Systems Pathology I Material Flashcards
What is the general term for a developmental anomaly of bone?
dysostosis
what causes dysostosis?
Abnormal mesenchymal migration during embryogenesis
what is the result of dysostosis?
Defective ossification of fetal cartilage
What is Klippel-Feil Syndrome?
Congenital fusion of any 2 cervical vertebrae
What is the most common congenital malformation?
Syndactyly
What condition represents malformation and dysostosis of the scapula?
Sprengel’s Deformity
What term is used to describe absent or incomplete development of tissue?
aplasia
What is dysplasia?
When mutations interfere with growth or homeostasis (dwarfism)
Multiple fractures, extremity bowing, scoliosis, ligamentous laxity (dislocations), and hearing loss are associated with what musculoskeletal congenital disorder?
Osteogenesis imperfecta
The zebra stripe sign is associated with what musculoskeletal congenital disorder?
Osteogenesis imperfecta
Is achondroplasia usually sporadic or inherited?
sporadic (75%)
What musculoskeletal congenital condition is accompanied by short proximal extremities, lower extremity bowing, frontal bossing, and mid face hypoplasia (low nasal bridge)?
Achondroplasia
What percentage of achondroplasia diagnoses are inherited?
25%
What type of dwarfism is primarily endocrine oriented and is more rare than achondroplasia?
Hypopituitary dwarfism
Spinal issues including hyperlordosis and hyperkyphosis at birth, bullet vertebrae, scoliosis, and spinal stenosis are common among which musculoskeletal genetic disorder?
achondroplasia
What two specific types of spinal stenosis are common among achondroplasia patients?
Foramen magnum stenosis and spinal canal stenosis
What is another name for osteogenesis imperfecta?
brittle bone disease
What type of dwarfism is completely fatal?
Thanatophoric dwarfism
Extremely small thorax with shortened long bones leading to perinatal respiratory failure occurs with which musculoskeletal congenital disorder?
Thanatophoric dwarfism
What rare genetic disorder is a result of decreased osteoclast-mediated bone resorption?
Osteopetrosis
Why is deranged hematopoiesis common with osteopetrosis?
The medullary cavity fills with extra bone due to the decreased osteoclast activity
Why does hepatosplenomegaly occur with osteopetrosis?
The liver and spleen attempt to take over the function of the bone marrow that has been compressed and therefore hypertrophy
Erlenmeyer flask deformity is present among which musculoskeletal disorder?
osteopetrosis
What is the most important form of osteopenia?
osteoporosis
What is usually the cause of localized osteoporosis?
disuse/immobilization
What is the most common type of osteoporosis?
primary
When does primary osteoporosis occur?
post-menopausal/ senile
Neoplasia, hyperparathyroidism, nutrient deficiency, and drug exposure are causes of what which type of osteoporosis?
secondary
What is mutated in osteogenesis imperfecta?
Type 1 collagen (alpha 1 or alpha 2 chains)
Osteoporosis is more likely to affect what kind of bone?
Trabecular (cancellous/spongy) bone
What are specific common locations of fractures as a result of osteoporosis due to these areas possessing increased amounts of trabecular bone?
Vertebral bodies, femoral neck, calcaneus
What type of bone cell is less impacted by aging and therefore retains normal activity?
osteoclasts
How is type I collagen affected by osteogenesis imperfecta?
Premature breakdown of collagen
Beginning in mid-20s, bone loss occurs at what rate?
.5% per year
What percentage of postmenopausal women experience an osteoporosis related fracture?
50%
Osteogenesis imperfecta follows what type of genetic pattern?
Autosomal dominant
What percentage of males (of the same age as postmenopausal women) experience an osteoporosis related fracture?
3%
Reduction in what hormone accelerates bone loss as seen in postmenopausal women with osteoporosis?
estrogens
What is the age of maximum bone density?
mid-adulthood, 25
How can osteoporosis be prevented?
diet and exercise
Calcium and vitamin D deficiency are most common among what gender?
females
Osteoporosis is usually asymptomatic, true or false?
true
What is the appropriate way of determining osteoporosis?
DEXA scan
What are the specific areas affected by osteogenesis imperfecta?
Eyes, inner ear bones, skin, joints, teeth
What are the two extreme issues with type II osteogenesis imperfecta?
Cerebral hemorrhage and respiratory failure
What is the unique effect of osteogenesis imperfecta on the eye?
Abnormal collagen of the sclera (choroid) giving a bluish appearance instead of white
With what type of osteogenesis imperfecta does abnormal collagen of the sclera occur?
type 1
What is the treatment used for children with osteogenesis imperfecta?
