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Systems Pathology Exam 1 > Ch 20 > Flashcards

Ch 20 Flashcards

1
Q
  1. Musculoskeletal system aka ___
  2. Tissues include (3)
  3. Integrates with ___
A
  1. Locomotor system
  2. Osseous, muscular, and connective
  3. Nervous System
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2
Q

MSK has what three jobs?

A

Form, function, protection (kinetics/ biomechanical movement)

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3
Q

MSK - ___ system and ___ storage

A

hematopoietic, mineral

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4
Q
  1. Define dysostosis

2. what are the four characteristics w/ it

A
  1. developmental anomaly of bone
    1. abnormal mesenchymal migration
    2. defective ossification of fetal cartilage
    3. sporadic (isolated) or part of syndrome
    4. homeobox gene alterations
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5
Q

Define homeobox gene

A

structural development during embryologic development

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6
Q

What are three subtypes of dysostosis?

A
  1. Aplasia
  2. Supernumerary digits
  3. abnormal fusion of bones
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7
Q

Explain aplasia

A

absent of incomplete development, abnormal function

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8
Q
  1. Define Dysplasia

2. give examples of both bone and cartilage

A
  1. mutations interfere with growth or homeostasis (dwarfism)

2. B = osteodysplasia, C = chondrodysplasia

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9
Q
  1. Dysostosis: ___ syndrome
  2. it is ___ with ___
  3. ___ deformity
A
  1. Klippel Feil
  2. idiopathic w/ congenital fusion (any 2 C vertebrae)
  3. Sprengel’s
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10
Q

Syndactyly: the MC ___

A

congenital malformation of the limbs

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11
Q
  1. Osteogenesis imperfecta aka ___
  2. Mutations of ___
  3. it is ___ dominant
  4. abnormal collagen leads to ___
  5. It can affect (5)
A
  1. brittle bone disease
  2. type 1 collagen
  3. autosomal
  4. premature breakdown
  5. ECM :eyes, inner ear bones, skin, joints, and teeth
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12
Q

O.I. - Range of severity has two types:

  1. Type 1 = ___
  2. Type 2 = ___
A
  1. normal lifespan

2. lethal in utero (cerebral hemorrhage, respiratory failure)

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13
Q

Type I of O.I. -

  1. Abnormal collagen of ___
  2. diagnosed in ___
  3. what can occur (6)?
A
  1. sclera
  2. childhood
  3. fractures, extremity bowing, scoliosis, ligamentous laxity (dislocations), hearing loss, short stature
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14
Q
  1. O.I. has what sign?

2. What were they treated with?

A
  1. Zebra stripe

2. bisphosphonates (cyclical)

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15
Q

What is the MC form of dwarfism?

A

Achondroplasia

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16
Q

Achondroplasia -

  1. decreased ___ equals decreased ___ (MC in (2))
  2. ___ mutation which inhibits ___
  3. % are spondaneous or autosomal dominant
  4. What are four signs?
A
  1. Cartilage synthesis, growth plate expansion, femur and humerus
  2. Fibroblast growth factor receptor (FGFR3), epiphyseal (growth plate) chondrocytes
  3. 75% and 25%
  4. Short proximal extremities, lower extremity bowing, frontal bossing, midface hypoplasia (low nasal bridge)
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17
Q

Causes of dwarfism (4)?

A

various

  1. Turner syndrome
  2. hypothyroidism
  3. malnutrition
  4. O.I.
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18
Q

Achondroplasia -

  1. ratio
  2. What can happen to the spine (5)?
  3. How can it cause death?
  4. What is a sign of achondroplasia dealing with the hand?
A
  1. 1: 10,000
  2. hyper lordosis or kyphosis at birth, bullet vertebrae, scoliosis, spinal stenosis (foramen magnum stenosis, spinal canal stenosis)
  3. Brain stem compression or cardiovascular abnormalities
  4. trident hand
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19
Q
  1. What is the name given to the fatal type of achondroplasia?
  2. Ratio?
  3. Explain
A
  1. Thanatophori dwarfism
  2. 1: 20,000 births
  3. extremely small thorax and shortened long bones (perinatal respiratory failure)
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20
Q

Osteopetrosis -

  1. Two ways of describing?
  2. ___ stenosis leads to ___
  3. ___ fills and leads to deranged ___
  4. Treatment?
A
  1. decreased osteoclast mediated bone resorption or skeletal sclerosis (stone like which increases fractures)
  2. foraminal, cranial nerve palsies
  3. medullary cavity, hematopoieses (hepatosplenomegaly or recurrent infections/anemia)
  4. stem cell replacement
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21
Q

