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SMS Week 5 > Bone Pathology > Flashcards

Bone Pathology Flashcards

1
Q

What is the term for demineralization of bone seen on x-ray?

A

osteopenia

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2
Q

What are the 4 main causes of osteopenia? Which is most common?

A

osteoporosis is most common

osteomalacia

malignancy

rare hereditary disorders

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3
Q

Are neoplasms involving bone usually primary neoplasms or metastases?

A

metastases

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4
Q

What is a pathological fracture?

A

a fracture thorugh diseased bones - usually refers to a fracture through tumorous or tumor-like bone

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5
Q

How do the growth plates close in puberty?

A

sex hormones signal blood vessel incursion through the cartilage, which causes it to mineralize and the plate closes.

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6
Q

How much of the total body calcium is in bone?

A

99 percet

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7
Q

Low serum calcium levels will trigger secretion of what hormone to induce calcium release from the skeleton?

A

parathyroid hormone - triggers osteoblasts to activate the osteoclasts

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8
Q

Why is VItamine D such an important molecule for the skeleton?

A

It helps get calcium from the gut into the blood so that bone mineralization can occur

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9
Q

Whta needs to happen to vitamin D before it can be useful?

A

It needs to by hydrosylated twice - first in th eliver and then in the kidney in the presence of PTH.

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10
Q

What molecule will inhibit the hydroxylation of vitamin D?

A

phosphate

and vit D(OH2) itself

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11
Q

What is unique about the blood clot that forms in fractures?

A

It will become fibrous like other blood clots, but then it will mineralize!

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12
Q

What reaction will the periosteum have in response to bone trauma?

A

It will lay down new bone

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13
Q

What are some complications of fractures thorugh healthy bone?

A

mal-alignment

non-union / pseudoarthrosis

osteomyalitis (especially in compound fractures)

growth disturbance (in kids)

arthritis (if fracture is intraarticular)

fat embolism syndrome

PE - from immobilization

Osteoporosis of immovilized bone

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14
Q

what is osteoporosis?

A

a type of osteopenia due to bone atrophy caused by an imbalance of the bone remodeling process - more osteoclast activity than osteoblast

its definitely age related, and much more in women

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15
Q

What are the clinical manifestations of osteoporosis?

A

pretty much asymptomatic until they get a fracture

vertebral fractures are the most common:

compression fractures (pancake fractures) are acutely painful, while wedge fractures (more common) are usually painless and just cause them to slowly stoop and shorten

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16
Q

What are some causes of osteoporosis?

A

low estrogen postmenopause

excess corticosteroids

hyperparathyroidism

hyperthyroidism

poor nutrtiion or malabsorption

immobilization

hypogonadism

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17
Q

WHy should you keep osteoporosis as a diagnosis of exclusion?

A

Becuase there are causes of secondary osteoporosis which are much more treatable and even reversible

osteopenia does NOT = osteoporosis

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18
Q

In osteopenia, is it the compact or cancellous bone that really demineralizes?

A

the cancellous bone.

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19
Q

Why do you get kyphosis in severe osteopenia?

A

You get wedge fractures of the anterior vertebral bodies under the weight of the head.

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20
Q

Besides the spine, what are some bones that are commonly affected by osteoporosis?

A

any bone that’s near key stress joints like the proximal femur, proximal humerus and distal radius

it will NOT take much force to break these

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21
Q

What is the best prevention for osteoporosis?

A

maximize peak bone mass in young adulthood and encourage weight bearing exercise and Ca and Vit D supplementation

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22
Q

What is the strongest predictor of ostoporosis risk?

A

maternal hip fracture

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23
Q

What is the actual way to diagnose osteoporosis - not an x-ray after a fracture?

A

bone densitometry

diagnose if they are under 2.5 deviations of the average for a yount adult

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24
Q

Most anti-osteroporosis meds inhibit what?

A

osteoclast bone resorption

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25
Q

Hypercalcemia is almost always due to what?

A

a primary hyperplasia or neoplastic enlargment of the parathyroid glands

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26
Q

Which type of bone is more resorbed in hyperparathyroidism - trabecular or cortical?

A

cortical

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27
Q

What are some complications of primary hyperparathyroidism?

A

fractures due to demineralization

metabolic impariment of the kidneys and renal stone disease (because of the excess calcium)

muscle weakness

neuropsychiatric syndromes

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28
Q

In hyperparathyroidism you will see ___ serum calcium and ____ serum phosphorus.

A

elevated Ca and decreased P

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29
Q

What is osteomalacia?

A

It’s decreased bone mineralization with excess osteoid due to an interference with calcium, phosphate, or vitamin D metabolism - sometimes hard to tell the difference

it will be osteopenic on radiology

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30
Q

How is the presentation for osteomalacia different from that of osteoporosis? 1 important distinction…

A

osteomalacia can present with diffuse skeletal pain without fracture while osteoporosis will be asymptomatic until the fracture

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31
Q

What can cause osteomalacia?

