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Advanced Pathology > Bones, Joints, Soft Tissue Tumors > Flashcards

Bones, Joints, Soft Tissue Tumors Flashcards

1
Q

Function of bone

A
  • support
  • transmission of forces generated by muscle
  • protection of viscera
  • mineral homeostasis
  • blood cell production
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2
Q

What is bone matrix made up of?

A
  • organic component

- mineral component

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3
Q

What is the organic component of bone called?

A

Osteoid

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4
Q

What are the three major types of bone cells?

A
  1. osteoblasts
  2. osteocytes
  3. osteoclasts
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5
Q

is the bone matrix extracellular or intracellular

A

extracellular

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6
Q

What is the role of the three major cell types?

A

production and maintenance of the matrix

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7
Q

Where are osteoblasts located?

A

surface of the matrix

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8
Q

What is the function of osteoblasts

A

Bone matrix:

  • synthesize
  • transport
  • assemble

And to regulate mineralization

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9
Q

Where are osteocytes located?

A

within the bone matrix

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10
Q

Function of osteocytes

A
  • control calcium/phosphate levels

- detect mechanical forces and translate them into biological activity

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11
Q

Where are osteoclasts located?

A

surface of bone

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12
Q

What is the function of osteoclasts?

A

bone reabsorption

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13
Q

Bone disorder categories

A
  • Congenital disorders
  • Metabolic disorders
  • Acute conditions
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14
Q

What is an example of a metabolic bone disorder?

A

Osteoporosis

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15
Q

What is an example of a acute bone disorder?

A

fractures

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16
Q

What is a fracture?

A

Loss of bone integrity

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17
Q

What causes a fracture?

A
  • mechanical injury

- diminished bone strength

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18
Q

Why is it important for the NP to know different bone fracture types?

A

So the NP can properly communicate to patients and colleagues

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19
Q

Which fracture is the most visibly severe?

A

compound fractures

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20
Q

Which fracture is the most subtle?

A

greenstick fractures

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21
Q

Is a greenstick fractures subtle even on xray?

A

yes

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22
Q

Which fracture is common in athletes?

A

stress fracture

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23
Q

How does a stress fracture occur?

A

slowly

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24
Q

Why does a stress fracture occur slowly?

A

r/t repetition

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25
Q

What is an example of a stress fracture?

A

Long distance runners get stress fractures in their feet

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26
Q

What types of fractures can be displaced?

A

Any type of fracture can also be displaced

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27
Q

How do most fractures heal?

A

Casting

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28
Q

Which fractures usually require a healing method other than casting?

A

displaced fractures

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29
Q

How are displaced fractures healed?

A

manipulation or surgery

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30
Q

Are dislocations considered fractures?

A

no

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31
Q

What is a dislocation?

A
  • The displacement or separation of bone ends with loss of articulation
  • the bone itself is not fractured
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32
Q

Compound fracture

A

the bone communicates with the skin surface

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33
Q

Compound fracture is also known as

A

an open fracture

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34
Q

Comminuted fracture

A

The bone is fragmented

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35
Q

Displaced fracture

A

The ends of the bone at the fracture site are not aligned

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36
Q

Stress

A

A slowly developing fracture that follows a period of increased physical activity in which the bone is subjected to repetitive loads

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37
Q

Greenstick

A

Extending only partially through the bone, common in infants when bones are soft

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38
Q

Osteomyelitis

A

Inflammation of bone and marrow

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39
Q

What causes osteomyelitis?

A

Secondary or Primary infection

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40
Q

Is secondary or primary infection more common in osteomyelitis?

A

Secondary

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41
Q

How does secondary infection occur in osteomyelitis?

A

Infections spread to the bone from an infection travelling in the blood stream or through nearby tissue

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42
Q

How does primary infection occur in osteomyelitis ?

A

When injury to the bone itself becomes exposed and exposes the bone to bacteria

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43
Q

Who is at a higher risk for contracting osteomyelitis?

A
  • diabetes

- smokers

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44
Q

Osteonecrosis

A

Infarction/death of bone and marrow cells

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45
Q

What causes osteonecrosis?

A

Lack of blood supply to gone

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46
Q

What is another name for osteonecrosis is what?

A

aka avascular necrosis

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47
Q

What can osteonecrosis lead to?

A

Tiny breaks in bone leading to eventual collapse

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48
Q

What are the three mechanisms by which osteonecrosis occurs?

A
  1. Mechanical disruption of vessels
  2. Thrombotic occlusion
  3. Extravascular compression
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49
Q

What does NOT cause osteonecrosis?

A

Unlike osteomyelitis it is NOT caused by infection

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50
Q

Compartment Syndrome

A

When excessive pressure builds up inside an enclosed muscle space in the body

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51
Q

What causes compartment syndrome?