Osteopetrosis has no ___ with ___ deformity

A

medulla, erlenmeyer flask

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22
Q

Osteoporosis -

  1. Most important form of ___
  2. decreased ___ equals increased ___
  3. What are the two categories?
  4. Generalized has both primary and secondary subtypes, explain each
  5. Basically the disease attacks more on the ___ and less on the __
A
  1. osteopenia
  2. bone mass, porosity (bony fagility/fractures)
  3. Localized (disuse) and Generalized to entire skeleton
    • primary = is the MC: senile, postmenopausal
    • secondary = various causes: neoplasia, hyperparathyroidism, nutrient deficiency, drug exposure (corticosteroids, alcohol, smoking)
  5. inside, outside
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23
Q

Osteoporosis -

  1. MC impacts ____
  2. What does it cause?
  3. Locations?
A
  1. trabecular bone (cancellous, spongy)
  2. thinned cortex
  3. VB, femoral neck, calcaneus
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24
Q

Generalized Osteoporosis - Primary Osteoporosis:
SENILE
1. ___ related, normal phenomenon
2. decreased __/___activity
3. ___ retain normal activity causing an imbalance
4. % bone loss per year, beginning at what age?
POSTMENOPAUSAL
1. decrease ___ accelerates bone loss
2. % or P.M females, % of age matched males

A
  1. age
  2. GFs/osteoblast
  3. osteoclasts
  4. 0.5%, mid 20s
  5. estrogens
  6. 50%, 3%
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25
Q

Osteoporosis -

  1. Maximize bone density in ___
  2. What helps keep bone density?
  3. What is MC decreased in females?
A
  1. young adulthood
  2. diet and regular exercise (resistance, athletics)
  3. Ca++ and Vit. D supplementation
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26
Q

Osteoporosis -

  1. loss of ___ homeostasis
  2. Risks (6)
  3. asymptomatic until?
  4. Where are two common fracture sites?
  5. Explain each
A
  1. osteoclast/blast
  2. increased age, females, sedentary, family history, eating disorders, malnutrition/malabsorption
  3. skeletal fragility
  4. -Vertebral compression fracture (thoracolumbar): dowager’s hump, kyphoscoliosis
    • Femoral Neck fracture: disabling, risk for pulmonary emboli
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27
Q

What machine is used to measure osteoporosis?

A

DEXA - dual energy xray absorptiometry

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28
Q

Osteoporosis -

  1. ___ are not sensitive enough, explain
  2. List three ways on how to prevent
A
  1. X-rays, non diagnostic for osteoporosis and require 30-40% decreased bone mass
    1. Physical activity/ regular exercise (best prior to age 30)
    2. dietary calcium and vitamin D
    3. antiresorptive pharmacologic agents (bisphosphonates)
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29
Q

Paget Disease -

  1. otherwise known as?
  2. __ phase leads to ___phase leads to exhaustion of cellular activity known as ___phase
  3. basically means increased ___, weak, with a ___ appearance
  4. regional ___ activity
  5. Excessive ___ consisting of disorganized ___ bone making bone?
  6. caused by?
A
  1. osteitis deformans
  2. lytic, mixed lytic and blastic, sclerotic
  3. bone mass, shaggy
  4. osteoclastic
  5. bone formation, lamellar, enlarged and fragile
  6. increased serum alkaline phosphatase (byproduct of osteoblast activity), idiopathic, paramyxoviridae antigens on osteoclasts
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30
Q

Paget Disease -

  1. MC associated with symptoms or assymptomatic (70-90%)
  2. becoming less ___ and less ___
  3. features depend on (2), but may include (4)
A
  1. asymptomatic (incidental x-ray findings, relatively benign)
  2. common, severe
  3. site and severity, bone pain (MC in neck and back), osseous deformation/fracture/increase vascularity), nerve compression (headache, visual/auditory), and 1% transition into sarcoma (poor prognosis)
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31
Q

Paget Disease -

  1. Lesions: solitary % and multiple %
  2. % of cases involve the axial skeleton or femur including (3)
  3. pathological ___ fractures or ___
  4. Adults: MC Dx at age ___
  5. Risks: males or females, parts of the world
  6. treatment?
A
  1. 15%, 85%
  2. 80%, pelvis, sacrum, skull
  3. “chalkstick”, bowing
  4. 70
  5. males (2x), europe, new sealand, australia (U.S. only 1-3%)
  6. bisphosphonates - intended to slow lytic phase
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32
Q

What disease is related to mosaic pattern/jigsaw puzzle?

A

Paget Disease

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33
Q

What three diseases can refer to “ivory vertebra sign”?