A
  1. rickets (environmental)
  2. Intestinal malabsorption - commonest cause of Vit D deficiency in the US
  3. Liver or renal disease - impaired hydrosylation of Vit D
  4. Rare congenital errors of metabolism
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32
Q

What will labs show in osteomalacia?

A

increased serum alkaline phosphatase becuase the osteoblasts are trying to repair…

low serum Ca or P

decreased urinary Ca excretion

Increased PTH - attempt at a compensatory mechanism

decreased in hydrosylated vitamin D

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33
Q

What will a vitamin D deficiency in children (rickets) cause?

A

widened/shortened growth plates

bowed legs due to softened bone

fractures

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34
Q

What is “renal rickets”?

A

Renal osteodystrophy

it’s a progressive destruction of the second hydroxylation of Vitamin D in the kidneys

most commonly a combination of secondary hyperparathyroidism and abnormal mineralization

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35
Q

Under histology, what is the hallmark of osteomalacia?

A

osteoid seams - the osteoid is layed down by the osteoblasts but doesn’t mineralize

36
Q

WHat is the primary mode of acquisition for an osteomyelitis in children? In adults? In diabetics?

A

kids: hematogenous spread to bone from an occult source
adults: direct infection through compound fractures or orthopedic procedures
diabetis: secondary infection through an adjacent contiguous infection like joint or soft tissue infections - usually feet

37
Q

Which bones are most often affected by osteomyelitis?

A

long bones - usually starts in the metaphyseal region

38
Q

How do you definitivly diagnose an osteomyelitis?

A

take a direct bone culture

blood cultures will work too, but children may culture negative

they’ll also have fever, high WBCs and bone pain - the bone pain without acute injury is the big tip off

39
Q

What is the most common microorganism for osteomyelitis?

A

staph auerus 95%!

Some streptococcus, gram negative bacilli and salmonella in sick cell patients

40
Q

Which radiological technique is better for catching an osteomyelitis?

A

MRI are better at early detection

x-ray won’t see it until about 10 days after it starts

41
Q

WHat are some potential chronic complications of suppurative osteomyelitis?

A

suppurative arthrtis of the adjacent joints

sinus tracks to skin - drianage

growth disturbance in kids

deformity

amyloidosis - in any chronic inflamatory condition

42
Q

What is the treatment for osteomyelitis?

A

aggressive!

IV antibiotics

can use surfical drainage/deridement

amputation in chronic cases

43
Q

What bones does TB usually spread to? WHat is this called?

A

spine and long bones

if in the spine = Pott’s disease

44
Q

What are the two major fungi that can cause osteomyelitis?

A

blastomycosis is the most common in immunocompetent patients

coccidioidomycosis

always secondary to hematogenous spread form lungs

45
Q

WHere in the long bones does osteomyelitis often start?

A

the metaphysis

46
Q

Where do spinal osteomyelitises start?

A

hematogenous spread directly into the disc, from there is goes into the disc above and below

47
Q

What are the most common causes of avascular bone necrosis/infarction?

A

fractures is the big one

corticosteroid Rx

alcoholism

48
Q

Which bone is most commonly affected by abascular necrosis?

A

femoral head

49
Q

What is the difference between a subchondral infarct and a medullary infart?

A

subchondral infarcts are in the epiphyses and affect the joint - causing pain wtih activity

medullary infarcts are infarcts of the shafts of bone and can be clinically silent unless they get very large (which they can) and cause fractures

50
Q

What are the complications of avascular bone necrosis?

A

secondary degenerative joint disease

bone growth deformities in kids

pathologic fracture

51
Q

What is Paget’s Disease of bone (osteitis deformans)?

A

it’s a deforming bone disease in middle aged ango-saxons

due to a latent viral infection of osteoclasts in a genetically susceptible person

usually makes large bones (skull, pelvis, tibia, etc) larger

52
Q

What are the 3 phases of paget’s disease of bone?

A
  1. lytic: increased osteoclasts with bone resorption and increased vasculatiry
  2. Mixed: increased osteoclast activity and increased osteoblast activity (as a componsation)
  3. Sclerotic: increased osteoblastic phase - most characteristic radiologically
53
Q

True or false:

Paget’s disease of bone causes widening slcerosis of the bone, and with that, a reduced risk of fractures.

A

False

It does widen bones and make them bigger, but ironically it also makes the bones weaker and more likely to fracture

54
Q

Paget’s disease of bone is usually asymptomatic, but what are some symptoms that can occur?