Bisphosphonates
What is the most common form of dwarfism?
achondroplasia
What are the results of achondroplasia?
Decreased cartilage synthesis and decreased growth plate expansion
What location is specifically affected by the decreased cartilage synthesis with achondroplasia?
growth plate
What is the genetic mutation with achondroplasia?
Fibroblast growth factor receptor (FGFR3) mutation
What is the genetic pattern of achondroplasia?
autosomal dominant
What is usually the death of those with achondroplasia?
brain stem compression
What is trident hand that is associated with achondroplasia?
Underdevelopment of the bones in the hands
What type of bone cell is inhibited in osteopetrosis & what is the result of that?
Osteoclasts; osteoblasts therefore overwork and build up extreme bone density leading to increased fractures
Why are cranial nerve palsies associated with osteopetrosis?
Foraminal stenosis occurs narrowing the bony canals for the nerves
What is the treatment for osteopetrosis?
stem cell replacement
Enlargement of what organ is a cause of secondary osteoporosis?
parathyroid
What types of drugs can be a cause of secondary osteoporosis?
Alcohol, smoking, long term corticosteroids
How is the cortex of the bone affected by osteoporosis?
Thinned (not completely destroyed)
What type of osteogenesis imperfecta results in a normal lifespan nonetheless?
type 1
What is the exaggerated forward hunching of those with osteoporosis called that is due to multiple compression fractures?
Dowager’s hump
What type of bone cells is affected by the aging cause of osteoporosis?
Osteoblasts (decreased synthesis)
What is another feature important to consider with the aging cause of osteoporosis besides the reduction in osteoblast synthesis?
general sedentary lifestyle
What is the main location affected by osteogenesis imperfecta?
Extracellular matrix (ECM)
What is the result with brain stem compression with achondroplasia?
Cardiovascular abnormalities (may be lethal)
What are some issues that occur when the medullary cavity fills with excess bone in osteopetrosis?
Hepatosplenomegaly, recurrent infections, anemia
Which type of osteogenesis imperfecta is lethal in utero?
type 2
Why is cerebral hemorrhage common with type II osteogenesis imperfecta?
weak skull
At what point does osteopenia become the severe form of osteoporosis?
T score of 2.5 standard deviation (threshold from the norm)
Activity of what substances are decreased in senile osteoporosis?
growth factors and osteoblasts
What are some concerns following surgery for a femoral neck (hip) fracture?
Pneumonia, deep vein thrombosis, pulmonary embolism (result of disablement)
What is osteopenia?
reduced bone mineralization
What is a positive note on the current findings of Paget’s Disease diagnoses?
its becoming less common and less severe
What is ivory vertebra sign?
Increased density of one specific vertebral level
What named conditions result from vitamin D deficiency?
Rickets (in children) or osteomalacia (in adults)
What is the name of the perpendicular fractures seen on X-ray with Paget’s Disease?
chalk stick fractures
What is secreted from the parathyroid glands?
Parathyroid hormone (PTH)
In what condition can a “brown tumor” result?
Hyperparathyroidism
What is a “brown tumor”?
Collection of loose connective tissue filling a space, giving off a bloody appearance (not actually a tumor but a lesion)
Renal stones, peptic ulcers, bowing of long bones, and pathological fractures are present with what condition?
hyperparathyroidism
The salt & pepper skull is indicative of what condition?
hyperparathyroidism
Is hyperparathyroidism possibly reversible?
Yes, with normalization of PTH levels
Most cases of Paget’s Disease are asymptomatic: true or false?
true, up to 90%
The appearance of Paget’s Disease of the pelvis on X-ray is what?
fuzzy/shaggy looking
What is the appearance of the bone cells with Paget’s Disease?
Mosaic, jigsaw puzzle appearance
What population is more like to develop Paget’s Disease?
caucasians
What is the older term for Paget’s Disease?
Osteitis Deformans
Why are there increased levels of serum alkaline phosphatase in those with Paget’s Disease?
It is a byproduct of osteoblast activity
When ivory vertebra sign is present, what are likely causes?
Paget’s Disease, metastatic cancer (usually from prostate cancer), lymphoma
If a patient comes in saying they’ve noticed their hats don’t quite fit anymore, it could be indicative of what condition?
Paget’s Disease
What is the average age of diagnosis of Paget’s Disease?
70 years old
What gender is at a greater risk for Paget’s Disease?
males (2X)
What is the treatment for Paget’s Disease?
Bisphosphonates
What is the intention with treating Paget’s Disease with bisphosphonates?
Slowing of the osteolytic (first) phase
What are ways vitamin D deficiency can occur?