A
  1. paget disease
  2. metastatic cancer (prostate)
  3. lymphoma
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34
Q

Vit D Deficiency -

  1. defective ___
  2. hypocalcemia leads to ___ which demineralizes bone
  3. Name when associated with children, explain
  4. name when associated with adults, explain
A
  1. mineralization (dietary/UV deficiency or abnormal metabolism)
  2. PTH (unmineralized bony matrix: soft/brittle)
  3. Rickets, poor growth plate mineralization, more severe
  4. osteomalacia, remodeled bone is undermineralized, mild, similar to osteoporosis fractures, associated with hyperparathyroidism
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35
Q

Hyperparathyroidism -

  1. parathyroid glands secrete ___, maintains ___
  2. Explain primary hyperparathyroidism
  3. explain secondary hyperparathyroidism
  4. Excessive PTH: MC from ___ %, __ osteoclast activity, increased ___
  5. Dx : (2), MC nonmalignant cause of ___
A
  1. PTH, serum Ca++
  2. autonomous PTH production
  3. renal failure, mild
  4. adenoma 80%, increased, renal tubule resorption of Ca++ and Vit. D synthesis
  5. hypercalcemia, parathyroid immunoassay, hypercalcemia
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36
Q

Hyperparathyroidism -

  1. > 50% are ___
  2. MC people who get this are ___
  3. excessive ___ activity impacts ___
  4. resorption of (2) bone
  5. replaced by ___
  6. Possible ___
A
  1. asymptomatic
  2. post-menopausal women
  3. osteoclast, skeletal homeostasis
  4. cortical and trabecular
  5. loose connective tissue
  6. “brown tumor”
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37
Q

Hyperparathyroidism -

  1. What are four results?
  2. Which is the MC?
  3. Characterized by a “___”, which are?
  4. X-rays of this are termed ___
A
  1. renal stones, peptic ulcers, pathologic fractures, bowing of long bones
  2. renal stones
  3. salt and pepper skull, small erosions
  4. Rugger-Jersey spine
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38
Q

Brown Tumor -

  1. very ___ lead to ___ leads to ___ leads to ___
  2. Not a true ___
A
  1. brittle/fracture, hemorrhage, macrophages, fibrosis

2. neoplasm/tumor

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39
Q

Hyperparathyroidism -

  1. Features are ___
  2. list 8
  3. treatment depends on ___
  4. list 3
  5. reversible with ?
A
  1. widespread
  2. bone pain, fractures, deformation, kidney stones, nausea, anorexia, fatigue, decreased cognition
  3. cause
  4. drinking water, physical activity, avoidance of diuretics (water pills)
  5. normalization of PTH levels
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40
Q

Fractures -

  1. ___ osseous pathology
  2. What are the five categories?
A
  1. commone
  2. -complete vs incomplete
    • closed
    • compound (open)
    • comminuted
    • displaced
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41
Q

Fractures - Categories

  1. Complete vs incomplete: MC among ____
  2. closed: overlying tissue is ___
  3. compound (open): skin is ___, risk for ___
  4. comminuted: means?
  5. displaced: ___ segment is ___
A
  1. children
  2. intact
  3. ruptured, infection
  4. fragmented/splintered
  5. distal, malaligned
42
Q

Fractures -

  1. pathological fracture is ___
  2. list three examples
  3. Explain a stress fracture, MC where?
  4. What is overloading?
A
  1. site of disease
  2. bone cyst, tumor, brown tumor
  3. develops slowly over time (repetitive injury), MC in the lower legs and feet esp tibia
  4. micro fractures accumulate
43
Q

Fractures - Repair

  1. Ruptured vessels lead to ___ lead to ___ lead to ___
  2. woven bone leads to ___ in (time___)
  3. endochondral ossification leads to ___(time___) leads to ___(time____)
A
  1. fibrin mesh, inflammation of cells and fibroblasts, soft tissue callus, noncalcified (1 week)
  2. chondroblasts in 2-3 weeks
  3. bony callus (6-8 weeks), continual remodeling (lifetime)
44
Q

Fractures -

1. What are six factor of delayed healing?

A
  1. nonunion
  2. comminuted fracture
  3. inadequate immobilization
  4. infection
  5. nutritional deficiencies
  6. advanced age
45
Q

Fractures - Delayed Healing

  1. Nonunion: ___ formation
  2. Comminuted fracture: ___ of fragments
  3. Inadequate immobilization: disrupts ___
  4. infection: MC occurs with ___, requires ___
  5. nutritional deficiencies: list three examples
A
  1. large callus
  2. resorption
  3. callus formation, too mobile
  4. compound (open) fractures, microbial eradication
  5. Ca+++, phosphorus, Vit D
46
Q

