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Pathology Exam 6 (FINAL :)) > Musculoskeletal System (lecture 1 and 2) > Flashcards

Musculoskeletal System (lecture 1 and 2) Flashcards

1
Q

What is the main mineral in bones?

A

Main mineral–Calcium Hydroxyapatite

  • Bones are mostly inorganic
  • Calcium and phosphorus homeostasis
    – Bones are 65% mineral and 35% organic
    – Contain 99% of body calcium and 85% of phosphorus
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2
Q

What type of cell is primary bone forming?

  • Synthesize and secrete osteoid (bonematrix)
  • Initiate mineralization
A

Osteoblasts

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3
Q

What type of cell are responsible for remodeling and dissolving minearlized bone?

  • Giant cells, derived from macrophages
  • Breakdown bone and remodel it for what is needed
A

Osteoclasts

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4
Q

What is the name for the head of the bone?

  • part closest to growth plate?
  • shaft?
A
  • Epiphysis
  • Metaphysis
  • diaphysis
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5
Q

What is this congenital disease?

  • Hereditary disorder–impaired cartilage maturation in growth plate of long bones
    • problem in physis = growth plate
  • Autosomal dominant; 80% of cases are new mutations
  • Morphology–clustered, disorganized chondrocytes in growth plate
    • arranged in a completely disorganized fashion

 Clinical

  • Major cause of dwarfism
  • Marked shortening of proximal extremities
  • Bowing of legs
  • Lordotic (“sway-backed”) posture
  • Most problems are with proximal extremitites
A

Achondroplasia

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6
Q

What is this congenital disease?

  • Defective synthesis of Type 1 collagen
    • ​type 1 collagen composes most bone
  • Autosomal dominant or recessive
  • Clinical features:
    • Bone fragility; multiple fractures
    • Blue sclerae; abnormal dentition; deafness
    • Wide spectrum of clinical severity, from death in perinatal period to normal life expectancy
A

Osteogenesis Imperfecta

“Brittle Bone Disease”

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7
Q

What is this metabolic/nutritional disease?

  • Any disorder which causes decrease in bone mass
  • Mostly in older females
  • Morphology
    • Thinning and wide spacing of trabeculae of medullary bone
    • X-ray changes–late in course of disease
  • Increased susceptibility to fractures
    • Vertebral compression fractures–decreased height
    • Hip and pelvic fractures–prolonged immobilization
A

Osteoporosis

Risk Factors for Osteoporosis:

  • Hormonal–lack of estrogen in women
  • Decreased peak bone mass
  • Dietary factors
  • Decreased physical activity
  • Genetic factors–vitamin D receptor
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8
Q

What is this metabolic/ nutritional disorder in children?

• Defect in bone mineralization due to Vitamin D deficiency

A

Rickets

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9
Q

What is this metabolic/nutritional disorder in adults?

  • Defect in bone mineralization due to Vitamin D deficiency
A

Osteomalacia

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10
Q

What is this metabolic/nutritional bone disease?

  • Principal direct PTH effect on bone is increase in osteoclast activity
    • Secondary osteoporosis
    • Fibrosis (“osteitis fibrosa cystica)
    • Fractures with hemorrhage and reactive fibrosis
      • more fibrosis and hemorrhage!
        • ”brown tumor”
A

Hyperparathyroid Bone Disease

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11
Q

What hormone?

  • Polypeptide hormone, regulates calcium and phosphorus metabolism
A

Parathyroid Hormone

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12
Q

What is primary hyperthyroidism caused by?

A

parathyroid tumors or hyperplasia

  • something directly affecting the gland so that it oversecretes
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13
Q

What is secondary hyperparathyroidism caused by?

