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Pathology > MSK > Flashcards

MSK Flashcards

1
Q

Which cells are involved in the formation of bone?

A

osteoblast

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2
Q

Which cells are responsible for bone resorption?

A

osteoclasts

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3
Q

Describe osteoblasts

A

;arge
mononuclear
found on surface on surface of bone

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4
Q

When do osteoblasts become osteocytes?

A

whenever they become surrounded by osteoid

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5
Q

Describe osteoclastss

A

large

multinnucleated

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6
Q

How is bone resorption regulated?

A

complex milia of hormones and local cell mediators

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7
Q

What happens in the immediate aftermath of a fracture?

A

haematoma formed

acute inflammatory response

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8
Q

What happens within a few days of a fracture?

A

granulation tissue formed

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9
Q

What is the primary callus response?

A

differentiation of osteoprogenitor cells into bone-forming cells

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10
Q

What is the external bridging callus stage?

A

bone formation bridging the gap where the fracture is

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11
Q

What is the remodelling stage in a fractre?

A

the obvious callus formation on the outside is reduced and streamlines to the shape of what it originally was

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12
Q

Label the arrows

A

blue: osteoblast
red: osteoid

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13
Q

What is vital in fracture healing?

A

complete immobilisation
good oxygen supply
good blood supply

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14
Q

What can happen when oxygen supply is poor in distal fractures especially?

A

cartilage forms instead of bone

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15
Q

What 2 areas do fractures complications fall into?

A

local

systemic

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16
Q

What are 5 reasons for early local fracture complications?

A 
infection
blood loss from haemhorrage
dislocation of joint
damage to nerves and vessels
skin loss and soft tissue injury
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17
Q

What are the 5 reasons for delayed local fracture complications>

A 
damage to epiphyseal plates
avascular necrosis of bone
secondary osetoarthritis
delayed union
non-union
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18
Q

What are 8 reasons for systemic complications in fractures?

A 
cardiac shock and circulatory failure
fat embolus
DVT and pulmonary embolus
respiratory distress syndrome
pneumonia
sepsis
bed sores
DIC (disseminated intravascular coagulation)
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19
Q

How long after fracturing a major long bone can a fat embolus occur?

A

24-72 hrs

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20
Q

How long after fracture can a DVT/PE form?

A

7-10 days if prolonged bed rest

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21
Q

What 11 factors can impair healing?

A 
age
malnutrition
diabetes
cancer
radiotherapy
soft tissue injury
compound fracture
large fracture gap
poor immobilisation
infection
ischaemia
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22
Q

What is infection in bones called?

A

osteomyelitis

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23
Q

What is an infection in a joint called?

A

septic arthritis

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24
Q

How does acute osteomyelitis present?

A 
septic process
high WCC
high CRP
high ESR
temperature
toxaemic
red/flushed
feeling sick
vomiting
25
Q

Who is affected most by acute osteomyelitis?

A

babies and young children

26
Q

How long does it take for X-ray changes in acute osteomyelitis?

A

10 days - too late to make diagnosis

27
Q

What is the most common organism in acute osteomyelitis?

A

Staph aureus

28
Q

In children younger than 4 what is the most common cause of acute osteomyelitis?

A

H influenzae

29
Q

What kind of reaction is seen in osteomyelitis?

A

periosteal reaction

30
Q

What is seen in this picture?

A

osteomyelitis

red: neutrophil polymorphs
blue: bone

31
Q

How do you prevent bone infection in fractures?

A

urgent and thorough debridement of open fractures in theatre on the same day
strict aseptic technique
appropriate prophylactic antibiotics esp. in metal prosthetic work

32
Q

Who is mostly affected by chronic osteomyelitis?

A

adults

33
Q

How does chronic osteomyelitis present?

A

smouldering infection causing bone necrosis and new bone formation
this causes marked bone deformity

34
Q

What is seen in the picture?

A

chronic myelitis

fibrous tissue with some chronic inflammatory cells

35
Q

6 complications of osteomyelitis

A 
septicaemia
bone deformity
secondary arthritis
formation of skin sinus
squamous carcinoma (Marjolin's ulcer)
systemic amyloid
36
Q

What is bone/joint TB?

A

occurs secondary to pulmonary TB

37
Q

Where is bone TB found?

A

spine

sometimes hips and joints or small bones of hands and feet

38
Q

What is the name of spinal TB?

A

Pott’s disease of the spine

39
Q

What is seen histologically in joint TB?

A

caseating granulomata
caseous necrosis
Langerhans multinuclear giant cells
cells distributed in horse shoe fashion

40
Q

What spinal deformities can be caused by joint TB?

A

ankylosis of joints
loss of joint movement
systemic amyloid

41
Q

What spinal deformities can be caused by joint TB?

A

ankylosis of joints
loss of joint movement
systemic amyloid

42
Q

What is systemic amyloid?

A

misfolded protein becomes resistant to the body’s catabolic processes and fibrils deposit extracellularly within tissues, leading to organ dysfunction and death

43
Q

What can be seen in the picture?

A

caseous necrosis

arrow: giant cells

44
Q

What are the 3 metabolic bone diseases?

A

osteoporosis
osteomalacia
Paget’s disease

45
Q

What is osteoporosis?

A

reduction in amount of bone and loss of microarchitecture

leading to weakened bone and pathological fracture

46
Q

What is true about bone mineralisation and osteoblast and clast activity in osteoporosis?

A

all normal
no increased activity
just smaller amount of bone

47
Q

7 causes of osteoporosis

A 
idiopathic/senility/post-menopausal
Cushing's disease/steroids
thyrotoxicosis
hypogonadism
hyperparathyroidism
alcohol abuse
scurvy
48
Q

Who are at risk of osteoporosis due to steroid therapy?

A

patients with long term asthma
IBD
transplant treatment

49
Q

How do steroids cause osteoporosis

A

increased output of glucocorticoids

50
Q

How can thyroxin cause osteoporosis?

A

stimulates osteoclasts

51
Q

How does hypogonadism cause osteoporosis?

A

lack of sex hormones results in reduced output of oestrogen and testosterone

52
Q

13 risk factors in osteoporosis

A 
female
caucasian/asian
early menopause
sedentary lifestyle
slim body build
nulliparity (woman who hasn't given birth)
amennhorhoea
positive family hx
smoking
alcohol
steroids
previous fractures
low Ca intake
53
Q

What can help females in perimenopausal stages for osteoporosis?

A

HRT

54
Q

When does the critical zone typically occur in bone structure for females?

A

65-70

55
Q

What is osteomalacia?

A

reduced mineralisation of the bone

56
Q

What causes osteomalacia?

A

low serum calcium and phosphate

57
Q

What are the causes of osteomalacia?

A 
deficient diet (calcium)
lack of sun exposure
malabsorption 
chronic liver disease
chronic renal disease
hypophosphataemia
phenytoin therapy
58
Q

What are symptoms of osteomalacia?

A 
abnormal blood chemistry - low serum calcium or phosphate
osteopenia on X-ray
pathological fracture
bone pain
proximal myopathy

Pathology (5 decks)

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