Avascular Necrosis -

  1. Aka ___
  2. ___ leads to ____
  3. MC cause ___ via ___
  4. list 5 other causes
  5. can be ___ or ___
  6. it gets worse with (3)
A
  1. AVN, osteonecrosis
  2. ischemia leads to bony necrosis (infarction)
  3. vascular disruption, fracture
  4. corticosteroids, embolism (sickle cell, bends), vasculities, irradiation, idiopathic
  5. asymptomatic (inside of bone) or painful (outside of bone)
  6. time, physical activity, pathologic fracture
47
Q

Avascular necrosis -

  1. Subchondral areas (5)
  2. may preserve ___
  3. possible ___: risk for ___
  4. eventual new bone growth: “___”
A
  1. hip, knee, shoulder, wrist, ankle
  2. cortex
  3. collapse, OA
  4. “creeping substitution”
48
Q

AVN -

  1. may be __ or ___
  2. joint called ___
A
  1. subchondral or medullary

2. osteochondritis dissecans

49
Q

Osteomyelitis -

  1. AKA “____”
  2. ___ infection
  3. ___ destroy bone
  4. ___ is MC but also can be ___
  5. What are the three modes of infection?
A
  1. “bone-marrow-inflammation”
  2. marrow
  3. leukocytes
  4. acute, chronic
  5. hematogenous (sepsis), adjacent infection, or traumatic implantation
50
Q

Osteomyelitis - Modes of infection

  1. hematogenous (sepsis): is it very rare or MC?
  2. adjacent infection: affects (2)
  3. traumatic implantation: results in (2)
  4. ___ means orthopedic instrumentation
A
  1. MC
  2. joint, soft tissue
  3. compound fracture or surgery
  4. iatrogenic
51
Q

Osteomyelitis -

  1. symptoms (3)
  2. What are the two categories?
  3. mixed ___
  4. % unable to identify agent
  5. considered to be ___, which means?
  6. What are three types of pyogenic? Which is MC
A
  1. acute fever, malaise, throbbing pain
  2. Pyogenic bacteria and mycobacterium tuberculosis
  3. bacterial infection
  4. 50%
  5. pyogenic, pus forming bacteria
  6. Staphylococcus aureus (MC), Neonates ( E. coli and Group B streptococci), sickle cell disease (salmonella spp)
52
Q

Pyogenic osteomyelitis -

  1. features (3)
  2. How do you find it?
  3. explain involucrum
  4. explain sequestrum
  5. explain draining sinus
A
  1. acute fever, malaise, and throbbing pain
  2. radiography, biopsy, blood culture
  3. reactive woven/lamellar bone, surrounds infected bone
  4. dead bone at site of infection
  5. ruptured periosteum leads to an abscess in the surrounding soft tissue
53
Q

Tuberculous Osteomyelitis -

  1. AKA ___
  2. % of ___ TB cases
  3. Found in ___
  4. associated with ___
  5. bony destruction leads to ___
A
  1. skeletal TB
  2. 3%, pulmonary
  3. recent immigrants and immunocompromied, developing countries
  4. caseous granulomas
  5. sever deformation
54
Q

Tuberculous osteomyelitis -

  1. How is it spread? Which is MC
  2. multifocal = ___
  3. solitary = (2)
  4. ___ disease leads to ___
A
  1. hematogenous (MC), and lymphatic
  2. immunodeficiency
  3. long bones and vertebrae
  4. Pott, neurologic deficits
55
Q

Bone Tumors (primary bone tumors) -

  1. Is it more common to spread to bone or to originate from bone?
  2. explain what it means by diverse features
  3. Features include (8), Which is the MC?
  4. Nomenclature includes (3)
A
  1. spread there
  2. benign or aggressively malignant
  3. bone pain, gradually increases (MC), fatigue, pyrexia, cachexia, anemia, pathological fracture, unexplained bony mass (superficial)
  4. bony matrix, cartilaginous, fibrous tissue
56
Q

Bone Tumors -

  1. List 6 characteristics of low back pain from cancer
  2. combination of (3)
  3. % sensitivity, % specificity
A
  1. -> 50yo
    • history of cancer
    • unexplained wt loss (cachexia)
    • failure to improve > 1 mo conservative care
    • unrelieved with bed rest
    • pain duration > 1 mo
  2. > 50, history of cancer, and cachexia
  3. 100%, 60%
57
Q

Bone Tumors -

  1. (2) producing tumors are MC
  2. ___ tumors are MC than ___
  3. What are two examples of tumors?
  4. Primary bone cancer is called ___
  5. list three examples
  6. elderly have __ risk of bone CA
A
  1. matrix and fibrous
  2. benign, malignant
  3. osteochondroma and fibrous cortical defects
  4. sarcomas
  5. osteosarcoma, chondrosarcoma, and Ewing sarcoma
  6. increased
58
Q

