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Musculoskeletal > Pathology > Flashcards

Pathology Flashcards

1
Q

of bones in body

A

206

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2
Q

Bone composition?

A

Inorganic (65%): calcium hydroxyapatiet (strength & hardness)
Organic (35%): collagen (structure)

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3
Q

Osteoid

A

bone that is not mineralized, takes 12-15 days

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4
Q

Active cell types in bone?

A 
Osteoprogenitor cell 
       -pluripotential mesenchymal stem cell    
       -become osteoblasts under CBFA-1
Osteoblast
Osterclasts
Osteocytes
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5
Q

Osteoblast

A
  • from bone
  • synthesize osteoid (Type I collagen, 90% of organic part)
  • initiate mineralization
  • eventually become surrounded by matrix: osteocytes
  • mediates osteoclast activity; have PTH receptors
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6
Q

Osteoclasts

A

-remodel bone and resorption
-require cytokines from differentiation
IL-1, IL-3, IL-6, IL-11, GM-CSF, M-CSF
-reside in resorption pits: Howship lacunae
-multinucleated

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7
Q

Osteocytes

A
  • sense mechanical stress
  • regulate serum calcium & phosphorous
  • encased in bone
  • communicate through canaliculi: contain osteocytic cell processes
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8
Q

Enchondral Bone Formation

A
  • mesenchyme becomes cartilage anlage

- cartilage becomes bone

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9
Q

growth plate

A

cartilage between ossification center

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10
Q

anlage

A

cartilaginous model of the future bone

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11
Q

Diaphysis

A

central portion of long bone

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12
Q

Metaphysis

A

between diaphysis and epiphysis

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13
Q

Epiphysis

A

end of long bones

contains growth plate

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14
Q

Osteogenesis Imperfecta

A

“brittle bone disease”

  • common mutations in type I collagen genes
  • most are autosomal dominant
  • most cases, the teeth are deformed
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15
Q

Blue Sclerae

A
  • characteristic with heritable disorders of connective tissue
  • problems with Type I collagen
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16
Q

Achondroplasia

A
  • reduction in chondrocytes at growth plate
  • most common cause of inherited dwarfism, autosomal dominant
  • short extremities, normal trunk, large head, normal mentation
  • higher level of intelligence than normal population
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17
Q

Osteopetrosis

A
  • “marble bone disease,” stone-like bones
  • osteoclast dysfunction; one variant associated with carbonic anhydrease II deficiency
  • bones lack a medullary canal; no trabeculaeor marrow; woven bone leads to fractures
  • ends of bones are misshapen and bulbous
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18
Q

Osteoporosis

A
  • systemic skeletal disease
  • low bone mass
  • microarchitectural deterioration of bone tissue leading to enhanced bone fragility and consequent increase in fracture risk
  • “porous bone” low hip bone mass & deterioration of bone tissue
  • increase risk of fracture-wrist, hip, spine
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19
Q

Risk factors of Osteoporosis

A
  • age>70
  • menopause < 45
  • hypogonadism
  • fragility fracture
  • hip fracture
  • glucocorticoids
  • malabsorption
  • high bone turnover
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20
Q

Paget Disease of Bone

A
  • unbalanced/excessive osteoclast & osteoblast function, increased bone turnover
  • osteolytic, mixed osteolytic-soteoblastic, osteoblastic & burnt-out stages
  • paramyxocirus and measles virus etiology mostly discredited
  • mosaic pattern or lamellar bone; skull & long bone; deforms bones
  • painful, mid-adulthood, Northern Europeans
  • predisposed to osteogenic sarcoma, chondrosarcoma, & malignant fibrous histiocytoma
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21
Q

Paget Disease of Bone

Clinical Points

A 
Thick skull
Deafness
Kyphosis
Pain
Bowed legs
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22
Q

Osteomalacia/Rickets

A

“soft bones”
-failure of the bone to mineralize properly in adult
-inadequate intake of Vit D/calcium
childhood-rickets
adults-osteomalacia (bone pain/fractures)
-surfaces of bone trabaculae are covered by a thicker than normal layer of osteoid
-von Kossa stain: calcified tissue is black

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23
Q

Renal Osteodystrophy

A
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24
Q

Hyperparathroidism

A

Primary: adenoma
Secondary: prolonged hypocalcemia w/compensatory hypersecretion
-results in unabated PTH secretion
-detected by osteoblasts
-results in release of mediators that stimulate osteoclasts & bone reabsorption
-cortical bone reabsorption>cancellous bone
-dissecting osteitis

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25
Q

Bone Tumors Information

A

1) age/sex of patient
2) location of lesion
3) radiographic appearance of lesion

26
Q

Primary Bone Tumors in Long Tubular Bones

A

Malignant Tumors: diaphysis-Ewing’s sarcoma and chondrosarcoma, fibrous dysplasia

metaphysis: osteosarcoma and juxtacortical osteosarcomas
benign: osteoblastoma, osteochondroma, non-ossifying fibroma, osteoid osteoma, chondromyxoid fibroma, giant cell tumors

27
Q

Fibrous Dysplasia

A

Benign, localized developmental arrest
-all components of bone present, do not mature
3 patterns:
-monostotic: single bone involved
-polystotic: multiple bones involved
-McCune Albright syndrome: polyostotic, cafe-au-lait skin pigmentation, endocrinopathies
Polyostotic disease: may transform to soteosarcoma

28
Q

Fibrous Dysplasia X-ray

A

lucent ground-glass appearance with well demarcated borders

“mothy”

29
Q

Fibrous Dysplasia Histology

A

loose whorled pattern of fibroblastic tissue with irregular spicules of woven bone

