Primary Bone Tumors

Question 1

What are the s/sx of hyperparathyroidism?

Answer 1

• Bones
• Stones
• Abdominal Groans
• Psychiatric overtones

Question 2

What is the effect of PTH on ca resorption in the renal tubules?

Answer 2

Increases Ca resorption, and increases phosphate secretion

Question 3

What is the effect of PTH on Vit D?

Answer 3

Increased synthesis of active form

Question 4

What happens to Serum Ca and phosphate levels with PTH excess?

Answer 4

Increased

Question 5

What is the most common cause of excess PTH?

Answer 5

Primary hyperparathyroidism

Question 6

What is the tunneling reabsorption seen in Hyper PTH?

Answer 6

Lines on x-ray r/t osteoclast resorption 2/2 PTH

Question 7

What are the brown tumors seen in hyperparathyroidism?

Answer 7

Collection of fibrous tissue, giant cells, and hemosiderin in bones that appear as areas of hypo-lucency on x-ray

Question 8

What is renal osteodystrophy?

Answer 8

Chronic renal failure causes decrease in 1,24 (OH) D3 deficiency and associated secondary increase in PTH

Question 9

What causes the osteomalacia with dialysis and renal osteodystrophy?

Answer 9

Metabolic acidosis, and increased PTH

Question 10

What are the complications from renal osteodystrophy?

Answer 10

Osteitis fibrosa cystica

Osteomalacia

Question 11

what is the pathophysiology behind Paget’s disease of the bone?

Answer 11

1. Aggressive osteoclast-mediated bone resorption and

2. Imperfect osteoblast mediated bone repair

Question 12

What is the progression of the pathophysiology of paget’s disease of the bone?

Answer 12

First aggressive osteoclast resorption is more prominent, then imperfect osteoblast rapri becomes the larger factor

Question 13

What is the supposed infectious etiology of Paget’s disease?

Answer 13

Paramyxovirus increases expression of RANK receptor

Question 14

What are the three major stages of Paget’s disease of the bone?

Answer 14

1. Osteolysis
2. Osteoblastic
3. Osteosclerosis

Question 15

Pt complaining of hat size changes = ?

Answer 15

Paget’s disease of the bone

Question 16

What are the histological findings of Paget’s disease of the bone?

Answer 16

• Sclerosis of the bone with wide trabeculae

- Large amounts of osteoid

Question 17

What happens to the osteoclasts with Paget’s disease of the bone?

Answer 17

Increased size

Question 18

What is the definition of scurvy?

Answer 18

Defective osteoid synthesis and collagen support of the blood vessels

Question 19

What are the characteristic hair findings of scurvy?

Answer 19

Corkscrew hairs and petechiae

Question 20

Where does hydroxylation of proline take place within a cell?

Answer 20

rER

Question 21

What are some major complications of scurvy?

Answer 21

Subperiosteal hemorrhages

Question 22

What, generally, is avascular necrosis?

Answer 22

Infarction of bone and marrow 2/2 ischemia

Question 23

What are the common mechanisms that lead to avascular necrosis? (4)

Answer 23

• Fracture (mechanical vascular interruption)
• Corticosteroids
• Idiopathic
• Sickle cell disease

Question 24

What are the gross characteristics of AVN?

Answer 24

Wedge shaped infarct in the bone, with separation of the subchondral area from the periosteum

Question 25

Why is the femoral head particularly susceptible to avascular necrosis?

Answer 25

Hip fracture can shear off blood supply

Question 26

What is the blood vessel that supplies the head of the femur?

Answer 26

Branch of the obturator artery

Question 27

What are the two blood vessels that supply the neck of the femoral head?

Answer 27

Medial and lateral circumflex arteries

Question 28

What is the first thing to happen when a bone is fractured?

Answer 28

Organization of a hematoma into a procallus

Question 29

What happens with a fractures after a procallus has formed?

Answer 29

Conversion of the procallus to fibrocartilaginous callus caused by deposition of woven bone

Question 30

What happens with a fracture after a fibrocartilaginous callus has formed

Answer 30

Replacement of the mesenchymal cells by osseous callus, with bone remodeling along stress lines

Question 31

What is the order of calluses that occurs with fractures? (3)

Answer 31

Procallus Fibrocartilaginous callus Osseous callus

Question 32

How much more common are fractures relative to primary bone tumors?

Answer 32

3000-4000x

Question 33

What are greenstick fractures?

Answer 33

Incomplete fractures with closed skin, with bowing on the opposite side

Question 34

What are stress fractures?

Answer 34

Fractures that develop slowly over time following a new repetitive stress

Question 35

What are pathological fractures?

Answer 35

Diseased bone--non-traumatic

Question 36

What is a compound fracture?

Answer 36

fracture where a part of the bone breaks through the skin

Question 37

What is the enzyme that is defective with Gaucher's disease?

Answer 37

Defect in glucocerebrosidase

Question 38

What is happening in the 0-3 day timeframe of fracture healing?

Answer 38

Hemorrhage, inflammatory infiltrate, and granulation tissue

Question 39

What is happening in the 3-7 day timeframe in fracture healing?

Answer 39

Chronic inflammation with granulation tissue and osteoclastic activity

Question 40

What is happening in the 7-35 day time frame of fracture healing?

Answer 40

Progressive increase in cartilage woven bone and cartilage formation

Question 41

What is happening in the 35+ day time frame of fracture healing?

Answer 41

Secondary callus, and replacement of woven bone by lamellar bone

Question 42

What are the five major impediments to fracture healing?

Answer 42

- infection - non-union - Poor circulation - Drugs

Question 43

What is osteomyelitis?

Answer 43

Inflammation of the bone and marrow caused by infection

Question 44

What are the bacteria that commonly cause osteomyelitis in sickle cell patients?

Answer 44

Salmonella

Question 45

What are the three major routes of spread for osteomyelitis?

Answer 45

- Hematogenous - Direct extension - Open fracture or surgery

Question 46

What is the most common bacterial cause of osteomyelitis in general?

Answer 46

Staph aureus

Question 47

What usually follows initial osteonecrosis with osteomyelitis?

Answer 47

Subperiosteal pyogenic abscesses

Question 48

What is the sequestrum with chronic osteomyelitis?

Answer 48

Residual necrotic bone

Question 49

What is the involucrum with chronic osteomyelitis?

Answer 49

Rim of reactive bone around sequestrum

Question 50

What is a brodie abscess?

Answer 50

Walled off abscess in bone by sclerotic bone

Question 51

True or false: viable organisms may persist in brodie abscesses

Answer 51

True

Question 52

What are some complications of chronic osteomyelitis?

Answer 52

Draining sinuses to the skin, which may serves as a nidus for sepsis or cancer

Question 53

What cancer do patients with chronic osteomyelitis have an increased risk for?

Answer 53

Osteosarcoma

Question 54

What usually causes tuberculosis osteomyelitis?

Answer 54

Hematogenous spread, but can be direct extension

Question 55

What bones in particular are affected with tuberculous osteomyelitis?

Answer 55

Vertebrae and long bones

Question 56

What is Pott's disease?

Answer 56

TB of the vertebral bodies, producing a gibbus deformity (loss of vertebral body encroaches on spinal cord)

Question 57

Why is there a resurgence of tuberculous osteomyelitis in developed countries?

Answer 57

Immigration and immunosuppressed people

Question 58

What is the general progression of tuberculous osteomyelitis?

Answer 58

Starts in the synovium, then progresses to the epiphysis and through the medullary cavity