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Pathology II > Musculoskeletal Pathology > Flashcards

Musculoskeletal Pathology Flashcards

1
Q

Osteoporosis

A
  • Increased porosity of the skeleton

- Reduced bone mass

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2
Q

Primary osteoporosis

A
  • Postmenopausal

- Senile

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3
Q

Secondary osteoporosis

A
  • Endocrine Disorders
  • Neoplasia
  • Gastrointestinal
  • Rheumatologic disease
  • Drugs
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4
Q

Determinants of peak bone mass

A
  • Genetic factors
  • Physical activity
  • Nutrition
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5
Q

Menopause factors with osteoporosis

A
  • Decreased estrogen
  • Increased IL-1, IL-6, TNF
  • Increased RANK, RANKL
  • Increased osteoclast activity
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6
Q

Aging factors with osteoporosis show decreased

A
  • Replicative activity of osteoprogenitor cells
  • Synthetic activity of osteoblasts
  • Biologic activity of matrix-bound growth factors
  • Physical activity
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7
Q

Postmenopausal osteoporosis

A
  • Hormone-dependent accelerated bone loss (decade after menopause)
  • Decreased estrogen levels
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8
Q

Decreased estrogen levels show increased secretion of

A
  • IL-1
  • IL-6
  • TNF
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9
Q

IL-1, IL-6, and TNF are all

A
  • From blood monocytes and bone marrow cells

- Stimulators of osteoclast recruitment and activity

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10
Q

Most affected in postmenopausal osteoporosis

A
  • Cancellous compartment of vertebral bodies
  • Trabeculae thinning
  • Microfractures
  • Vertebral collapse
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11
Q

Trabecular bone effects in postmenopausal osteoporosis

A
  • Loss of bone is most rapid
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12
Q

Vertebral effects in postmenopausal osteoporosis

A
  • Prominent trabecular component

- Fractures

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13
Q

Postmenopausal osteoporosis vertebral fractures (clinical features)

A
  • Back Pain
  • Shortening of stature
  • Dorsal kyphosis
  • Cervical lordosis
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14
Q

Senile osteoporosis features

A
  • Decreased osteoblast response (reduced replication and biosynthetic potential)
  • Decline in biologic potency of growth factors
  • Thinning of Cortex
  • Widened haversian systems
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15
Q

General clinical course of postmenopausal and senile osteoporosis

A
  • Painful thoracic and lumbar regions
  • Other fracture sites include; femoral neck, pelvis
  • Plain radiographs not helpful
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16
Q

Postmenopausal and senile osteoporosis prevention and treatment

A
  • Exercise
  • Appropriate calcium and vitamin D intake
  • Pharmacologic Agents (Bisphosphonates, Recombinant PTH)
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17
Q

Rickets and Osteomalacia vitamin D involvement

A
  • Maintains normal plasma Ca+2 and Phosphorus
  • Maintains the correct concentration of ionized calcium
  • Absorption of Ca+2 from GI tract
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18
Q

Calcium is essential for

A
  • Skeletal mineralization
  • Blood coagulation
  • Neural transmission
  • Membrane preservation
  • Skeletal and cardiac muscle
  • Normal tone
  • Excitability
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19
Q

Phosphorous constituents

A
  • Nucleic Acids
  • Phospholipids
  • ATP
  • NADP
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20
Q

Phosphorous is essential for

A
  • Muscle Contraction
  • Neural Function
  • Electrolyte Transport
  • O2 carrier for Hgb
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21
Q

Vitamin D deficiency may result from

A
  • Dietary deprivation

- Chronic renal failure

22
Q

Dietary deprivation vitamin D deficiency

A
  • Fat malabsorption

- Prolonged lack of sunlight

23
Q

Chronic renal failure vitamin D deficiency

A
  • Vitamin D conversion to active form hindered
24
Q

Vitamin D deficiency or phosphate depletion

A
  • Rickets in Children

- Osteomalacia (soft bones) in adults

25
Q

Rickets

A
  • Children
  • Deranged bone growth produces skeletal deformities
  • Ends of long bones (epiphyseal plate ossification)
26
Q