A

bleeding or swelling after an injury such as a fracture

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52
Q

How long does it take for compartment syndrome to occur?

A
  • RAPIDLY

- hours to days

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53
Q

When deciding how to treat a fracture what is important to remember when considering compartment syndrome?

A

Place a looser splint/aircast instead of immediately placing a cast

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54
Q

Phantom Limb Pain

A

Pain that feels like it’s coming from a body part that’s no longer there

55
Q

Is phantom limb pain truly felt by the pt with an amputation?

A

Yes

56
Q

Patho of phantom limb pain

A

the end of a regenerating nerve becomes trapped in the scar tissue at the amputation site

57
Q

Who gets amputations?

A
  • veterans

- diabetes

58
Q

Where does phantom pain originate?

A

spinal cord

59
Q

What type of pain is felt when amputaion is AKA

A

cramping

60
Q

What type of pain is felt when amputaion is BKA

A

Shooting/stabbing

61
Q

What type of pain is felt when amputaion is below the ankle?

A

Burning

62
Q

How are osteopenia and osteoporosis similar?

A

osteoporosis is the worsening of osteopenia

63
Q

What is the difference between osteopenia and osteoporosis?

A

PENIA- bone density has begun to dwindle but not yet dangerous

POROSIS- density levels become critical and frequent fractures likely

64
Q

What can cause fractures in osteoporosis?

A

Simply bending over or coughing can cause a fracture

65
Q

Where do most fractures occur in osteoporosis?

A

hip, wrist or spine

66
Q

Patho of osteoporosis?

A

Creation of new bone can’t keep up with the loss of old bone

67
Q

As a clinician what is an important action when treating someone with osteoporosis?

A

Document height and spinal alignment

68
Q

Why do pts with osteoporosis loose height over time?

A

Loss of height over time d/t micro fractures

69
Q

Who most commonly gets osteoporosis?

A

older, white and Asian women after menopause

70
Q

Why does osteoporosis effect women more commonly?

A
  • less estrogen after menopause
  • lower bone density than men
  • absorb less calcium then men
71
Q

Paget Disease

A
  • Local areas of excessive bone turnover
  • Disorganized osteoid formation
  • Essentially structural unsound bone
72
Q

What is the hallmark sign of Paget disease?

A

Mosaic pattern of lamellar bone

73
Q

Is pagets disease unique?

A

yes

74
Q

How does pagets disease progress?

A

in 3 phases

75
Q

What happens in the 3 phases?

A

symptoms progress

76
Q

What age group does pagets occur in?

A

late adulthood

77
Q

What causes pagets?

A
  • genetic

- environmental

78
Q

What is a commonality between the cause of genetic and environmental pagets disease?

A

50% of familial cases and 10% of sporadic cases share a mutation in the SQSTM1 gene

79
Q

What is a common symptom you will find in every pt with pagets disease?

A

Pain is localized in the effected bone

80
Q

What is common about rickets and Osteomalacia?

A

Both are manifestations of Vitamin D deficiency or its abnormal metabolism.

81
Q

What is different between rickets and Osteomalacia?

A
  • rickets= children

- ostemalacia= adults

82
Q

Patho of rickets

A
  • Vit D deficiency interferes with bone deposition in the growth plates
  • Softens/weakens the bone
  • legs bow
83
Q

Patho of osteomalacia

A
  • bone forms during remodeling
  • under mineralized
  • legs bow
84
Q

Rheumatoid arthritis

A
  • chronic
  • inflammatory disorder
  • autoimmune origin
85
Q

What does Rheumatoid arthritis effect?

A

Principally attacks the joints

86
Q

What happens to the joints in Rheumatoid arthritis?

A

nonsuppurative proliferation/inflammatory synovitis

87
Q

synovitis

A

when the synovium of a joint becomes inflamed

88
Q

nonsuppurative

A

not involving pus

89
Q

proliferation

A

rapid increase in numbers.

90
Q

What is are characteristic signs of Rheumatoid arthritis?

A
  • swan-neck deformity

- boutonnière deformity

91
Q

What can Rheumatoid arthritis lead to?

A
  • destruction of the articulate cartilage
  • ankylosis
  • adhesion of joints
92
Q

What contributes to the development and progression of Rheumatoid arthritis?

A
  • genetic predisposition

- environmental factors

93
Q

What contributes to almost all autoimmune diseases?

A
  • genetic predisposition

- environmental factors

94
Q

Patho of Rheumatoid arthritis

A
  • antibodies react against self antigens
  • T helper cells secrete cytokines
  • inflammation
95
Q

Is Rheumatoid arthritis a slow or fast progressing disease?