Bone Tumors -

  1. list 6 additional risks
  2. MC: ___ development, age?, benign or malignant, symptomatic or asymptomatic?
  3. Speed of growth?, which bones are affected, causes?
  4. determine type based on (2)
  5. osteosarcoma: age and location
  6. osteoma: age and location
A
  1. RB or TP53 mutations, AVN, chronic osteomyelitis, Paget disease, irradiation, orthopedic hardware
  2. early,
59
Q

Bone forming tumors -

  1. ___ growth (___ producing)
  2. ___ bone, variable ___
  3. benign or malignant?
  4. how to we find them?
  5. List the 3 main types and whether they are benign or malignant
A
  1. bony, matrix
  2. woven, mineralization
  3. both
  4. biopsy
  5. osteoma B, osteoid osteoma and osteoblastoma B, osteosarcoma M
60
Q

Osteoma -

  1. developmental ___
  2. ___ growth, very similar to ___
  3. exophytic, ___ and ___
  4. Completely ___, meaning>
  5. MC locations
  6. age range?
  7. list three concerns
A
  1. anomaly
  2. reactive, normal bone
  3. solitary and slow growing (superficial and hard)
  4. benign, noninvasive (woven/lamellar obone)
  5. head (skull, facial) and neck
  6. middle age 40-50yo
  7. cosmetic, local mechanical problems, sinus obstruction
61
Q

Osteoid osteoma and osteoblastoma -

  1. benign or malignant
  2. vary by (2)
  3. Who is at risk (sex and age)
  4. ___ lesion, meaning?
  5. List two examples
  6. list a very important feature
A
  1. benign
  2. size and location
  3. male (2X) age 10-20yo
  4. bound to oval, near cortex and well circumscribed
  5. Central “nidus” (radiolucent) and rim of sclerosis (prominent in osteoid osteomas)
  6. localized nocturnal pain
62
Q

Osteoid osteoma and osteoblastoma -

  • osteoid osteoma*
    1. size
    2. location with 2 examples
    3. pain?
    4. does asprin help?
  • osteoblastoma*
    1. size
    2. location
    3. Pain?
    4. does asprin help
    5. treatment
A
  1. small
  2. near cortex of long bones, proximal femur, tibia
  3. well localized nocturnal
  4. yes
  5. large
  6. vertebral process: spinous, transverse
  7. mild and poorly localized
  8. no
  9. excision, possible irradiation (malignant transformation is very rare)
63
Q

Osteosarcoma -

  1. benign or malignant
  2. ___ producing sarcoma (mesenchyme)
  3. MC ___
  4. Risks: (age and sex)
  5. If young explain
  6. if older explain
A
  1. aggressive malignancy
  2. bone
  3. primary bone CA
  4. adolescents, male (1.5X)
  5. 10-20yo (75%) (any age sarcoma)
  6. > 40, comorbid bone pathology (paget disease, AVN and irradiation)
64
Q

Osteosarcoma -

  1. metaphysis of ___ bones
  2. list three examples
  3. ___ reaction, explain
  4. immature bone - explain
A
  1. long
  2. knee 60%, hip 15%, shoulder 10%
  3. periosteal, destroys cortex “sunburst”
  4. mineralized or unmineralized (osteoid formation)
65
Q

Osteosarcoma -

  1. it is very ___
  2. size, mixes __ and ___ lesion
  3. ___ and ___ mass
  4. (2) distruction
  5. list two characteristics
  6. risk for ___
A
  1. aggressive
  2. large, lytic and blastic
  3. painful, rapidly enlarging
  4. periosteal and medullary
  5. codman triangle, sunburst, spiculations
  6. pathological fractures
66
Q

Osteosarcoma -

  1. % have mets to ___ at finding
  2. ___ gene mutations
  3. ___ syndrome: 1000 increased risk
A
  1. 10-20%, lungs
  2. sporadic RB gene or TP53
  3. retinoblastoma
67
Q

Osteosarcoma -

  1. ___: primary osteosarcoma
  2. age
  3. % long term survival rate
  4. treatment
  5. ___: secondary osteosarcoma
  6. age
  7. related diseases (2)
  8. how does it respond to therapy
  9. outcome
A
  1. typical
  2. 10-20
  3. 60-70%
  4. amputation or chemotherapy
  5. co morbid
  6. > 40
  7. paget disease, multiple myeloma
  8. poorly
  9. typically fatal
68
Q

What is it called when they amputate a limb but reattach a prosthetic backwards?

