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MSDR > Histology of MSDR Disorders > Flashcards

Histology of MSDR Disorders Flashcards

1
Q

Common features of bones and cartilage

A
  1. Designed for support and movement
  2. Common origin of mesenchymal cells
  3. Contains extracellular matrix and cells
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2
Q

Functions of bone

A
  1. Mineral storage – provides “sink” for calcium, phosphates, and “poisons”
  2. Hematopoietic – medullary canal is site of hematopoiesis
  3. Mechanical support – framework for muscle attachment
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3
Q

Wolff’s Law

A

Wolff’s Law – bone remodeling by osteoclasts and osteoblasts occur due to electrical current changes produced by pressure changes on bone

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4
Q

Extracellular matrix

A

type I collagen fibers laid down in ground substance called osteoid

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5
Q

Specific components of bones

A
  1. Extracellular matrix
  2. Mineral component – inorganic mineral salts (osteoblasts deposit calcium)
  3. Cells
    1. Osteoblasts
    2. Osteocytes
    3. Osteoclasts
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6
Q
A

Osteoblasts – mononuclear cells that sit on surface of bone and build bone

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7
Q
A

Osteocytes – osteoblasts with dendritic ends that get incorporated into bone matrix that maintain bone and participate in ion exchange

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8
Q
A

Osteoclasts – multinucleated giant cells that degrade bone

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9
Q

Woven bone

A
  1. Randomly oriented collagen fibers (think: particle board)
  2. Only found in fetus and abnormal states in adults (i.e. tumor, fractures)
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10
Q

Lamellar bone

A
  1. Highly organized, strong, parallel collagen fibers (think: sheets of wood)
  2. Mature bone
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11
Q

Cortical bone

A
  • Outer lamellar shell of bone
  • Shows up as brightest white on X-ray
  • Contains osteons, Haversian canal (vertical supplying blood to individual osteon), and Volkmann’s canal (horizontal connecting osteons)
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12
Q

Trabecular bone

A

Spongy bone in medullary canal

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13
Q

Periosteum

A
  • Fibrovascular sheath surrounding cortex (read: cortical) bone
  • Contains progenitor cells (osteoblasts and fibroblasts) that are involved in fracture healing
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14
Q

Enchondral ossification

A
  • Cartilage undergoes degeneration and calcification and gradually gets replaced by osteoid by coupled reaction of osteoblasts and osteoclasts except for the skull and clavicle bones
  • Most bones are formed this way
  • Physis growth pathway (lengthening of bone)
    • Physis is made up of cartilage
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15
Q

Steps in Enchondral ossification

A

Necrosis → calcification → ingrowth of new vessels → resorption → transformation into osteoid matrix

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16
Q

Membranous bone formation

A
  • Osteoid forms directly from primitive fibrous tissue without cartilage
  • Skull and part of clavicle are formed this way
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17
Q

Function of cartilage

Tow main discriminating factors?

A
  • Function of cartilage: structural model for development of bone (endochondral ossification) → allows for articulation of joints
    • Type II collagen
    • Avascular
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18
Q

Diarthrodial (or synovial) joint

A
  • Diarthrodial (or synovial): allows for complete movement with hyaline cartilage
    • Enclosed by synovial membrane
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19
Q

Types of cells in the synovial membrane

A
  • Type A cells have phagocytic properties
    • Take metabolites made by articular cartilage and transfers to blood stream
  • Type B cells have secretory properties
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20
Q

Fibrocartilagenous joints

Found where?

A
  • Fibrocartilagenous: limited movement usually with fibrocartilage
    • Vertebral joints
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21
Q

Fibrous (synarthrosis) joint

Found where?