  • may contain small islands of cartilage
  • can undergo cystic degeneration
30
Q

Fibrous Cortical Defect

A

30-50% of all children > 2y/o

  • developmental defect
  • metaphysics of femur and proximal tibia
  • 1/2 bilateral/multiple
  • if > 5-6cm: nonossifying fibroma
  • usually undergo spontaneous resolution
31
Q

Fibrous Cortical Defect X-ray

A
  • scooped out with borders which are scalloped and sclerotic
  • denser than bone that surrounds them
32
Q

Fibrous Cortical Defect Features

A

-

33
Q

Fibrous Cortical Defect Pathology

A

-

34
Q

Nonossifying Fibroma

A
  • large fibrous cortical defect
  • sclerotic margin on x-ray
  • microscope: “woven mat” or storiform pattern
35
Q

Solitary Bone Cyst

A
  • benign, fluid filled cyst

- thin, lytic bone lesion

36
Q

Aneurysmal Bone Cyst

A
  • bloody, cystic lesions
  • “sponge filled with blood”
  • can contribute to pathologic fracture
37
Q

Aneurysmal Bone Cyst Features

A
  • not true tumor
  • arise from surface of bone
  • children/young adults
38
Q

Benign Primary Bone Neoplasms

A
  • greatest frequency 1st 3 decades of life
  • usually removed only if pain
  • usually found on x-ray
  • osteoma, osteoid osteoma, osteochrondroma/chondroma, fibroma, giant cell tumor
  • rarely malignant except chrondromas
39
Q

Osteoma

A

Bone-forming tumor

  • round that project from sub- or endosteal surfaces of cortex
  • usually solitary, multiple is Gardner’s syndrome
  • slow growing; usually of little clinical sig unless obstruction
40
Q

Osteoid Osteoma

A

< 2cm in size

41
Q

Osteochondroma

A

“exostosis”

  • benign, cartilage capped tumor
  • attached to underlying skeleton by underlying stalk
  • displacement of growth plate in endochrondral bones
  • multiple hereditary exostosis AD, rare rise to chondrosarcomas
42
Q

Chondroma

A
  • benign tumor of hyaline cartilage
  • Enchondromas: arise in medullary cavity, hands/feet
  • juxtacortical: on surface of bone
43
Q

Enchondromas

A
  • usually solitary
  • metaphyses of tubular bones: hands and feet
  • multiple enchondromas/enchondramatosis
    • Ollier disease-nonhereditary
    • Maffucci syndrome
44
Q

Enchondromas: X-ray

A
  • radiolucent nodules of hyaline cartilage

- scalloped endosteal surface

45
Q

Giant Cell Tumor of Bone

A

Multinucleated osteoclast type giant cells

46
Q

Malignant Bone Tumors

A

rare <1% of all mag tumors

-50% derived from blood forming cells and connective tissue cells

47
Q

Osteosarcoma

A

“osteogenic sarcoma”
-20% of primary bone cancers, most COMMON primary bone tumor
-75% < 20y/o; smaller peak in elderly - Paget irradiation
-Knee, metaphysis
Retinoblastoma; Rb; MDM2
-painful, progressively enlarging, fracture

48
Q

Osteosarcoma Location

A

knee>hip>shoulder>jaw

49
Q

Osteosarcoma X-ray

A

CODMAN TRIANGLE

-periosteal elevation

50
Q

Chondrosarcoma Location

A

axial skeleton: trunk, pelvis, vertebrae, ribs

  • rarely in distal extremities
  • diaphysis or metaphysis
51
Q

Chondrosarcoma

A

Age 35-60
2nd most common primary malignant bone tumor
Surgery, insensitive to chemo
-may arise in association w/preexisting enchondroma

52
Q

Ewing Sarcoma

A
  • small round blue cell tumor
  • age 10 to 15, whites
  • 85% related to PNET
  • arise in medulla
  • diaphysis of long bones
  • onion skin; layers reactive periosteum
  • 75% 5y survivial with surgery & chemo
53
Q

Metastatic Bone Tumors

A

-most common tumor in bone
>75% from prostate, breast, lung, kidney
Children: neuroblastoma, Wilms’ tumor, osteosarcoma, Ewing sarcoma (extraosseous) and rhabdomyosarcoma
-Usually multifocal:vertebrae, pelvis, ribs, skull, sternum

54
Q

Metastatic Lytic from?

A

Multiple Myeloma

55
Q

Metastatic Blastic from?

A

Prostate Cancer

56
Q

Lipomas/Liposarcoma

A

fatty tumors

57
Q

Dermatofibroma

A
  • “fibrous histiocytoma”
  • due to non-cancerous growth of dermal dendritic histiocytic cells
  • can arise from minor injury
58
Q

Rhabdomyosarcoma

A
  • tumor made up of cancerous muscle cells called rhabdomyoblasts
  • 350 cases/year in children < 15y/o
  • almost 2/3 develop in children <10
  • may arise in any muscle in the body
59
Q

Rhabdomyosarcoma Location

A
  • adj to base of skull
  • around eye
  • nose/throat
  • arms/legs
  • urinary system/GU
60
Q

Rhabdomyosarcoma Microscope

A
  • bizarre cells

- elongated “strap” cells

61
Q

Leiomyoma

A

-uterine leiomyoma with regressive change, wall of uterus is smooth muscle - most common location
-unknown etiology
-cells are clonal & estrogen sensitive
-affect 25-40% reproductive organs
-regress after metapause
-

62
Q

Leiomyosarcoma

A

-arise anywhere

Musculoskeletal (19 decks)

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