A

chronic renal disease

  • other factors!
  • chronic renal disease leads to low levels of calcium in the blood and this leads to an overactive parathyroid gland!
  • something outside leads to this
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14
Q

What is this metabolic/nutritonal disease where

  • Skeletal manifestations of chronic renal disease
  • Hyperparathyroid effects
    • Increased osteoclast activity
    • Osteoporosis
  • Osteomalacia-like effect
    • Vitamin D converted into active form in kidney
    • Defect in bone mineralization
A

Renal Osteodystrophy

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15
Q

What is this infectious/inflammatory disease?

  • Infection of bone
    • Caused by pyogenic bacteria
      • Staphylococcus aureus--most common
      • Enteric pathogens–Klebsiella, Pseudomonas, E. Coli
      • Hemophilus and Strep in neonatal period
      • Salmonella in sickle cell anemia patients
    • Causative organism unknown in 50% of cases
  • Pathogenesis:
    • Hematogenous spread of infection to bone
    • Direct spread from adjacent soft tissue or joint infection–most common!!!
    • Traumatic (or iatrogenic) implantation
  • Clinical features
    • Pain, fever, malaise, leukocytosis
A

Pyogenic osteomyelitis

  • Osteomyelitis = bone, medullary, inflammation

Diagnosis and treatment:

  • Clinical signs localizing to bone may be subtle
  • X-ray signs may not be present initially
  • Nuclear medicine (bone scan) often helpful
    • Treatment–aggressive, prolonged antibiotic treatment necessary
    • difficult to get antibiotics into bone
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16
Q

What is this infectious/inflammatory bone disease?

  • Caused by Mycobacterium tuberculosis
  • Usually hematogenous spread–complicates 1-3% of pulmonary TB cases
  • Very destructive; difficult to treat
  • Common locations
    • Long bones, especially around knees and hips
    • Vertebrae (Pott’s disease)
A

Tuberculous Osteomyelitis

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17
Q

What is this infectious/inflammatory bone disease?

  • “Osteitis Deformans”-deforming of certain parts of the bone
  • Pathogenesis–three stages
    • Osteolytic stage–increased osteoclast activity
    • Mixed osteoclastic/osteoblastic stage
    • Sclerotic stage–characteristic mosaic pattern
      • bone overgrows
  • Usually asymptomatic–incidental x-ray finding
  • Most common sites–pelvis, hips, vertebrae, skull
    • axial skeleton
  • Symptoms related to bone deformity and inability to adapt to mechanical stresses
    • Headache, visual and hearing loss
    • Back pain; bowing of legs
A

Paget’s Disease

Complications

  • Fractures
  • Osteoarthritis
  • Malignant transformation
    • Osteogenic Sarcoma
    • About 1% percent of cases
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18
Q

What is this bone complication?

  • Bone infarct–ischemic necrosis due to:
    • Fracture
    • Steroid therapy
    • Radiation damage (Osteoradionecrosis)
    • Idiopathic
  • Most common site is head of femur
  • Complications: osteoarthritis, fractures
A

Avascular Necrosis

19
Q
  • Benign–histologically same as normal bone
    • Most common in head and neck–solitary, hard “bump” on surface of bone “Mandible/maxilla”
    • Important only because of cosmetic or mechanical reasons
  • Do not undergo malignant transformation
  • Dont have to remove unless getting in the wya of something else
A

Osteoma (Torus)

  • “bone” “benign”
20
Q

Tumor of young men

– Long bones around knee; less than 2 cm

– Quite painful; distinctive xray appearance due to reactive, sclerotic bone around tumor

A

 Osteoid osteoma

21
Q

Tumor of young men

  • –vertebra; >2cm; dull pain
  • dull annoying back pain
A

Osteoblastoma

22
Q
  • Malignant, bone-forming tumor; tumor cells by definition produce osteoid
  • Large, bulky tumors arising in and destroying bone
  • Metastasis common; most often to lungs
A

Osteosarcoma (Osteogenic Sarcoma)

23
Q

What is this type of osteosarcoma?

