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Systems Pathology > Exam 1- Musculoskeletal Pathologies > Flashcards

Exam 1- Musculoskeletal Pathologies Flashcards

1
Q

____ may induce a fracture in musculoskeletal pathologies.

A

Trauma

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2
Q

Age, Genetics and Lifestyle choices are more likely to have an influence on the development of a condition like ________

A

Osteoporosis

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3
Q

Disorder of bony development resulting in defective ossification of the skeletal system
Develops due to irregular mesenchymal cell migration, during embryogenesis

A

Dysostosis

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4
Q

Examples of Dysostoses

A

Cleidocranial Dysostosis
Klippel-Feil Syndrome
Polydactyly/Syndactyly
Aplasia

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5
Q

Musculoskeletal pathology
Interferes with body’s ability to perform normal growth or regulate normal musculoskeletal homeostasis
Primarily abnormal bone formation (isolated/widespread)

A

Dysplasia

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6
Q

Examples of Dysplasias

A

Type 1 Spondylolisthesis
Osteogenesis Imperfecta
Osteoporosis
Achondroplasia

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7
Q

Stunted Growth

Individuals does not achieve a mature height of at least 4 ft. 11 in.

A

Dwarfism

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8
Q

Pathologies resulting in Dwarfism

A 
Turner Syndrome 
Achondroplasia
Osteogenesis Imperfecta
Hypopituitarism
Severe Malnutrition
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9
Q

Form skeletal dysostosis that involves congenital abnormalities of the bones and teeth

A

Cleiodocranial Dysostosis (Cleidocranial Dysplasia)

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10
Q

Characteristically, the ______ are either underdeveloped (hypoplastic) or absent and allows affected individuals to ______ their shoulders to an extreme degree

A

Clavicles

Adduct

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11
Q

Enlarged fontanelles (“soft spots”)
Normal intelligence
Mutation in the RUNX2 gene
Autosomal Dominant

A

Cleidocranial Dysostosis

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12
Q 
Form of skeletal dysostosis
Presence of 2+ cervical vertebrae w/ abnormal fusion
Shortened neck height
Low-appearing hairline
Limited ROM in cervical spine
A

Klippel-Feil Syndrome

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13
Q

Conditions associated with Klippel-Feil Syndrome

A

Renal Abnormalities
Cardiac Abnormalities
Hearing Problems

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14
Q

Skeletal abnormality of the scapula
Failure of the scapula to descend during early embryogenesis
Characteristically associated with Klippel-Feil Syndrome

A

Sprengel’s Deformitiy

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15
Q

MC form of skeletal dysplasia and develops following a single gene mutation that affects many different areas of the musculoskeletal system
Autosomal dominant
MC Sporadic Mutations

A

Achondroplasia

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16
Q

What is the gene responsible for Achondroplasia?

A

FGFR3

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17
Q

What part of the body is most affected in achondroplasia with growth suppression?

A

Long bone elongation of the extremity bones

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18
Q

Sporadic mutations of Achondroplasia involve mutations in the FGFR3 gene within the

A

Father’s sperm

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19
Q

Advanced ______ age increases the risk of father’s sperm developing these spontaneous FGFR3 mutations

A

Paternal

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20
Q

Characteristics of Achondroplasia

A 
Short Extremity Bones
Trident Hand Appearance
Frontal Bossing
Stenosis of Foramen Magnum
Midface Hypoplasia
Lumbar Spinal Stenosis
Bullet Vertebrae
Lower Extremity Radiculopathy
Normal Intelligence
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21
Q

Most common form of lethal dwarfism

A

Thanatophoric Dwarfism (Thanatophoric Dysplasia)

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22
Q

Severely diminished chondrocyte activity resulting in severely inhibited endochondral ossification

A

Thanatophoric Dwarfism (Thanatophoric Dysplasia)

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23
Q

FGFR3 gene mutation that traditionally causes achondroplasia with potentially lethal tissue distortions

A

Thanatophoric Dwarfism (Thanatophoric Dysplasia)

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24
Q

Lethal in utero or shortly after birth

1 in 20,000 pregnancies

A

Thanatophoric Dwarfism (Thanatophoric Dysplasia)

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25
Q

Greek for “death bearing”