A

Rotationplasty or Van-Ness rotation

69
Q

Cartilage-forming tumors -

  1. What two types of cartilage?
  2. benign or malignant
  3. What are the three main parts?
A
  1. hyaline or myxoid
  2. both, MC benign
  3. osteochondroma, chondroma, chondrosarcoma
70
Q

Osteochondroma (exostosis) -

  1. benign or malignant
  2. ___ outgrowth
  3. ___ cartilage
  4. who is at risk (sex and age)
  5. rare or common?
A
  1. benign
  2. cartilage- capped
  3. hyaline
  4. males (3X) 10-30yo
  5. common (incidental finding)
71
Q

Osteochondroma -

  1. What are the two types?
  2. Solitary: ___, and MC in what age group
  3. Multiple hereditary osteochondromas: genetic ___, ___ onset
  4. this causes an increased risk for ___
A
  1. solitary and multiple hereditary osteochondromas
  2. sporadic, adolescence/young adults
  3. mutated TSGs, childhood
  4. sarcomas (little chance for transition into chondrosarcoma)
72
Q

Osteochondroma -

  1. Originate on metaphysis of ___ bones, near ___
  2. List five examples and point out the MC
  3. size
  4. characteristics (2)
  5. growth rate
  6. rare after ___
  7. ___ merges with ___, may be ___
A
  1. long, growth plate
  2. Knee MC, pelvis, scapula, ribs, hands/feet
  3. 1-20cm
  4. sessile or pedunculated
  5. slow growing
  6. skeletal maturity
  7. cortex, host bone, painful (fracture or impingement)
73
Q

Chondroma -

  1. benign or malignant?
  2. ___ cartilage
  3. What are the two types based on location?
  4. age
  5. ___ lesions, metaphysis, meaning?
  6. ___ lesions = ____ disease, AKA ___ or ____, MC uni or bilateral?
A
  1. benign
  2. hyaline
  3. enchondroma (medullary) and juxtacortical chondroma (bone surface)
  4. 20-50
  5. solitary, tubular bones of hands (MC) and feet
  6. multiple, Ollier, multiple enchondromas or enchondromatosis, unilateral
74
Q

Chondroma -

  1. describe
  2. size
  3. ___ lucency
  4. “___” sign
  5. Center?
  6. symptoms or asymptomatic, or possible pathologic ___
  7. MC found ___
  8. % of knee MRIs
  9. % of all benign bone tumors
A
  1. gray-blue, translucent (hyaline) nodules

2.

75
Q

Chondrosarcoma -

  1. ___ common than osteosarcomas
  2. sex and age
  3. location
  4. expansile “___”
  5. (2) cartilage
  6. may thin or thicken?
A
  1. less
  2. males (2X) and 40-60
  3. intramedullary (MC) or jextacortical, pelvis, shoulder, ribs, prox femus, rare in distal extremities
  4. glistening mass
  5. neoplastic hyaline and myxoid
  6. thicken or erode cortex
76
Q

Chondrosarcoma -

  1. ___ mass
  2. (2) cartilage expanded within the ___, formed a sessile (paracortical) mass
A
  1. sessile

2. hyaline and myxoid, medulla

77
Q

Chondrosarcoma -

  1. ___ mass
  2. Two types
  3. Low-grade: it is the ___, ___ growing (indolent), size, reactive ____ of cortex, ___ survival rate
  4. High-grade: cortical ___, size, soft tissue mass of ___, % mets (2 locations), survival rate
  5. treatment
  6. high ___= high risk of ___
A
  1. painful
  2. low-grade and high-grade
  3. MC, slow, small, thickening, 80-90% 5 year survival
  4. erosion, large, cartilaginous, 70%, lungs (MC) or other bones, poor prognosis
  5. wide excision, chemotherapy
  6. radiolucency, high-grade
78
Q

Miscellaneous Bone tumors -

  1. ___ variety
  2. List two fibrous and fibro-osseous tumors
  3. list 2 bone tumors with unique cells
A
  1. wide
  2. Fibrous cortical defect (nonossifying fibroma), Fibrous Dysplasia
  3. Ewing Sarcoma (primitive neuroectodermal tumor (PNETs)) and Giant cell tumor of bone
79
Q

FCD and NOF -

  1. ___ lesions: (2)
  2. reaction to ___ injury
  3. not a true ___
  4. who gets this
  5. % of benign bone tumors
  6. ___ radiolucency, thin ___
  7. MC size?
  8. NOF size
A
  1. benign, fibroblasts and macrophages
  2. periosteal
  3. neoplasm
  4. 30-50% of all children > 2 years, adolescents
  5. 5%
  6. well-defined, sclerosis
  7. small
  8. larger lesion
80
Q

FCD and NOF -

  1. location
  2. % are multiple
  3. MC symptomatic or asymptomatic
  4. ___ is rare, possible with pathologic ___
  5. how long does it last
  6. biopsy is not generally required except if ____
A
  1. eccentric, metaphysis (knee: distal femur (MC), proximal tibia)
  2. 50%
  3. asymptomatic
  4. pain, fracture
  5. self resolve within 2-3 years
  6. fractured NOF
81
Q

