Skeletal system

Question 1

Condition with defective connective tissue due to a deficiency of normal Type I collagen which forms bone matrix

Answer 1

Osteogenesis imperfecta

Question 2

Condition with idiopathic avascular osteonecrosis of femoral head leads to interruption of blood supply

Answer 2

Legg-Calve-Perthes syndrome

Question 3

In toddlers with Rickets, this type of deformity is seen

Answer 3

genu varum (bowed legs)

Question 4

In older children with Rickets, this type of deformity is seen

Answer 4

Genu valgum (knock knees)

Question 5

Underlying processes for osteoporosis

Answer 5

malabsorption, hyperthyroidism, hyperparathyroidism

Question 6

Type of spinal curvature associated with osteoporosis

Answer 6

kyphosis

Question 7

Characterized by high bone turnover with accelerated osteoclast and osteoblast activity

Answer 7

Paget’s

Question 8

Osteopetrosis presents at what age?

Answer 8

birth

Question 9

Paget’s disease most commonly presents at what age?

Answer 9

4th decade of life

Question 10

Three route of osteomyelitis

Answer 10

1) hematogenous spread
2) direct implantation (surgery)
3) spread from contiguous soft tissues

Question 11

Solitary bone cysts occur mostly in what type/location of bone?

Answer 11

distal ends of long bones

Question 12

Histologic hallmark is mosaic pattern of lamellar bone

Answer 12

Paget’s

Question 13

Most common Sx of bone cysts

Answer 13

pain and swelling

Question 14

a) bones harden/more dense
b) bones soften
c) bones less dense/brittle
d) infx of bone or marrow
e) benign bone tumor

Answer 14

a) Osteopetrosis
b) Osteomalacia
c) Osteoporosis
d) Osteomyelitis
e) Osteoid osteoma

Question 15

Features of solitary bone cyst seen on XR

Answer 15

Symmetrical, fluid filled, larger bone diam, thin cortex near epiphysis

Question 16

Treatment for solitary bone cyst

Answer 16

curettage and insertion of bone chips

Question 17

Aneurysmal bone cysts occur MC in what location/type of bone?

Answer 17

Metaphysis of long bones and in vertebrae

Question 18

Gross pathology of aneurysmal bone cyst? XR?

Answer 18

Honeycombed, distortion of bone, less symmetry

Question 19

Multiple lesions of _______ are seen in patients with Gardner syndrome

Answer 19

osteoid osteoma

Question 20

Appearance on XR of osteoid osteoma

Answer 20

small, well circumscribed lesion (round or oval) located in or near the cortex and surrounded by densely sclerotic bone.

Question 21

Histo appearance of osteoid osteoma

Answer 21

narrow trabeculae of osteoid or newly formed bone in richly vascularized parenchyma, surrounded by wide trabeculae and sclerotic bone

Question 22

What is the primary malignant tumor of bone (exclusive of myelomas and lymphomas)?
It primarily affects what age group?

Answer 22

osteosarcoma

75% of pts younger than 20 yo

Question 23

In elderly patients, osteosarcoma is most common in those with ______ (condition)

Answer 23

Paget’s

Question 24

Osteosarcomas are
___% lytic
___% sclerotic
___% mixed

Answer 24

25, 35, 40

Question 25

Characterized by sheets of spindle cells

Answer 25

Fibrosarcoma

Question 26

Giant cell tumor causes cortical erosion and thinning, which expands bone contours (with/without) a border of new bone formation and sclerosis?

Answer 26

without

Question 27

Histo of GCT

Answer 27

oval tumor cells and large multinucleated tumor (giant) cells

Question 28

uniform, densely packed, cells with a single, round or oval nucleus, indistinct cellular borders. resemble lymphocytes

Answer 28

Ewing sarcoma

Question 29

XR of Ewing sarcoma shows

Answer 29

moth eaten lesion

Question 30

In multiple myeloma, monoclonal overgrowth of plasma cells produces ____

Answer 30

monoclonal immunoglobulin or paraprotein

Question 31

Common Sx of multiple myeloma

Answer 31

back pain, fractures

Question 32

In adults 75% of skeletal metastasis originate from CA of _____(4)

