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Pathology 2 > Bone Pathology 1 > Flashcards

Bone Pathology 1 Flashcards

1
Q

Focal Osteoporotic Defect
(2)

A

 Area of hematopoietic marrow which produces a defect
 75% adult females

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2
Q

Focal Osteoporotic Defect
Possible pathogenesis:
(3)

A

 Aberrant bone regeneration after tooth extraction
 Persistence of fetal marrow
 Marrow hyperplasia in response to increased demand for erythrocytes

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3
Q

Focal Osteoporotic Defect
 Clinical and Radiographic features:
(3)

A

 70% posterior mandible, MC in edentulous areas
 Asymptomatic, nonexpansile
 Well-defined or ill-defined radiolucency

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4
Q

Focal Osteoporotic Defect
 Histopathologic features:
(1)

A

 Cellular hematopoietic/fatty marrow

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5
Q

Focal Osteoporotic Defect
 Treatment:
(2)

A

 Incisional biopsy indicated to establish diagnosis
 No further treatment needed after diagnosis established

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6
Q

Traumatic bone cyst - Simple bone cyst
(4)

A

 Bone cavity that is empty or fluid-filled
 NOT a true cyst – no epithelial lining
 Etiology uncertain: Trauma-hemorrhage theory
 Reported in most bones of the body

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7
Q

Traumatic bone cyst
 Clinical features:
where
who
infrequent (2)
may exhibit

A

 MC in mandible
 MC in young patients, peak in the second decade
 Pain and paresthesia infrequent
 May exhibit painless jaw swelling

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8
Q

Traumatic bone cyst
 Radiographic features:
(5)

A

 Well-defined, unilocular RL
 Occasionally ill-defined, multi-locular
 Range from 1-10 cm
 RL defect often scallops upward between roots of teeth
 Root resorption, cortical expansion infrequent

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9
Q

Traumatic bone cyst
 Treatment:
(4)

A

 Surgical exploration and biopsy
 Cavity often empty, may contain serosanguinous fluid
 New bone formation, resolve after 1-2 years
 Low recurrence

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10
Q

Idiopathic osteosclerosis
Dense bone island, Bone scar
(2)

A

 Focally increased bone density of unknown cause
 Most arise in late 1st decade or early 2nd decade

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11
Q

Idiopathic osteosclerosis
 Clinical features:
(3)

A

 May remain static or slowly increase in size
 Asymptomatic and nonexpansile
 90% occur in mandible, 1st molar MC

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12
Q

Idiopathic osteosclerosis
 Radiographic features:
(2)

A

 Well-defined radiopacity, 0.2 cm to 2.0 cm
 Nonexpansile

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13
Q

Idiopathic osteosclerosis
 Diagnosis:
(2)

A

 History, clinical features and radiographic findings
 Lack of cortical expansion and continued growth rule against a neoplastic
process

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14
Q

Idiopathic osteosclerosis
 Treatment:
(1)

A

 Periodic radiographs during adolescence

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15
Q

Osteogenesis imperfecta
 “— bone disease”
 Group of heritable disorders characterized by (2)
 Worldwide prevalence of

A

Brittle
osteopenia and bone fragility
6-7 per 100,000 population

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16
Q

Osteogenesis Imperfecta
 –% AD inheritance pattern
 Type I collagen gene mutations: (2)
 Type I collagen: (5)
 Mutations result in abnormal
 Disease characterized as

A

90
COL1A1 and COL1A2
bone, dentin, sclerae, ligaments, skin
type I collagen, low tensile strength
mild, moderate, severe

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17
Q

Osteogenesis Imperfecta
 Clinical Findings:
(6)

A

 Bone fractures
 Long bone, spine deformity
 Growth impairment
 Blue sclerae
 Hearing loss
 Joint hyperextensibility or contractures

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18
Q

Osteogenesis Imperfecta
 Radiographic findings:
(4)

A

 Osteopenia
 Bowing deformity of long bones
 Multiple fractures
 Wormian bones (skull)
- Small sutural bones arranged in a mosaic pattern

19
Q

Osteogenesis Imperfecta
 Dental alterations
(5)

A

 Clinically and radiographically identical to dentinogenesis imperfecta
 Blue, yellow, brown translucence (primary and permanent)
 Severe attrition, loss of VDO
 Tooth roots narrow
 Class III malocclusion due to maxillary hypoplasia, crossbite, open bite

20
Q

Osteogenesis Imperfecta
 Diagnosis requires correlation of the
 Treatment:

A

clinical features, radiographic and/or
prenatal ultrasound findings, family hx

physiotherapy, rehabilitation, orthopedic surgery, IV
bisphosphonates

21
Q

Osteopetrosis
 Markedly increased
 Failure of
 Decreased

A

bone density
osteoclast function or differentiation
bone resorption →sclerotic bone