A

Thanatophoric

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26
Q

Severely underdeveloped _____ does not provide enough space for normal heart and lung development

A

Thorax

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27
Q

Most common cause of death among individuals affected with thanatophoric dwarfism

A

Respiratory Failure

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28
Q

Also known as brittle bone disease or Type I Collagen Disease

A

Osteogenesis Imperfecta (OI)

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29
Q

Autosomal dominant mutation in the genes that code for the formation of α1 - or α2- chains of type I collagen, which causes premature breakdown of bone due to irregular formation

A

Osteogenesis Imperfecta (OI)

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30
Q

T/F. Only bones, teeth, eyes, skin and joints are affected by Osteogenesis Imperfecta.

A

False (all tissues throughout body containing Type I Collagen are impacted)

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31
Q

What tissues are prominently impacted by Osteogenesis Imperfecta?

A

Bones, teeth, eyes, skin and joints

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32
Q

What’s the most characteristic feature of Osteogenesis Imperfecta?

A

Severely under-mineralized bony tissue (which are very prone to fracture)

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33
Q

The presence of “blue sclerae” is very specific to

A

Osteogenesis Imperfecta (OI)

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34
Q

What causes the blue shade in the sclerae with an individual with Osteogenesis Imperfecta?

A

Sclerae is most translucent due to irregular Type I collagen, this allows the vascular choroid layer of eye to show blue

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35
Q

Hearing loss occurs due to middle ear bones irregularly forming
Teeth are likely to be small and misshapen due to an inability to produce normal dentin

A

Osteogenesis Imperfecta (OI)

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36
Q

What type of Osteogenesis Imperfecta is compatible with life, MC recognized during childhood, bowing of lower extremity bones, dwarfism or scoliosis

A

Type I Osteogenesis Imperfecta

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37
Q

What type of Osteogenesis Imperfecta is a contraindication to high-velocity, low-amplitude (HVLA) adjusting?

A

Type I Osteogenesis Imperfecta

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38
Q

What type of Osteogenesis Imperfecta is incompatible with postnatal life due to extreme skeletal fragility, suffer multiple fractures in utero or during birthing process resulting in lethal intracranial hemorrhage?

A

Type II Osteogenesis Imperfecta

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39
Q

AKA Marble Bone Disease

A

Osteopetrosis

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40
Q

Reduced osteoclast formation or activity resulting in widespread skeletal sclerosis

A

Osteopetrosis

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41
Q

Abnormal hardening of a body tissue

A

Sclerosis

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42
Q

Increased skeletal density, via Osteopetrosis, causes bones to be more prone to ______

A

Fracture

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43
Q

What is the condition that is occuring if an individual suffers from a “chalk stick fracture”?

A

Osteopetrosis

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44
Q

Bone marrow of individuals with _____ will fill with mineralized bone, which displaces functional red bone marrow and causes reduced hematopoiesis

A

Osteopetrosis

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45
Q

Erlenmeyer flask deformity associated with long bone distortion
Various cranial nerve defects due to foraminal stenosis

A

Osteopetrosis

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46
Q

Serve reduction in bone mineral density

A

Osteoporosis

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47
Q

At least ____ standard deviations from normal mineralization

A

-2.5

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48
Q

What is the primary complication of osteporosis?

A

Fracture

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49
Q

With Osteoporosis, fractures are most common in areas that have abundant ______ bone.

A

Trabecular

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50
Q

When diagnosing for Osteoporosis, bone mineral density is best evaluated with a

A

DEXA Scanner

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51
Q

Determines how many SD the patient’s bone mineralization is away from normal (average bone mineral density of a 25 y.o. of the same sex), with a T Score

A

DEXA Scanner

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52
Q

T/F. Plain film radiography is not sensitive enough to be used as a diagnostic test.

A

True

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53
Q

Bone mineralization is below normal, but not yet reaching a severity to be considered osteoporosis

A

Osteopenia

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54
Q

Osteopenia is considered to have a SD of bone mineralization of ___ and ___ SD’s below normal

A

1 and 2.5

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55
Q

Bone mineralization peaks during young adulthood, around the ages of

A

25-30

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56
Q

About _____ of individuals bone mineralization is lost with each of the following years.