Answer 32

prostate, breast, kidney, lung

Question 33

In children, boney metastasis MC originate from

Answer 33

neuroblastoma, Wilm's tumor, or bone tumor such as osteosarcoma and Ewing sarcoma

Question 34

Condition associated with rachitic rosary (beading of ribs)

Answer 34

Rickets

Question 35

Rickets can be caused by deficiencies in ___ and ___

Answer 35

Vit D, calcium

Question 36

Common sites of fracture related to osteoporosis

Answer 36

hip, spine, wrist

Question 37

Causes of primary osteoporosis

Answer 37

advanced age, menopause

Question 38

Causes of secondary osteoporosis

Answer 38

other medical conditions, meds, malabsorption, immobilization

Question 39

End result is increased calcification of bone esp in skull, pelvis, tibia, femur

Answer 39

Paget's

Question 40

In Paget's, labs may show increased ____

Answer 40

Alk phos

Question 41

Bone that is mechanically weak, haphazard organization of collagen fibers

Answer 41

woven bone aka mosaic pattern

Question 42

Most fractures due to osteoporosis occur in this location

Answer 42

vertebrae

Question 43

Possible sequelae of Paget's

Answer 43

malignant neoplasms, such as osteosarcoma

Question 44

Imaging of Paget's shows _______.

Answer 44

Cotton ball appearance (sclerotic and lucent areas), widened bone with coarse trabecular markings. may fracture straight line across

Question 45

Most cases of Paget's involve single or multiple bones?

Answer 45

multiple - 85% | single - 15%

Question 46

Osteomyelitis usu affects ___ bones in children and ___ in adults.

Answer 46

Long bones | vertebrae and pelvis

Question 47

Organism MC present with osteomyelitis overall?

Answer 47

overall Staph aureus

Question 48

MC organisms present with osteomyelitis in infants?

Answer 48

Staph aureus, Group B strep, E coli

Question 49

MC organisms present with osteomyelitis in children?

Answer 49

Staph aureus, Strep pyogenes, H flu

Question 50

MC etiology of osteomyelitis in adults?

Answer 50

injury exposing bone to local infx

Question 51

Preferred method to Dx osteomyelitis?

Answer 51

bone biopsy

Question 52

renal osteodystrophy

Answer 52

bone changes in chronic renal dz (osteoclastic bone resorption, osteomalacia, osteosclerosis, osteoporosis)

Question 53

In chronic renal failure, there is interrelationship between what 3 aspects of illness?

Answer 53

inadequate kidney function, hyperparathyroidism, altered vit D metab.

Question 54

What is the gender and age group associated with solitary bone cysts? aneurysmal bone cysts?

Answer 54

solitary - male 1st and 2nd decades | aneurysmal - female 2nd and 3rd decades

Question 55

Gross examination of osteoid osteoma

Answer 55

area of gritty, cherry red tissue surrounded by dense sclerotic bone usu in cortical area

Question 56

MC site for lesion of osteosarcoma? What other condition affects same location?

Answer 56

distal femur or knee | fibrosarcoma affects distal femur and/or proximal tibia

Question 57

Features of XR of osteosarcoma

Answer 57

bone destruction alongside abnormal new bone growth combination of radio-lucent and radio-opaque

Question 58

Can metastasize as "skip" lesions

Answer 58

osteosarcoma

Question 59

Histo of osteosarcoma

Answer 59

atypical cells w large nuclei and scant cytoplasm. osteoid formation

Question 60

Fibrosarcoma tumors produce ______ but not ________.

Answer 60

collagen matrix | but not osteoid or chondroid

Question 61

Histo of fibrosarcoma

Answer 61

sheets of spindle shaped cells

Question 62

XR finding of giant call tumor

Answer 62

well defined destructive radiolucent lesion with nonsclerotic border. oval shaped and centered in epiphysis. enlarging lytic mass

Question 63

Ewing sarcoma affects mainly what age group?

Answer 63

10-20 yo (avg 13-14)

Question 64

MC presenting symptoms of Ewing sarcoma

Answer 64

bone pain, swelling, tenderness, heat, slight fever, elev ESR (non-diagnostic)

Question 65

Multiple myeloma is characterized by _____ lesions on XR

Answer 65

lytic