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STEP Pathology > deck_5366245 > Flashcards

deck_5366245 Flashcards

1
Q

What is osteoporosis?

A

a reduction in trabecular bone mass resulting in porous bone with an increased risk of fracture and increased marrow space (that fills with fat mostly)

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2
Q

What are the most common forms of osteoporosis?

A

senile and postmenopausal

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3
Q

How does menopause decrease bone mass?

A

-decreased serum estrogen-increased IL-1, IL-6, and TNF levels -increased expression of RANK, RANKL and increased osteoclast activity

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4
Q

How does aging decrease bone mass?

A

there is decreased replicative activity of osteoprogenitor cells, osteoblast activity, activity of matrix-bound growth factors, as well as reduced physical activity

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5
Q

What causes type 1 (postmenopausal) osteoporosis?

A

decreased osteoblastic activity

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6
Q

What causes type 2 (senile) osteoporosis?

A

increased osteoclastic activity

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7
Q

What is a very common fracture with osteoporosis?

A

proximal femoral fractures (high mortality in older adults). Note, a fall to the side increases the risk of hip fracture by about 6 times compared to falls in other directions

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8
Q

What is a common treatment for osteoporosis?

A

Bisphosphates (also good for Paget’s disease)

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9
Q

How do bisphosphates work?

A

they bind to hydroxyoptite and inhibits osteoclast activity

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10
Q

AEs of bisphosphates?

A

1) corrosive esophagitis- take with water and remain upright for at least 30 minutes 2) osteonecrosis of the jaw

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11
Q

What is osteomyelitis?

A

infection (most often bacterial) of the bone, typically in children caused from direct inoculation (trauma), contiguous spread (cellulitis), or blood spread

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12
Q

How does osteomyelitis present?

A

bone pain with systemic signs of infection

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13
Q

How does chronic osteomyelitis appear on x-ray (this is the best imaging for chronic)?

A

lytic abscess (aka sequestrum) surrounded by sclerosis of bone (aka involurum)

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14
Q

How does acute osteomyelitis appear on MRI (this is the best imaging for acute)?

A

inflammation

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15
Q

T or F. Get blood cultures before treating osteomyelitis

A

will commonly see elevated CRP and ESR (but not specific)

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16
Q

What is the most common cause of osteomyelitis?

A

Staph aureus (90%)

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17
Q

What is the most common cause of osteomyelitis in sexually active young adults?

A

N. gonorrhoeae

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18
Q

What is the most common cause of osteomyelitis in sickle cell patients?

A

Salmonella (encapsulated)

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19
Q

What is the most common cause of osteomyelitis in diabetics or IVDUs?

A

Pseudomonas (or candida or staph aureus)

20
Q

What is the most common cause of osteomyelitis of the spine (Pott’s Disease)?

A

Mycobacterium TB (giant cells without necrosis)

21
Q

What is the most common cause of osteomyelitis with prosthetic limbs/joints?

A

Staph epidermidis

22
Q

What is the most common cause of osteomyelitis from dog and cat bites?

A

Pasteurella

23
Q

What are a few common pathologies that raise ESR over 100mm/hr?

A

-Osteomyelitis (staph aureus mostly)-temporal arteritis-polymyalgia rheumatica

24
Q

What is the common end pathway for any pathology that disrupts vascular supply to the femoral head?

A

avascular necrosis/osteonecrosis

25
Q

What are some common causes of avascular necrosis/osteonecrosis?

A

-fracture/trauma-decompression sickness (the bends)-exo/endogenous corticosteroids-SCD-alcohol abuse-pancreatitis -storage diseasesPASS FDS`

26
Q

What are some common causes of avascular necrosis/osteonecrosis in 4-10 yo boys?

A

legg calve-perthes disease (idiopathic)

27
Q

What is Paget’s disease? Presentation

A

typically localized imbalance (increased) of osteoclast and osteoblast function-thick bone (idiopathic, possibly viral). Can be widespreadPatients might present with hearing loss (due to narrowing of the auditory foramen), bow legs, kyphosis or increased hat size

28
Q

What is a suspected genetic cause of Paget’s disease?

A

chromosome 18 mutations

29
Q

Paget’s disease is the most common cause of what?

A

isolated elevated alkaline phosphatase in patients over 40 yo

30
Q

Paget’s disease carries an increased risk of what?

A

osteosarcoma, increased AV shunts (heart failure), long bone fracture

31
Q

T or F. Serum Ca2+ and PTH are normal in Paget’s disease

A

T.

32
Q

What are the phases of Paget Disease?

A

1) lytic- osteoclasts predominate2) mixed- neither predominate3) sclerotic- osteoblasts predominate leads to thick bones that fracture easily

33
Q

Skulls can take on a ____ appearance in Paget’s disease

A

cotton wool

34
Q

What is Osteomalacia (adults)/rickets (kids)?

A

inadequate mineralization of osteoid leads to weak bones and fractures due to vitamin D deficiency leading to soft, bowing bones

35
Q

How do osteomalacia/rickets present in labs?

A

-decreased vitD, serum Ca2+ and phosphate (PO4)-increased PTH and alkaline phosphate (due to increased osteoblast activity which need an alkaline environment)

36
Q

What stain can be sued to ID osteomalacia/rickets?

A

von Kossa stain: calcified tissue is black and they are covered by a layer of unmineralized osteoid (dark pink)

37
Q

T or F. There is abundant osteoid in Osteomalacia/rickets but it is not mineralized

A

T. Causing the bone to be weak and increase risk of fracture

38
Q

What causes primary hyperparathyroidism?

A

hyperplasia or tumor (adenoma) of the parathyroid gland

39
Q

What causes secondary hyperparathyroidism?

A

prolonged states of hypocalcemia due to chronic renal failure with resulting hyper secretion of PTH

40
Q

What does increased PTH cause?

A

it is detected by osteoBLasts which stimulate osteoclasts leading to unabated bone resorption causing cyst-like brown tumors within the bone

41
Q

What do the cyst-like brown tumors consist of?

A

fibrous tissue and woven bone without matrix

42
Q

Why do the tumors of hyperparathyroidism take on a brown appearance?

A

there is cyst formation within the bone making it prone to hemorrhage which then turns brown from residual hemosiderin

43
Q

Labs with hyperparathryoidism?

A

hypercalcemia, increased PTH and x-ray changed consistent with osteopenia secondayr will show decreased GFR

44
Q

What is osteitis fibrosa cystica (von Recklinghausen disease of bone)?

A

rare progressive disease of hyperparathyroidism with triad of:-increase bone cell activity-peritrabecular fibrosis-cystic brown tumors not seen often

45
Q

What is renal osteodystrophy?

A

collectively describes skeletal changes associated with chronic renal disease when the kidney cannot convert vitamin D to active form

46
Q

What does renal osteodystrophy encompass?

A

-increased osteoclastic bone respiration mimicking osteitis fibrosis cystica-delayed matrix mineralization (osteomalacia)-osterosclerosis-growth retardation-osteoporosis

47
Q

Pathology of renal osteodystrophy?

A

decreased vitD leads to reduced Ca2+ absorption by the intestine leading to hypocalcemia and increased PTH secretion leading to increased bone resorption

STEP Pathology (80 decks)

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