Bone: Infection & Metabolic bone disease

Question 1

Most common agent of osteomyelitis?

Answer 1

Staph

Question 2

Most common mechanism for contracting osteomyelitis?

Answer 2

Direct penetration

Question 3

Hematogenous osteomyelitis is most commonly seen in…

Answer 3

boys (post infection) and IV drug users

Question 4

What area of the bone does hematogenous osteomyelitis mainly affect?

Answer 4

Metaphysis

Question 5

Hole formed in the bone during the formation of a draining sinus?

Answer 5

cloaca

Question 6

Fragment of necrotic bone that is embedded in pus?

Answer 6

Sequestration

Question 7

Reactive bone formation from the periosteum and the endosteum (which surrounds and contains the infection)?

Answer 7

Brodie infection

Question 8

Peristeal new bone formation forms a sheath around the necrotic sequestration?

Answer 8

Involucrum

Question 9

What occurs in veterbral osteomyelitis?

Answer 9

intervertebral disk expands with pus and is destryed

Question 10

What are two possible complications of osteomyelitis?

Answer 10

amyloidosis, chronic osteomyelitis, and SCC

Question 11

What # vertebrae does TB effect in Pott disease?

Answer 11

T11

Question 12

In Pott Disease TB…how are the vertebrae destroyed?

Answer 12

resorption of bony trabeculae (mechanical collapse)

Question 13

Aside from pott disease, how else can TB manifest int the bone?

Answer 13

1. Tubercuous Arthritis… granulomas in synovial/ joint tissue
2. Osteomyelitis of the Long Bones

Question 14

How can syphilis affect the bone?

Answer 14

slowly progressive, chronic, inflammatory disease of bone characterized by granulomas necrosis and reactive bone formation

Question 15

In congenital syphilis what is the most commonly affected joint?

Answer 15

knee

Question 16

In acquired syphilis when are bone lesions seen?

Answer 16

Tertiary syphilis…2-5 years after inoculation

Question 17

In acquired syphilis which bones are commonly affected?

Answer 17

tibia, nose, palate and skull

“saber shin” and “saddle nose” deformities

Question 18

What are the bone defects seen in langerhans cell histiocytosis?

Answer 18

Punched out lytic defects without reactive bone formation

Question 19

Name the 3 langerhans cell histiocytosis?

Answer 19

1- eosinophilic granuloma

2- Hand- Schuller- Christian disease

3- Letterer- Siwe Disease

Question 20

Which is the worst langerhans histiocytosis?

Answer 20

Letterer- Siwe Disease

failure to thrive, cachexia, hepatosplenomegaly, anemia, leukopenia, skin lesions

Question 21

Name the disease:

“diffuse skeletal lesions marked by decreased skeletal mass and inadequate mechanical support”

Answer 21

osteoporosis

Question 22

Main causes of osteoporosis?

Answer 22

Menopause and aging

Question 23

Match the categories:

1: Type 1 Primary Osteoporosis, Type 2 Primary Osteoporosis
2: Menopause, aging
3: decreased osteoblast function, increased osteoclast recruitment

Answer 23

Type 1–> menopause–> increased osteoclast recruitment

Type 2–> aging–> decreased osteoblast function

Question 24

Name the disorder:

“inadequate mineralization of newly formed bone matrix”

Answer 24

Osteomalacia and ricketes

Question 25

What is milkman- Looser syndrome:

Answer 25

formation of radiolucent psuedofracutres )often on the concave side of long bones)

Question 26

What does von Kossa stain do?

Answer 26

colors calcified tissue black

Question 27

“Buddha-like” posture? “Pigeon breast”? “potbelly”?

Answer 27

seen in children with rickets

Question 28

What is a common causes of osteomalacia and rickets?

Answer 28

Vit D deficiency–> decreased Ca

Question 29

What is the difference between vit D dependent rickets type I and type II?

Answer 29

Type I: mutation in 1-alpha hydroxylase (treat with vit D)

Type II: mutation of vit D receptor (treat with Ca)

Question 30

Name the disease:

mutation of PHEX–> inactivation of FGF23–> phosphate wasting and impaired osteoblast function

Answer 30

X- linked hypophosphatemia

Question 31

What is fanconi syndrome?

Answer 31

Wasting from the proximal tubule leading to renal tubular acidosis resulting in rickets and osteomalacia

Question 32

What can cause fanconi syndrome?

Answer 32

Bence -Jones proteinuria, amyloidosis, Iron/ Mercury poinoning, glycogen storage diseases

Question 33

In what disease is osteitis fibrosa seen (accelerated bone remodeling)

Answer 33

primary hyperthyroidism

Question 34

What are the stages of osteitis fibrosia?

Answer 34

1- dissecting osteitis

2- osteitis fibrosa

3- osteitis fibrosa cystica

Question 35

How does osteitis fibrosa cystica present?

Answer 35

“brown tumor”–> bulbous swelling with multiple lytic lesions

Question 36

Symptoms of renal osteodystrophy?

Answer 36

Decreased GFR
Hypocalcemia
Increased PTH and phsophate
Osteomalacia

Question 37

Name the disease:

lytic lesions of bone resulting from disordered remodeling

Answer 37

Paget disease of the bone

Question 38

What are the 3 stages of paget disease?

Answer 38

1- “hot” or osteoclastic resorptive stage

2- mixed stage (osteoblast and osteoclast activity)

3- “cold” or burnt-out stage (decreased cellularity)

Question 39

What is the pathological cell of pathologic disease?

Answer 39

osteoclast (super-multinucleated osteoclasts)

Question 40

Most common symptom of paget’s?

Answer 40

Bone pain

Question 41

Name the disease:

developmental abnormality characterized by a disorganized mixture of fibrous and osseous elements in medullary region of affected bones

Answer 41

fibrous dysplasia

Question 42

What is McCune- Albright Syndreme?

Answer 42

form of fibrous dysplasia, short stature, pigmented “cafe-au-lit” macules