A

0.5-0.7%

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57
Q

Factors that influence bone mineral density include:

A 
Lifestyle choices
Diet
Physical Activity
Muscle Strength
Age
Hormonal Factors
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58
Q

Osteo____ activity decreases with age

A

-blast

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59
Q

Age-related loss in bone mineralization

A

Senile Osteoporosis

60
Q

____ have accelerated rates of osteoclast activity, due to estrogen levels.

A

Women

61
Q

Screening for osteoporosis is recommended for all women over age ____

A

65

62
Q

Asymptomatic until the development of a fracture

A

Osteopenia

Osteoporosis

63
Q

Most common locations for osteoporosis-related fractures are the

A

Femoral Neck

Vertebral Bodies

64
Q

Vertebral body osteoporosis-related fracture that is most likely to cause compression fractures within the ______ spine

A

Thoracolumbar

65
Q

Loss of overall height and what other feature are observable features of advanced osteoporosis

A

Dowager’s Hump

66
Q

Complications from osteoporosis-related fractures include:

A

Immobility
Spinal Deformation
Pneumonia
Pulmonary Embolism

67
Q

_______ are a group of medications that decrease osteoclast activity

A

Bisphosphonates

68
Q

Metabolic bone diseases that develop following a deficiency in Vitamin D

A

Rickets and Osteomalacia

69
Q 
Develop in children
Deficient in Vitamin D
Reduced bones deposition at the epiphyseal region
Stunted growth
Bowing of lower extremities
Increased risk of fractures
Abnormal spinal curvatures
A

Rickets

70
Q 
Adults
"adult counterpart of rickets"
Skeletally mature
Bone is left under-mineralized
Less severe than rickets
Limited to increased fracture risk
Mimics Osteoporosis
A

Osteomalacia

71
Q

Evaluating serum vitamin D levels is needed to establish diagnosis of

A

Osteomalacia

72
Q

Elevated parathyroid hormones (PTH) levels

A

Hyperparathyroidism

73
Q

Parathyroid hormone levels regulate blood calcium levels by stimulating _______ activity, which releases calcium into the serum

A

Osteoclast

74
Q 
Parathyroid glands  overproducing PTH
Adenoma of the parathyroid gland.
Women ~50
Removal of the Parathyroid adenoma
Asymptomatic
A

Primary Hyperparathyroidism

75
Q

Cause the parathyroid glands to increase production of PTH
Chronic Kidney Disease –> causes Hypocalcemia
Parathyroid gland responds by elevating PTH production

A

Secondary Hyperparathyroidism

76
Q

Less commonly, Secondary Hyperparathyroidism is caused by

A

Vitamin D deficiency

77
Q

What is the most common symptom of Primary Hyperparathyroidism?

A

Symptomatic kidney stones

78
Q

What is the most common sign of Primary Hyperparathyroidism?

A

Hypercalcemia

79
Q

T/F. Hyperparathyroidism will not affect many areas of the body

A

False (it is an endocrine disorder- it affects many areas of the body)

80
Q

Skeletal changes associated with hyperparathyroidism involve resorption of ______ and _____ bone throughout the entire skeleton

A

Cortical

Trabecular

81
Q

Hyperparathyroidism most characteristically affects the

A 
Phalange
Vertebral Body
Calvaria
Femur
Tibia
82
Q

Rugger Jersey Spine is present with an individual suffering from Hyperparathyroidism would have problems at what location?

A

Vertebral Bodiers

83
Q

Resorption of the cortex, primarily on the radial side of the middle and distal phalanges is present with an individual suffering from Hyperparathyroidism would have problems at what location?

A

Phalanges

84
Q

Salt and Pepper Skull is present with an individual suffering from Hyperparathyroidism would have problems at what location?

A

Calvaria

85
Q

Osteitis Fibrosa Cystica is present with an individual suffering from Hyperparathyroidism would have problems at what location?