Osteomalacia (soft bones)

A
  • Adults

- Under-mineralized remodeled bone

27
Q

Basic abnormality in Rickets and Osteomalacia (morphology)

A
  • Defective mineralization of osteoid
  • Increased unmineralized matrix
  • Wide osteoid seams
  • Decreased calcified bone
28
Q

Rickets clinical features

A
  • Pain
  • Bone deformities
  • Outward curvature of sternum (pigeon chest)
  • Shortened and deformed limbs with bowing of arms and legs
  • Frequent fractures
29
Q

Bone deformities in Rickets

A
  • Rachitic rosary (swollen costochondral junctions of ribs)
30
Q

X-ray findings in Rickets

A
  • Thickened, irregular and lobulated epiphyseal plate
31
Q

Deranged bone growth in Rickets

A
  • Bowing of Extremities
  • Rachitic rosary
  • Frontal bossing
32
Q

Osteomalacia under-mineralized bone may be visualized histologically with

A
  • Von Kossa stain
33
Q

Clinical features of osteomalacia

A
  • Osteopenic x-ray pattern
  • Compression fractures
  • Decrease in bone thickness
  • Low serum calcium and phosphorus
34
Q

Osteopenia

A
  • Early manifestation of osteoporosis
35
Q

Basic common abnormalities (Rickets and Osteomalacia)

A
  • Vitamin D deficiency
  • Low serum levels of Ca+2 and Phosphorus
  • Secondary hyperparathyroidism
  • Defective mineralization of osteoid
  • Increased unmineralized matrix
36
Q

Primary hyperparathyroidism of the parathyroid gland may result from

A
  • Hyperplasia
  • Adenoma
  • Carcinoma
37
Q

PTH secreting adenomas may cause

A
  • Depression
  • Seizures
  • Nephrocalcinosis
  • Nephrolithiasis
  • Acute pancreatitis
  • Gallstones
38
Q

Morphology of primary hyperparathyroidism

A
  • Dissecting osteitis
  • Osteopenia
  • Osteoblast activity increased
  • Marrow space replaced by fibrovascular tissue
39
Q

Secondary Hyperparathyroidism

A
  • Compensatory hypersecretion of PTH

- Osteoclast activity stimulation

40
Q

Secondary Hyperparathyroidism may be caused my

A
  • Prolonged states of hypocalcemia
41
Q

Hyperparathyroidism is associated with

A
  • Microfractures and secondary hemorrhages
  • Brown Tumor
  • Cystic Degeneration
42
Q

Brown tumor

A
  • Vascularity, hemorrhage, and hemosiderin deposition by macrophages
43
Q

Cystic degeneration

A
  • Severe hyperparathyroidism

- Generalized Osteitis Fibrosa Cystica (Von Recklinghausen Disease of Bone )

44
Q

Hyperparathyroididm pathology features

A
  • Increased bone cell Activity
  • Peritrabecular fibrosis
  • Cystic Brown Tumors
45
Q

Morphology of hyperparathyroidism

A
  • Cortical bone = widened haversion canals
  • Cancellous bone = dissecting osteitis
  • Osteopenia
46
Q

Renal osteodystrophy may result from chronic renal diseases such as

A
  • End stage renal disease (ESRD)

- Uremic osteodystrophy

47
Q

Features of renal osteodystrophy

A
  • Increased osteoclastic bone resorption
  • Delayed matrix mineralization (osteomalacia)
  • Osteosclerosis
  • Growth Retardation
  • Osteoporosis
48
Q

Effects of chronic renal failure results in

A
  • Hyperphosphatemia
  • Hyperphosphatemia –> secondary hyperparathyroidism
  • Hypocalcemia develops (damaged kidneys)
  • PTH secretion –> at all levels of serum Ca+2
  • PTH –> Increased osteoclast activity
  • Metabolic Acidosis
49
Q

Effects of Aluminum (Al 3+)

A
  • Interferes with deposition of Ca+2 hydroxyapatite

- Promotes Osteomalacia

50
Q

Magnesium

A
  • Modulates secretion of PTH

- Cofactor for α-1-hydroxylase

Pathology II (7 decks)

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