A

Slow

96
Q

Early symptoms of Rheumatoid arthritis

A
  1. Malaise/fatigue

2. Generalized musculoskeletal pain

97
Q

Symptoms of Rheumatoid arthritis after weeks to months of onset

A

Joints become involved

98
Q

In what pattern do symptoms progress in Rheumatoid arthritis once joints are involved?

A

Symmetrically

99
Q

Symptoms in the involved joints in Rheumatoid arthritis

A
  • swollen
  • warm
  • painful joints
100
Q

What becomes inflamed in Rheumatoid arthritis?

A
  • tendons
  • ligaments
  • adjacent skeletal muscle (sometimes)
101
Q

What does swelling in Rheumatoid arthritis cause to happen?

A

In fingers:

  • ulnar deviation
  • flexion hyperextension
102
Q

Ankylosing spondylitis

A
  • Chronic
  • systemic
  • inflammatory disease
103
Q

Symptoms of Ankylosing spondylitis

A
  • low back pain

- spinal immobility

104
Q

Product of Ankylosing spondylitis

A

Inflammatory erosion where tendons and ligaments attach to bone

105
Q

Where does Inflammatory erosion in ankylosing spondylitis typically occur

A

sacroiliac joints

106
Q

Patho of ankylosing spondylitis

A
  • Undefined antigen (possibly an infection) cross reacts with antigen expressed on cells of musculoskeletal system
  • T cell response
  • Immune mediated response
107
Q

Osteoarthritis is aka

A

Degenerative Joint Disease

108
Q

Osteoarthritis

A

degeneration of cartilage

109
Q

Result of Osteoarthritis

A

structural and functional failure of synovial joints

110
Q

Characteristic symptoms of Osteoarthritis

A
  • Joints stiff when first rising in AM or following inactivity
  • Heberden’s nodes
  • Bouchard’s nodes
111
Q

What are Heberden’s nodes?

A

deformity of the distal interphalangeal joints (DIP)

112
Q

What are Bouchard’s nodes?

A

deformity of the proximal interphalangeal joints (PIP)

113
Q

Way to remember differnce between Heberden’s and Bouchard’s nodes.

A
  • HD- like high deff TV

- h= herberders d=distal

114
Q

Gout

A

Crystal Induced Arthropathy

115
Q

Patho of gout

A
  • urate crystals deposited within and around joints
  • stimulates production of cytokines
  • cytokines recruit leukocytes
  • inflammation
  • attacks of acute arthritis
116
Q

What is a common feature associated with gout?

A

Excessive Uric Acid in tissues and body fluids

117
Q

How long does uric acid accumulation take to cause gout?

A

20-30 years

118
Q

Other than urate crystals what contributes to gout?

A

increased age

119
Q

Who is at higher risk of gout?

A
  • genetic
  • drugs
  • alcohol
  • certain foods
  • obesity
120
Q

Which drugs cause higher risk of gout?

A

Thiazides

121
Q

Why do Thiazides cause higher risk of gout?

A

they reduce excretion of urate

122
Q

Polymyalgia Rheumatica

A

An inflammatory disorder

123
Q

Characteristics of Polymyalgia Rheumatica

A
  • muscle pain

- stiffness

124
Q

Where does pain/stiffness in Polymyalgia Rheumatica commonly occur?

A
  • shoulders

- hips

125
Q

Where does pain/stiffness in Polymyalgia Rheumatica commonly occur?

A
  • shoulders

- hips

126
Q

Who does Polymyalgia Rheumatica effect?

A

people 65+ y/o

127
Q

Who does Polymyalgia Rheumatica rarely effect?

A

people < 50 y/o

128
Q

What condition can Polymyalgia Rheumatica lead to?

A

giant cell arthritis

129
Q

giant cell arthritis is aka

A

temporal arthritis

130
Q

What does giant cell arthritis affect?

A

ophthalmic arteries

131
Q

What can giant cell arthritis result in?

A

blindness

132
Q

Symptoms of giant cell arthritis

A
  • temporal headaches
  • vision difficulties
  • jaw pain
  • scalp tenderness
133
Q

Is it possible to have Polymyalgia Rheumatica and giant cell arthritis at the same time?

A

Yes

134
Q

Teacher’s pearl-giant cell arthritis

A
  • Older woman in her 70s
  • Had seen 5 other providers - Experiencing prolonged shoulder pain, stiffness with temporal headaches and severe vision impairment.
  • No one knew what was happening to her
  • She was afraid she was going to go blind
  • Teacher was listening to podcast and heard about this giant cell arthritis
  • Sent pt for biopsy
  • Was positive for giant cell arthritis
  • Saved her vision

Advanced Pathology (27 decks)

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