A

Long bones of the lower extremities

86
Q

_____ ____ develop following localized osteolysis whereas the bone weakens, hemorrhage occurs, macrophages accumulate within the area, and fibrotic tissue fills the area

A

Brown Tumors

87
Q

Localized areas of osteolysis may give rise to areas of “cystic degeneration” and produce what is known as

A

Osteitis Fibrosa Cystica

88
Q

Three stages of Paget Disease are known as:

A

Osteolysis –> Mixed Osteoclastic-Osteoblastic Stage –> Osteosclerotic stage

89
Q

Results in increased, but structurally weak, bone mass

A

Paget Disease of Bone

90
Q

Caucasian males 70 y.o.
MC in North America, Australia and New Zealand
1% of general adult population affected
10% adults older than 80 y.o.

A

Paget Disease of Bone

91
Q

T/F. Most patients with Paget disease are symptomatic

A

False (most (80%) are asymptomatic)

92
Q

A sign of Paget disease involves elevated serum levels of _____ _____, which represents elevated osteoblastic activity

A

Alkaline Phosphatase

93
Q

Symptoms of Paget Disease:

A 
Back/Neck Paine
Bony Deformation
Increased fracture risk
Headache
Cranial Nerve Compression
94
Q

_____ disease may cause an “ivory vertebra sign”, discovered upon radiological examination.

A

Paget

95
Q

Paget disease on x-ray’s is usually referred to as a ______ appearance while histological exams of a site of the disease will manifest with an irregular _____ or jigsaw puzzle pattern

A

Shaggy

Mosaic

96
Q

Paget disease is most likely to develop within the ____ ______ and the proximal _____

A

Axial Skeleton

Femurs

97
Q

T/F. A large percentage (about 75% or less) of all cases of Paget disease will transition into an aggressive bone cancer known as Osteosarcoma

A

False (A small percentage [1% or less])

98
Q

Osteosarcoma is associated with a very high _____ rate

A

Mortality

99
Q

What is the cause of Paget disease?

A

Idiopathic

100
Q

Complete or partial loss of bone integrity

A

Bone Fracture

101
Q

T/F. Just as much force is needed to break a pathological bony tissue versus a normal bony tissue

A

False (smaller amount of force)

102
Q

Fracture at the site of a bone-weakening pathology

A

Pathological Fracture

103
Q

Completely separates what was previously a single bone
Separation of bone’s cortex
MC site of a pathological fracture
Occurs in an adult or older adult

A

Complete Fracture

104
Q

Fracture that does not separate the fragments of the fractured bone
MC occur in long bones
Occur in pediatric individuals

A

Incomplete Fracture

105
Q

Skin overlying the fracture remains intact

Reduces the risk that this fracture site will become infected

A

Closed (Simple) Fracture

106
Q

Fracture is in communication with overlying skin
Exposes the fracture site to the external environment
Increases risk of infection at site

A

Compound (Open) Fracture

107
Q

Fracture is splintered into multiple fragments.

High-velocity forces cause the fracture

A

Comminuted Fracture

108
Q

Ends of the bones at the fracture site are not in alignment

A

Displaced Fracture

109
Q

Slowly-developing fracture

Increased physical activity and repetitive loading

A

Stress Fracture

110
Q

Fractures are typically painful because the fracture disrupts the sensitive ______

A

Periosteum

111
Q

The fracture of a bone will induce an __1.__ inflammatory response that initiates the ___2.___ process while also inducing a painful response via ____3.___ and ____4._ ____ production

A
  1. Acute
  2. Reparative
  3. Prostaglandin
  4. Substance P
112
Q

Normal fracture healing begins immediately after the fracture occurs with the development of a ______

A

Hematoma

113
Q

The hematoma developed to initiate healing of a fracture will also prompt formation of a fibrin-rich clot and fibroblasts will form a ____ ___ by the end of the 1st week of healing.

A

Soft Callus

114
Q

By the end of the 2nd week of healing, a ___ ____ will have formed and woven bone will rise to endochondral ossification

A

Bony Callus

115
Q

Woven bone will forming through endochondral ossification will result in mature _____ bone at the end of the healing process.

A

Lamellar

116
Q

How long does bone take to heal after a normal fracture?

A

6-8 weeks

117
Q

What aspect of the healing process of a fractured bone will be remodeled over that persons lifetime?

A

Bony Callus

118
Q

T/F. Bony callus’ will become more noticeable as that individual ages.

A

False (less noticeable over time)

119
Q

What may delay fracture healing?