A
  • Fibrous (synarthrosis): allows for no movement usually with fibrocartilage or just fibrous tissue
    • Cranial sutures
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22
Q

Fibrocartilage

A

Description: Layers of collagen

Location: Intervertebral discs, joint capsules, pubic symphysis

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23
Q
A

Fibrocartilage

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24
Q
A

Fibrocartilage

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25
Q
A

Elastic

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26
Q
A

Hyaline

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27
Q
A

Hyaline

28
Q

Elastic

A

Description: Bundles of branching elastic fibers

Location: Ears, epiglottis

29
Q

Hyaline

A

Description: Glossy white lining of bone articulations

Location: Joints, nasal septum

30
Q

What is shown?

What is the related disorder?

A
  • Osteoarthritis
    • Eburnation (1) – cartilage is worn away and underlying bone is polished
    • Subchondral cyst (2) – a fluid sac under the cartilage near the epiphysis
    • Normal cartilage (3)
    • Osteophytes – bone growths
31
Q

What is shown?

What is the related disorder?

A
  • Rheumatoid arthritis
    • Pannus – synovial lesion in RA
32
Q

What is shown?

What is the related disorder?

A
  • Gout
    • Tophi – chalky paste-like deposits made up of sodium urate crystals
    • Needle-like crystals
33
Q

What is shown?

What is the related disorder?

A
  • Pseudogout (Calcium pyrophosphate dehydrate)
    • Rhomboid shaped-like crystals
34
Q

What is shown?

What is the related disease?

A
  • Avascular necrosis of bone
    • Loss of blood supply resulting in wedged shaped infarct (aka necrosis)
    • Can be seen on radiographs as a “crescent sign”
35
Q

Achondroplasia

Inheritance pattern? Clinical presentation?

A
  • Defect in formation of cartilage – mutation in fibroblast growth factor-3 receptor
  • Mainly affects physeal plates – decrease in chondrocyte proliferation
  • Autosomal dominant
  • Most common inherited form of dwarfism
    • Large heads and clavicle bones because there is no cartilage present
    • Bridge of nose is compressed
36
Q

Osteogenesis Imperfecta Congenita

A
  • Affects formation – both quantity and quality – of type I collagen (COL1A1 and COL1A2)
  • Bone fragility causes repeated fractures with ineffectual healing causing short stature
  • Bones look bendy, but they actually only heal this way after fractures
37
Q

Fibrous Dysplasia

Clinical presentation? Common site of dsease?

A
  • Benign disorder where woven bone is unable to form organized lamellar bone
  • Bones affected – femur, tibia, ribs, maxilla
  • Clinical
    • Usually affects only one bone (monostotic)
38
Q

Fibrous Dysplasia

Pathology? (Gross and Micro)

A
  • Gross – involves medullary canal which causes bone expansion
    • Ground glass appearance with widened bone under XR
  • Micro – islands of osteoid without osteoblasts
39
Q
A

Fibrous Dysplasia

40
Q

Paget’s Disease

Patho? Epidemology? Symptoms? Sites of Disease?

A
  • Osteoclasts “go crazy” autonomously without external signals
    • Remove bone where it doesn’t need to be broken down
  • Clinical – after age 40 in white northern Europeans
  • Symptoms
    • Pain = bone turnover
    • Microfractures = immature bone laid down
    • Large forehead
    • Bowed legs
    • Enlarged bones
    • Compression of the brain = herniation
  • Bones affected – skull, pelvis, and femur
    • Affects more than one bone at a time, and affects them with different waves of activity
41
Q

Paget’s Disease

Three Phases

A
  • Osteolytic phase – crazy osteoclasts resorb bone
  • Mixed phase – bone formation in attempt to repair (osteoclast activity > osteoblast)
  • Burnt out phase – quiescent with mosaic pattern of cement lines
42
Q

Paget’s Disease

Treatment?

A

Treatment with bisphosphonates (inhibits osteoclast activity)

43
Q

Osteosarcoma

A
  • Osteosarcoma – neoplasm of bone
    • Anaplastic cells making osteoid
44
Q

Chondrosarcoma

A
  • Chondrosarcoma – neoplasm of cartilage
    • Lots of chondrocytes that grow in clones
    • Invasion of marrow space
45
Q

Primary neoplasms of bone metastaize to?