22
Q

Osteopetrosis
 AD Adult Osteopetrosis:
 MC type, — severe manifestations
 Sclerosis affects
 — frequent
 Increased risk of

A

less
axial skeleton, minimal involvement in long bones
Bone pain
fracture and osteomyelitis following tooth extraction

23
Q

Osteopetrosis
 AD Adult Osteopetrosis
 Radiographic findings:

A

 Diffuse radiopacity of medullary bone

24
Q

Osteopetrosis
 Treatment:
 Adult osteopetrosis:
 Infantile osteopetrosis:

A

management of disease complications
Poor prognosis
- Most patients die during 1st decade

25
Q

Cleidocranial Dysplasia

 Mutations in — gene
 Worldwide prevalence:

A

Bone disorder, dental and clavicular abnormalities
RUNX2
1:1,000,000

26
Q

 Mutations in RUNX2 gene
(2)

A

 Osteoblastic differentiation, chondrocyte maturation
 May also have role in odontogenesis

27
Q

Cleidocranial Dysplasia
 Clinical Features:
(5)

A

 Clavicles: hypoplastic, 10% cases absent
- Approximate shoulders anteriorly
 Short stature
 Enlarged skull
 Ocular hypertelorism
 Broad-based nose

28
Q

Cleidocranial Dysplasia
 Radiographic features
 Skull radiographs:
(2)

A

sutures and fontanels show delayed closure
 Wormian bones

29
Q

Cleidocranial Dysplasia
 Dental
(2)

A

 Over-retained deciduous teeth
 Numerous unerupted permanent and supernumerary teeth

30
Q

Cleidocranial Dysplasia
 Treatment
(2)

A

 Removal of primary and supernumerary teeth
 Orthognathic surgery

31
Q

Paget disease of bone
(4)

A

 Abnormal, anarchic resorption and deposition of bone
 Skeletal weakening
 Anglo-Saxon ancestry, highest rates in UK
 Genetic and environmental factors involved

32
Q

Paget disease of bone
 Clinical features:
(5)

A

 Older patients, rare in patients <40 years
 Male predilection
 40% present with bone pain
 Arises in one or more bones simultaneously
 Pelvis, femur, lumbar vertebrae, skull and tibia

33
Q

Paget disease of bone
 Clinical features:
 Affected bones:
 Deformity:
 Skull involvement:

A

thickened, enlarged, weakened →increased risk of fracture
Bowing
progressive increase in head circumference

34
Q

Paget disease of bone
 Clinical features:
involvement
where
special fact

A

 Jaw involvement (17% patients)
 Maxilla: mandible (2:1)
 Alveolar ridges grossly enlarged: spacing between teeth

35
Q

Paget disease of bone
 Alveolar ridges grossly enlarged: spacing between teeth
 Denture too —!

A

small

36
Q

Paget disease of bone
 Maxilla: mandible (2:1)
(3)

A

 Enlargement of middle third of face
 Nasal obstruction, obliterated sinuses
 Severe cases: leontiasis ossea

37
Q

Paget disease of bone
 Radiographic findings:
 Early stages:
 Later stages:
 Generalized — may be observed

A

decreased radiodensity, course trabecular pattern

patchy areas of bone sclerosis
 “cotton wool” appearance

hypercementosis

38
Q

Paget disease of bone
 Diagnosis:
(2)

A

 Correlation of clinical and radiographic findings
 Lab testing: elevated serum alkaline phosphatase increased levels

39
Q

Paget disease of bone
 Dental complications:
(4)

A

 Difficult extractions (hypercementosis/ankylosis)
 Extensive hemorrhage –vascular lytic phase
 Poor wound healing, osteomyelitis – avascular sclerotic phase
 Edentulous patients- provide new dentures periodically

40
Q

Paget disease of bone
 Disease is
 Malignant transformation:

A

chronic and slowly progressive
osteosarcoma <1%

41
Q

Paget disease of bone
 Treatment:
(2)

A

 Bisphosphonate therapy – reduce bone turnover, decrease bone pain
 Orthotics, canes, orthopedic surgery

42
Q

Antral Pseudocyst
 Common finding on
 Develops due to
 Results in a

A

panoramic
an accumulation of inflammatory exudate
sessile elevation

43
Q

Antral Pseudocyst
 Radiographic findings:

A

 Uniform, dome shaped faintly opaque lesion

44
Q

Antral Pseudocyst
 Treatment:
(2)

A

 No treatment if asymptomatic
 Symptomatic cases – endoscopic surgery

Pathology 2 (12 decks)

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