  • Arises about knee (or proximal arm) of adolescent
    • ​metaphysis
  • About 70% of all osteosarcomas
  • Enlarging, painful mass or pathologic fracture
  • Painful swelling occuring around knee, shoulder, ect; usually a young individual
  • Very invasive tumors and large and bulky!
  • imaging is extremely important in making this diagnosis
A

Conventional Osteosarcoma

24
Q

What type of osteosarcoma is this?

  • Arises in diseased bone–arises because of some other disease process
    • Radiation therapy
    • Paget’s disease
  • About 20 percent of cases
  • Prognosis worse
    • Sites (pelvis, vertebrae, jaws) harder to resect
      • arise more often in axial skeleton which makes thme worse
    • Pain from underlying disease delays diagnosis
    • More resistant to chemotherapy
A

Secondary Osteosarcoma

25
Q

What are the most common sites of orign for malignant bone tumors?

A

Most common sites

  • Breast
  • Lung
  • Thyroid
  • Kidney
  • Prostate
  • BLT w/ Kosher Pickle
26
Q
  • Benign tumor of mature cartilage
    • hard to tell because just looks like mature cartilage
      • Most commonly in medullary cavity of long bones of hands or feet; 20-50 years
      • Usually solitary–no malignant transformation
  • May be multiple
  • Ollier’s disease; Maffucci’s syndrome
  • Malignant transformation possible, but rare
A

Enchondroma (Chondroma)

27
Q
  • Bony tumor with a cartilaginous cap; may be sessile or pedunculated
    • both bone and cartilage!
  • Arise near growth plate of long bones; young adults
  • Usually solitary; rarely multiple (hereditary exostosis)
  • Malignant transformation rare; only in multiple lesions
    • malignant portion would most likely be the cartilagonous part
A

Osteochondroma (Exostosis)

28
Q
  • Malignant tumor of cartilage
  • Older adults (age 50-70)
  • Most common sites proximal extremities, pelvis, ribs
    • axial skeleton
  • Prognosis related to histologic grade and resectability
  • Aggressive tumors; destroy bone; metastasize to lungs
  • hard to distinguish between benign cartilage
A

Chondrosarcoma

29
Q
  • 20% of all benign bone tumors
    • arises right at the end of long bone
    • so you see a lot of hemorrhage
  • Osteoclast-like giant cells and histiocytes
  • Epiphyses of long bones of young adults
  • Clinical features
    • Present with pain; may simulate arthritis
    • Benign, but often recur locally if not completely resected. Metastasis rare.
    • will slowly grow and take over most of the bone
A

Giant Cell Tumor of Bone

30
Q
  • Malignant bone tumor of children
  • Preferred sites–diaphysis of long bones and pelvis
    • right in the middle
  • Histology–”small round blue cell tumor”
  • Histogenesis uncertain; thought to be of neuroectodermal origin
  • chromosomal translocation
  • Treated by surgery and chemotherapy; 5-year survival now 75 percent
  • neural cells drive this tumor!
A

Ewing’s Sarcoma

aka Primitive Neuroectodermal Tumor (PNET)

31
Q
  •  Benign, tumorlike condition
  • Replacement of bone by combination of fibrous tissue and malformed bone
  • nonneoplastic swelling of the bone
A

Fibrous Dysplasia

32
Q

What is this type of fibrous dysplasia?

  • Adolescence; usually asymptomatic
  • Ribs (most common), long bones of legs, skull, jaws
A

Monostotic Fibrous Dysplasia (70%)

33
Q

What is this type of fibrous dysplasia?