A

principally pain due to fractures, compression of cranial nerves or spinal nerves

or pain from secondary degenerative joint disease due to subchondral bone deformity

sometimes the skin overlying an affected bone is warm during lytic/vascular phase

55
Q

What lap finding will be significant in Paget’s disease of bone?

A

increased serum alkaline phosphatase (without liver disease)

56
Q

What are 4 major congenital bone disorders? Which are we most likely to see in our offices?

A

neural tube defects

achondroplasia

osteogenesis imperfecta - most common we’ll see

osteopetrosis

57
Q

What is osteogenesis imperfecta a disorder of?

A

type 1 collagen synthesis - either abnormal or not enough

as a result you have insufficient collagen for normal osteoid production and you get brittle bones and slow growth (causes osteopenia)

58
Q

What is osteopetrosis a disorder of?

A

osteoclasts - they dont resorb bone normally so the bones get huge.

the cure for this is a bone marrow transplant

very rare

59
Q

Using x-ray, bone tumors can be classified as either ___ or ______ or mixed.

A

osteolytic (demineralizing)

osteoblastic (increased bone density)

60
Q

What is the classic example of a purely osteolytic maligancy? How about a ostoblastic malignancy?

A

osteolytic = myeloma

osteoblastic = metastatic prostate cancer

61
Q

Metastatic tumors are the most common malignancies to bone. What are the most common source cancers?

A

lung breast and prostate

but pretty much every malignant neopplasm is capable to metastasizing to bone

62
Q

Which bones are the more common sites of mets?

A

larger bones but can be anywhere

63
Q

What are the four hemic malignancies often affecting bone?

A

classic myeloma

plasmacytoma

lymphoma

leukemia

64
Q

What does plasmacytoma of bone (localized tumor of plasma cells) frequently evolve into?

A

classic myeloma

65
Q

Most non-Hodgkins lymphomas involve bone as a secondary or primary lesion?

A

secondary

66
Q

How do you diagnose myeloma on pathology?

A

blood smear shows huge ugly plasma cells

67
Q

What are some clues on x-ray that a bone cancer is malignant?

A

areas of demineraization and hypermineralization - unable to draw a nice line around the areas

penetrates the bone cortex

infiltrates surrounding STs

68
Q

Where do primary bone tumors most often arise?

A

metaphyses of long bones

69
Q

What are the most common benign tumors of bone?

A

osteochondroma

giant cell tumor

chondroma

osteoid osteoma

fibroma (metaphyseal fibrous defect)

70
Q

What are the most common malignant tumors of bone?

A

osteogenic sarcoma (osteosarcoma)

chondrosarcoma

lymphoma

Ewing’s sarcoma

Chordoma

71
Q

Which is the most common primary malignant tumor of bone in children and young adults?

Middle aged and older adults?

A

young = osteosarcoma

old = chondrosarcoma

72
Q

Most benign cartilage tumors (chondromas) involves ___ bones while malignant cartilage tumors (chondrosarcomas) tend to involve ___ bones.

A

benign = small bones

malignant = large bones

73
Q

Malignant bone tumors tend to spread through blood or lymph?

A

blood

74
Q

What is the commonest bone lesion?

A

metaphyseal fibrous defect - fibroma

benign developmental defect found in a third of children - often regress spontaneously

75
Q

What does an osteochondroma look like?

A

It’s a bony stalk of bone with a cartilage cap

basically, a piece of the epiphyseal frowth plate broke up and moved down to establish on the shaft. then ti started forming a new long bone.

76
Q

Where do chondromas of bone usually occur?

A

in the small bone - particularly hands

you’ll see calcification on x-ray

77
Q

If you have a kiddo with bone pain occurring at night that’s relieved by aspirin, what is the likly diagnosis?

A

osteoid osteoma

78
Q

Where do giant cell tumors occur in bone?

Usually lytic or blastic?

A

epiphysis

lytic - it’s basically just huge osteoclasts

79
Q

Osteogenic sarcoma prefers metaphyseal regions of large long bones, especially the…

A

knee

80
Q

Osteogenic sarcoma may be secondary to…..3

A

paget’s disease of bone

prior irradiation

old bone infarcts

81
Q

Most sarcomas will metastasize to the….

A

lungs

82
Q

CHondrosarcoma prefers large long bones and central skeleotn especially the….

A

pelvis

83
Q

chondosarcoma has the world record for…

A

forming the largest tumors

84
Q

What is the most aggressive/lethal of the primary bone tumors?

A

Ewing’s sarcoma

85
Q

Ewing’s sarcoma affects what type of bone preferentially?

A

the DIAPHYSIS of long bones and flat bones of pelvis

86
Q

Ewing sarcoma is composed fo small undifferentiated tumor cells known as…

A

primitive neuroectodermal neoplasm (PNET)

87
Q
A

SMS Week 5 (15 decks)

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