Fibrous dysplasia (FD) -

  1. ___ lesion, failure of ____
  2. well ____, location, size
  3. possible ___
  4. List the 3 categories, all from ___ mutations
  5. Monostotic: ___ involvement
  6. Polyostotic: ___ involvement
  7. Polyostotic + café-au-lait spots and endocrinopathy: AKA ___
A
  1. benign, bony differentiation (arrested development of bone)
  2. circumscribed, intramedullary, variable
  3. osseous deformation
  4. Monostotic, polyostotic, polyostotic + café au lait spots and endocrinopathy
  5. single bone
  6. multiple bone
  7. McCune-Albright syndrome
82
Q

Monostotic FD -

  1. %
  2. age
  3. found (6)
  4. symptomatic or asymptomatic
  5. found how
  6. minimal bony ____
A
  1. 70%
  2. 10-30
  3. ribs, femur, tibia, jawbones, calvaria, humerus
  4. asymptomatic
  5. incidental finding6. distortion/enlargement
83
Q

Polyostotic FD -

  1. %
  2. No _____
  3. Age
  4. severe ___, ___ is common
  5. found (5)
  6. ___ involvement: % of cases
  7. ____ margins, ____ appearance
  8. treatment
A
  1. 27%
  2. endocrinopathy
  3. late childhood/adolescence
  4. deformation, pathologic fracture
  5. femus, calvaria, tibia, humerus, pelvis
  6. craniofacial, 50%
  7. well defined, fround glass
  8. excision, ortho hardware
84
Q

McCune-Albright Syndrome -

  1. % of FD cases
  2. affects (3), explain
  3. ___ hyperfunction (3)
  4. ___ severity
  5. skin and bony lesions are commonly uni or bilateral, (2)
A
  1. 3%
  2. skeletal, skin, and endocrinopathy, café au lait spots, precocious puberty (MC females)
  3. endocrine, hyperthyroidism, pituitary adenoma, adrenal hyperplasia
  4. variable
  5. unilateral, femur and tibia
85
Q

Ewing Sarcoma and Primitive Neuroectodermal Tumor (PNET) -

  1. variants of the same ____
  2. t___ or t___
  3. “___” of bone
  4. What happens
  5. location
A
  1. malignant tumor
  2. (11:22) or (21:22)
  3. small round cell tumor
  4. hemorrhage and necrosis
  5. medulla and cortex
86
Q

Ewing Sarcoma -

  1. undifferentiated or neural differentiation
  2. % of primary bone CA
  3. 2nd MC ____
A
  1. undifferentiated
  2. 10%
  3. pediatric bone CA
87
Q

PNET -

  1. undifferentiated or neural differentiation
  2. AKA ___
A
  1. neural differentiation

2. homer-wright rosettes

88
Q

Ewing Sarcoma and PNET -

  1. MC age?
  2. sex and race risks
  3. ___ mass, location, example
  4. mimics infection by (3)
  5. Periosteum: “___” or “___”
  6. % survival rate, % complete remission
  7. may invade surrounding___, means?
A
  1. 10-20
  2. Males, Caucasians (9X)
  3. painful enlarging, long bone diaphysis, femur (MC) or pelvis
  4. pyrexia, leukocytosis, increased ESR
  5. onion-skinning or sunburst
  6. soft tissues, worse prognosis
89
Q

Secondary metastasis to bone -

  1. color?
  2. Location
  3. MC forms in adults (3)
  4. MC forms in children (5)
A
  1. lytic (dark black), blastic (bright white), mixed (MC)
  2. axial skeleton, proximal femur/humerus, red marrow (statsis, nutrient rich)
  3. prostate (blastic), breast (lytic), lung
  4. neuroblastoma, Wilms tumor, osteosarcoma, Ewing Sarcoma, rhabdomyosarcoma
90
Q

Joints -

  1. ___ variety
  2. list 5 types of arthritis
A
  1. wide

2. degenerative (OA, DJD), Immune-mediated (RA, AS), Metabolic (gout, pseudogout (CPDD)), infectious, and neoplastic

91
Q

Oseoarthritis (OA, DJD) -

  1. often confused with ___
  2. __ joint disorder
  3. Major sours of ___ in ___
  4. degeneration of __ cartilage (__)
  5. decreased __ = ___ breakdown
  6. not necessarily ___
  7. subchondral changes are ___
  8. mechanical wear and tear (___)
  9. ___ influence
A
  1. RA
  2. MC
  3. morbidity in elderly
  4. articular, collagen
  5. proteoglycans, matrix
  6. inflammatory
  7. secondary
  8. age
  9. genetic
92
Q