A

Fracture…

  • Fragments remain displaced
  • Splintered
  • Not immobilized
  • Becomes infected
  • Malnourished (Calcium, Vitamin D, Phosphorus or Magnesium)
  • Occurs in an older adult
120
Q

Place the healing process of bone fracture in order:
Bony Callus, Hematoma,
Soft Callus, Lamellar Bone, Woven Bone

A

1st. Hematoma
2. Soft Callus
3. Bony Callus
4. Woven Bone
5. Lamellar Bone

121
Q

Fractures that involve the epiphyseal growth plate

A

Salter-Harris Fractures (SHF)

122
Q

Salter-Harris Fractures (SHF) only apply to individuals who have open or active ____ ____.

A

Growth Plates

123
Q

Salter-Harris Fractures (SHF) are limited to ____ who have not reached skeletal maturity

A

Pediatrics

124
Q

Occur in about 15% of all pediatric long bone fractures

A

Salter-Harris Fractures (SHF)

125
Q

Fracture that extends through the entire growth plate (physis)
5% of all SHF’s
Favorable Prognosis

A

Type I

126
Q

Fracture extends from the growth plate into the metaphysis
75% of all SHF’s
Favorable Prognosis

A

Type II

127
Q

Fracture extends from the growth plate into the epiphysis
10% of all SHF’s
Limited prognosis, due to joint involvement

A

Type III

128
Q

Fracture extends through the growth plate, metaphysis and epiphysis
10% of all SHF’s
Poor Prognosis

A

Type IV

129
Q

Compression fracture of the growth plate
<1% of all SHF’s
Poor Prognosis

A

Type V

130
Q

Site of necrosis, due to reduced blood supply (ischemia).

A

Avascular Necrosis (AVN)

131
Q

___ dislocations may also cause vascular damage that result in an AVN.

A

Joint

132
Q

Other causes of AVN:

A

Autoimmune Vasculitis (Type III Hypersensitivity reaction)
Prolonged use of Corticosteroids
Ionizing Radiation
Blood Clots
Blood Disorders (that increase clotting risk i.e. Sickle Cell Disease)
Idiopathic (about 25% of all cases)

133
Q

What is the healing process called for AVN’s?

A

Creeping Substitution

134
Q

Is healing of AVN’s managed?

A

No

135
Q

_____ AVN’s may collapse and cause acute pain and surface irregularities at the joint, accelerating osteoarthritis. This is known as

A

Secondary Osteoarthritis

136
Q

Term given to an AVN that develops at the subchondral area of a joint.
Originates from an ischemic injury and causes pain
Due to death of osseous and cartilaginous tissues

A

Osteochondritis Dissecans

137
Q

What are the most common locations for Osteochondritis Dissecans to develop?

A

Knee and Hip Joints

138
Q

Most AVN cases occur around age

A

30-50

139
Q

Site of bone marrow inflammation, due to an infection

A

Osteomyelitis

140
Q

Osteomyelitis is more commonly a feature of a localized bacterial infection with ______ ____ or _____

A

Pyogenic Bacteria or Mycobacteria

141
Q

The site of an infected bone will die and this is refereed to as the ______, which is surrounded by irregular bone known as the _____ and the pus draining location is the ______

A

Sequestrum
Involucurm
Draining Sinus

142
Q

Involves a bone marrow infection that reaches the marrow via hematogenous spread
Extension from nearby infection
Direct Implantation from trauma or a compound fracture
Occur at any age
Long bones of extremities tend to be MC site

A

Pyogenic Osteomyelitis

143
Q

What bacteria, of Pyogenic Osteomyelitis, is the microbial origin of up to 90% of all cases?

A

Staph. Aureus

144
Q

May develop in patients with pulmonary TB (about 3% of all Pulm. TB cases)
Invades the local mediastinal lymph nodes and spreads to the blood
MC among individuals with a suppressed immune sytstem
Result of chronic infection
Less likely to manifest with acute features

A

Mycobacterial Osteomyelitis

145
Q

Mycobacterial Osteomyelitis will cause ____ ____ to form at the area of infection and tends to involve the long bones of extremities and the ___ ____.

A

Caseous Granulomas

Vertebral Bodies

Systems Pathology (1 decks)

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