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OMFS > Bone Pathology > Flashcards

Bone Pathology Flashcards

1
Q

Diff dx of well defined radiopacity

A 
Retained root
Impacted tooth 
Odontoma (complex/compound)
Condensing osteitis
Cementoblastoma
Osteoma
Osteoid ostetoma
Osteoblastoma
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2
Q

Diff dx of poorly defined radiopacity

A 
Condensing osteitis
Cementoosseous dysplasia (late)
Fibrous dysplasia
Sclerosing osteomyelitis
Proliferative periostitis (Garres osteomyelitis)
Pagets disease
Osteosarcoma
Osteopetrosis
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3
Q

Ground glass appearance

A

Fibrous dysplasia

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4
Q

Cotton wool appearance

A

Cementoosseous dysplasia
Pagets disease
Multiple osteomas (Gardner syndrome)

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5
Q

Sunburst appearance

A

Osteosarcoma

Intraoosseous hemangioma

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6
Q

Onion skin appearance

A 
Proliferative periostitis (Garres osteomyelitis)
Ewing sarcoma
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7
Q

Diff dx of periapical radiolucency associated with vital teeth

A

Early COD

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8
Q

Osteoid osteoma

A

Well defined radiopacity with characteristic NOCTURNAL pain

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9
Q

Clinical types of FD

A

Monostotic

Polyostotic

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10
Q

Clinical features of FD

A 
Painless unilateral bony hard swelling
Slow growth generally (but can be accelerated in some cases) 
Maxilla > mandible 
Maxilla commonly involve adj bones (zygoma, ethmoid, sphenoid, frontal, temporal, occiput) - craniofacial FD 
- vision changes
- hearing impairment
- sinonasal congestion
- airway obstruction

Polyostotic - craniofacial + other limbs

  • cafe au lait (Jaffe-lichenstein syndrome)
  • cafe au lait + endocrinopathies (McCune Albright)
  • cafe au lait + myxomas (Mazabraud)

Coast of Maine - irregular borders of cafe au lait spots

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11
Q

Questions to ask with FD patients

A

Symptoms related to craniofacial

  • vision disturbance
  • sensory changes
  • hearing impairment
  • sinonasal congestion
  • airway obstruction

Symptoms related to other skeletal parts

  • bone pain in limbs
  • limping
  • hx of fracture?

Symptoms assoc with endocrinopathies

  • early puberty?
  • hyperthyroidism symptoms?
  • cushings syndrome?

Cafe au lait spots?

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12
Q

Investigations for ptns suspected or diagnosed with FD

A

Diagnosis of FD - achieved by clinical, radiographic, trephine biopsy - bony hard swelling +/- pain, ground glass appearance, irregular shaped trabecular of immature bone in fibrous stroma

CT - to seen extension of disease

Bone scan whole body

  • screen other FD in the body
  • look for intramuscular myxomas (Mazbraud syndrome)
Serum levels of 
- phosphate
- androgen
- sex hormones
- thyroid hormone
- growth hormone
- cortisol
- parathyroid hormone 
(to rule of McCune albright syndrome)
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13
Q

Treatment of FD

A

Conservative mx - potential to stabilize and regress

Surgical contouring, shaving, debulking - continued growth with large or extensive lesions

Complete surgical removal with recons - very aggressive lesions or refractory to repeated debulking

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14
Q

Is there any risk of malignant transformation for FD

A

Yes. 1% developed osteosarcoma

Esp in

  • McCune-Albright
  • Mazabraud syndrome
  • history of RT

Rapid growth with sudden onset of pain, neurosensory changes, marked changes in radiographic appearance

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15
Q

Diff dx of FD

A 
Cementoosseous dysplasia
Ossifying fibroma
Osteoma
Osteoblastoma
Osteoid osteoma
Osteosarcoma
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16
Q

Ossifying fibroma diff dx

A 
Fibrous dysplasia (histologically similar but radiographically encapsulated - fd has no capsule)
Late COD
Osteoblastoma
Osteoid osteoma
Cementoblastoma/condensing osteitis
17
Q

Types of OF

A

Conventional

Juvenile - more aggressive <15yrs of age

18
Q

Tx of OF

A

Conventional - surgical enucleation and curettage

Juvenile - wide resection with 0.5cm margin

19
Q

Pagets disease

A

Bone disease that causes resorption of bone and replacement of bone that is disorganized

Hence weaken the bone

20
Q

Presentations of Pagets

A

Asymptomatic
Radiogrpahic changes - cotton wool appearance , late stage , elderly

Symptoms in craniofacial - vision changes, hearing impairment.

Pathologic fracture

21
Q

Tx of Pagets

A

Bisphosphonates
Calcitonin
Surgery if fracture, bone deformity, degenerative arthritis

22
Q

Osteosarcoma classic radiographic appearance

A

Sunburst appearance
Codman triangle
Garrington sign - widened PDL

23
Q

clinical types of osteosarcoma

A

Central medullary OS

Peripheral OS (doesnt involve medulla) - better prognosis

  • paraosteal (sorta exophytic
  • periosteal (cause elevated perisoteum)
24
Q

Treatment of osteosarcoma

A

Resection with 2cm margin
Chemotherapy

NO RT - radiation induced sarcona
NO Neck dissection - hematogenous spread

OMFS (54 decks)

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