Osteoarthritis -

  1. Primary OA: explain
  2. Secondary: explain
  3. % of OA occurs in __, secondary OA
  4. common locations include (4)
  5. Female common locations
  6. male common locations
A
  1. insidious, oligoarticular (few), no trauma, adults
  2. predisposing injury or deformity, trauma (obesity), deformity, systemic disease
    1. children
  4. spine (C and L), DIP joints, 1st MCP joint, 1st TMT joint
  5. knees and hands
  6. hips
93
Q

Osteoarthritis -

  1. degeneration of __, explain
  2. explain 5 steps of what is happening
  3. ___ may develop, secondary to degeneration
  4. __ leads to ___ leads to ___
  5. possible joint ___, means
A
  1. cartilage matrix, chondrocytes: limited capacity for growth
  2. matrix cracks, softening/degradation (chondromalacia), exposure of subchondral bone, sclerosis of bone (eburnation), oseophytosis
  3. inflammation
  4. subchondral fractures, exposure to synovial fluid, subchondral cysts
  5. mice, joint locking and pain
94
Q

Osteoarthritis -

  1. list two functions of articular cartilage
  2. require (2)
  3. made of (2)
  4. ___ disrupts chondrocyte function
  5. ___ resilience of cartilage
  6. define degeneration
A
  1. decreased friction and load distribution (decreased shock)
  2. elasticity and tensile strength
  3. proteoglycans and type II collagen (healthy chondorcytes)
  4. OA
  5. decreased
  6. inability to adapt to stress (decreased normal cartilage)
95
Q

Oseoarthritis -

  1. Risks (5), not simply wear and tear
  2. features 5
  3. generally ___ progressive
  4. osteophytes may impinge ___
  5. causes (3)
  6. treatment
A
  1. mechanical stress, age 50-60, genetics, increased bone density and estrogen
  2. insidious, deep/achy pain, crepitus, decreased ROM, worse in morning
  3. slowly
  4. nerve roots
  5. radiculopathy (pain, weak, numb), spasm, atrophy
  6. palliative: ice, heat, NSAIDS, adjust, joint replacement
96
Q

Oseoarthritis -

  1. loss of ___ because of ___
  2. no ___
  3. MC sex?
  4. (2) nodes
A
  1. joint space, dehydration
  2. ankylosis
  3. Female
  4. heberden’s and bouchard’s
97
Q

Rheumatoid Arthritis (RA) -

  1. ___, ___ autoimmune disease
  2. consist of (4)
  3. Joints: increase (2) activity
  4. HLA ___
  5. ___ peptides (___ antibodies), % of cases, inflammation due to (2)
  6. ___ autoantibodies: %, includes (2)
  7. symptoms (8)
A
  1. systemic, chronic
  2. CD4+, T cells, cytokines, macrophages
  3. collagenase and osteoclast activity
  4. DRB1
  5. anti-cyclic citrullinated, anti-CCP, 70%, smoking and infection
  6. IgM, 80%, RF and IgG immune complex
  7. weakness, malaise, low grade fever, cachexia, insidious, aching, joint stiffness, decreased ROM
98
Q

RA -

  1. ___, __ joints
  2. affects (6)
  3. MC affects (2)
  4. “____ swelling”
  5. what happens to the spine?
  6. explain
  7. # years
  8. two special features
  9. eventual ___
A
  1. symmetric, small
  2. hands, feet, ankles, wrists, elbows, knees
  3. MCP and PIP (Bouchard’s)
  4. fusiform
  5. 30% have atlanto-axial instability
  6. pannus, articular destruction/disability
  7. 10-15
  8. ulnar deviation and swan neck deformity
  9. ankylosis
99
Q

RA vs OA -

  1. no ankylosis
  2. inflammatory
  3. autoimmune
  4. ankylosis
  5. degenerative
  6. non-inflammatory
A
  1. OA
  2. RA
  3. RA
  4. RA
  5. OA
  6. OA
100
Q

Additional immune-mediated injury -

  1. Juvenile rheumatoid arthritis (JRA, JIA): ___ conditions
  2. group of ___ disorders, MC ___
  3. age
  4. symptoms for ___
  5. list two subcategories
  6. inflammation?
  7. ___ joints, (2) examples
  8. what sex is more likely to develop?
A
  1. autoimmune
  2. multifactorial, neg for RF
  3. 6weeks
  4. oligoarthritis/polyarthritis and Still’s disease (spiking fever, rash, pericarditis
  5. pronounced inflammation, produces dysfunction
  6. large, knees and hips
  7. girls 2-3X

Systems Pathology Exam 1 (1 decks)

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