A

flat bones, which Arsh for some reason thinks is spelled “falt bones”. So I had to look up what a “falt bone” was. And there is no such thing. Thanks Arsh.

46
Q

Secondary neoplasms of the bone come from

A

blt w/kp, m – breast, lung, thyroid, kidney, prostate, melanoma

47
Q

Pseudo-tumors

A
  • Arise from primitive mesenchymal cells (pluripotent stem cell)
  • When one cell type grows where another cell type exists
48
Q

Nodular Fasciitis

A

Nodular Fasciitis – after injury, reparative cells become fibroblasts rather than fibrous tissue

49
Q

Myositis Ossificans

A

Myositis Ossificans – bone forms inside of muscle

50
Q

Signicifance of seeing this type of radiograpgh?

A

All three stages of Paget’s disease are seen

51
Q
A

Paget’s disease: Mixed stage

52
Q
A

Paget’s disease: Burnt out phase

53
Q
A

Osteosarcoma

Anaplastic cells making osteoid

54
Q
A

Chondrosarcoma

55
Q
A

Nodular Fasciitis

56
Q
A

Myositis Ossificans

57
Q

What is Osteoporosis?

Patho? Areas affected? symptoms?

A

Osteoporosis – low bone mineral density causing increased risk of fracture

  • Pathophysiology
    • Osteoclast activity overtakes osteoblast activity due to physical activity, genetic factors, and nutrition
  • Common affected areas
    • Wrist, hip, and spine
  • Sequelae
    • Fragility fractures – any fracture that occurs from a fall at ground level
    • Deformities of bone (secondary to fractures)
    • High incidence rate and high mortality
58
Q

Osteoporosis

Risk factors? Sceening options?

A
  • Risk Factors
    • Age
    • Females more than males
      • Post-menopause (2%/year bone loss)
    • Every comorbidity under the sun
  • Screening
    • DEXA Scan – measures bone density
      • Considered gold standard of diagnosis
59
Q

Osteopenia treatment?

A
  • Treatment
    • Medications
    • Calcium and vitamin D
    • Weightbearing exercise
60
Q

Osteopenia versus osteoporosis

A
  • Patients with osteopenia have higher bone density than osteoporosis
  • Patients with osteopenia have higher incidence of fractures because oftentimes more active lifestyles
61
Q

What is Rickets/Osteomalacia?

Who does each effect?

A

Rickets/Osteomalacia – decrease in the mineralization of the otherwise normally formed matrix secondary to vitamin D deficiency

  • Rickets – growing child
  • Osteomalacia – skeletally mature person
62
Q

Normal vitamin D metabolism

A
  • Normal vitamin D metabolism
    • Maintains normal levels of plasma levels of Ca++ and phosphate
    • Absorption through skin and GI tract
    • Metabolism in liver and kidney
63
Q

Hyperparathyroidism Types?

A
  • Types
    • Primary – tumor on parathyroid
    • Secondary – abnormal Ca++ or phosphate levels influencing parathyroid activity
64
Q

Hyperparathyroidism

Patho? Symptoms?

A
  • Increased secretion of PTH by parathyroid → stimulation of osteoclasts (via osteoblasts)
    • Ca++ resorption
    • Results
      • Osteopenia – loss of bone
      • Brown tumor of bone – hemorrhagic cysts
      • Osteitis fibrosa cystica – cystic spaces in bone replaced with fibrous tissue instead of bone
65
Q

Renal Osteodystrophy

A
  • Blanket term for when chronic renal disease causes disorders of bone, including secondary hyperparathyroidism
    • Chronic renal failure (CRF) → increase in serum phosphate → stimulation of parathyroid gland → secondary hyperparathyroidism → bone disease

MSDR (7 decks)

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