  • Children; craniofacial involvement common
  • May cause deformities and pathologic fractures
A

Polyostotic Fibrous Dysplasia (25%)

34
Q
  • Most common joint disease in U.S.
  • “Degenerative joint disease” is a better name
  • Primary defect is degeneration of articular cartilage
  • Splitting and fissuring of articular cartilage
  • Erosion of articular cartilage
    • Sclerosis and polishing (“eburnation”) of underlying bone
    • Fragments of bone and cartilage (“joint mice”) in synovial cavity
  • Fissuring of underlying bone
    • Bone cysts
  •  Reactive synovial inflammation–late in course
  • Carliagonous cap is eventually just worn away
A

Osteoarthritis

  • Risk Factors
    • Age
    • Mechanical stress (joint deformity, extreme obesity, athletes)
  • Clinical
    • Gradual onset–usually elderly persons unless significant risk factors presen
    • Common joints–knees, hips, vertebra, fingers Symptoms–dull pain, morning stiffness, decreased range of motion
    • Second most common cause of long-term disability in U.S.
    • Treatment–Joint replacement
35
Q
  • Systemic autoimmune disorder primarily affecting joints
  • Morphologic features
    • Chronic, proliferative synovitis
    • Predominantly lymphocytes and plasma cells
    • Pannus formation–fibrous mass of proliferating synovium, eventually filling synovial cavity
    • End stage–ankylosis (obliteration of synovial cavity)
    • *mostly synovial joints
A

Rheumatoid Arthritis

Clinical

  • Diagnosis based mostly on clinical features
  • Morning stiffness
  • Most commonly affects hands and feet
  • Several joints affected

 Radiographic and laboratory findings

36
Q
  • Systemic disease caused by precipitation of excessive concentrations of uric acid in and around synovial space
  • Uric acid metabolism:
    • End product of purine nucleotide metabolism
    • Primary accumulation (90% of cases) due to enzyme deficiency
    • Secondary accumulation :
      • Increased cell turnover (e.g.,leukemia therapy)
      • Decreased excretion (chronic renal disease)
A

Gout

  • Uric acid crystals in synovial fluid
    • Birefringent, needle-shaped crystals
    • in and around joint space
37
Q

Chalky white accumulations of uric acid in joint and surrounding tissues

  • In chronic gout
A

Gouty tophus

38
Q

Precipitation of uric acid in renal tubules

A

Gouty nephropathy

39
Q

– Sudden, very painful onset of swelling and redness

  • pain at an 8 or 9

– Usually one joint– great toe most common

  • isolated joint

– Diagnosis– demonstration of urate crystals in synovial fluid

  • try and get some of the joint fluid out
    • look for uric crystals in fluid
A

 Acute gouty arthritis

40
Q

Result of multiple acute gout attacks

  • more swelling from accumulation of urate acid
A

Chronic Tophaceous Arthritis

41
Q
  • Pyogenic bacterial infection of joint
    • fluid may look a little yellow
  • Fever, malaise, local pain, pus in joint
  • Gonococci, staph, strep most common agents
  • Prompt antibiotic treatment necessary to prevent joint damage
A

Acute suppurative arthritis

42
Q
  • Chronic infectious disease involving primarily skin and joints
  • Most common arthropod-borne disease in U.S.
  • Vector is deer tick (VECTOR born disease)
  • Agent is spirochete, Borrelia burgdorferi
  • first affects other places of body and then comes and affects your joints
A

Lyme Disease

  • Acute stage
    • Redness, induration at site of tick bite
    • Lasts a few weeks
  • Secondary stage
    • Skin lesions distant from tick bite
    • Cardiac symptoms, meningitis
  • Late stage
    • Arthritis in 80%
    • Knees, shoulders, elbows
    • multiple larger synovial joints
43
Q
  • Very common
  • Small (1-2 cm) cyst near joint or tendon sheath
  • Caused by degeneration of fibrous tissue surrounding joint

•Wrist area most common

  • cystic swelling–remove it surgically and pts dont have any new problems
A

Ganglion Cyst

44
Q
  • Most common neoplasm of joint space
  • Benign proliferation of synovial cells forming villous projections of synovium
  • Usually one joint affected; knee in 80%
  • Clinical: pain, stiffness, “locking” of joint
    • Eventually, decreased range of motion
    • occurs within joint space
    • not an inflammatory disease
A

Villonodular Synovitis

Pathology Exam 6 (FINAL :)) (4 decks)

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