-FLI1 fusion protein

Path - Histopath (21 decks)

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