Malnutrition, deficient UV Rays, abnormal metabolism
Osteomalacia is similar to what condition?
osteoporosis
What is the main function of the parathyroid glands?
Maintains serum calcium (in blood)
What type of hyperparathyroidism involves autonomous PTH production?
primary
What is the most common cause of excessive PTH?
From an adenoma (80%)
Excessive PTH has what kind of effect on bone cells?
Increased osteoclast activity
What is absorbed more heavily from renal tubules in a state of excessive amounts of PTH?
vitamin D and calcium
What can result from secondary hyperparathyroidism?
Mild renal failure
How is hyperparathyroidism diagnosed?
Hypercalcemia, parathyroid immunoassay
What is the most common nonmalignant cause of hypercalcemia?
Hyperparathyroidism
In which group is hyperparathyroidism most common?
Post menopausal women
Hyperparathyroidism results in resorption of what type of bone?
BOTH cortical and trabecular bone
When cortical and trabecular bone are resorbed in hyperparathyroidism, what replaces that bone?
Loose connective tissue
What is a condition that produces holes in the skull that can appear similar to the salt and pepper skull seen on X-rays of those with hyperparathyroidism?
multiple myeloma
Rugger-jersey spine is seen on X-rays of those with what condition?
Hyperparathyroidism
Bone pain, fractures, deformation, kidney stones, nausea, anorexia, fatigue, and decreased cognition are features of what condition?
hyperparathyroidism
Subperiosteal resorption of the radial side of the middle phalanges is unique to what condition?
hyperparathyroidism
What are the three phases of Paget’s Disease?
Osteolytic phase, mixed osteolytic and osteoblastic phase, osteosclerotic phase
What are the general symptoms of Paget’s Disease when they’re present?
Bone pain, multiple fractures, nerve compression
In what percentage of cases is hyperparathyroidism asymptomatic?
> 50%
What is the most common joint disorder?
Osteoarthritis
What is affected with osteoarthritis?
Degeneration of articular cartilage occurs (collagen)
What substance is decreased in OA and what is the result of that reduction?
Decreased proteoglycans leading to matrix breakdown
Is OA largely inflammatory?
not necessarily
What causes OA?
Both mechanical wear and tear from aging along with a genetic influence
Which type of OA occurs without trauma and is common among adults?
primary
Which type of OA is insidious in onset and is oligocarticular in nature?
primary
Which type of OA is associated with trauma or obesity, deformity, or a systemic disease?
secondary
Which type of OA involves a predisposing injury or deformity?
secondary
What are the common specific locations for OA?
Spine (cervical, lumbar), DIP joints, 1st metacarpal joint, 1st tarsal metatarsal joint
What is the most common location for OA in females?
knees and hands
What is the most common location for OA in males?
hips
What occurs to the intervertebral discs and is seen on X-ray during OA?
Dehydration of discs
When can inflammation in OA develop?
After full blown degeneration
What are the functions of articular cartilage?
Decrease friction and shock allow load absorption
OA disrupts the function of what cells?
chondrocytes
What are risks for OA?
Mechanical stress, age 50s-60s, genetics, increased bone density, increased circulating estrogen
Insidious onset, deep/achy pain, crepitus, decreased range of motion, and worse pain the morning are all associated with what joint condition?
OA
What affect can osteophytes in OA have on nerves?
possible impingement on nerve rootlets
What is the treatment for OA?
Palliative: ice, heat, NSAIDs, adjust, joint replacement
What is ankylosis?
Abnormal fusion of joints
Is ankylosis present in OA?
no
Is ankylosis present in rheumatoid arthritis?
yes
OA is more common among which gender?
females
What is the name for the enlargement of the DIP joints?
Heberden’s nodes
What is the name for the visual enlargement of the PIP joints?
Bouchard’s nodes
Which joint disease is a systemic, chronic autoimmune disease?
RA
RA results in what effect on the joints?
Increased collagenase and osteoclast activity
The biomarker, HLA-DRB1, is a risk factor for what joint issue?
RA
What two things are commonly tested for when checking for RA?
Anti-CCP antibodies and rheumatoid factor (RF)
In 70% of cases, RA patients test positive for what?
anti-CCP antibodies
What is another cause of testing positive for anti-CCP antibodies?
inflammation due to smoking or infection
80% of people, with RA will test positive for what test?
rheumatoid factor (RF)
What are the most common specific locations for RA?
MCP and PIP joints (Bouchard’s nodes)
What is the name for the visual swelling in the fingers seen with RA?
Fusiform swelling
What is significant about the patients with RA and their C1/C2 region?
30% demonstrate atlanto-axial instability
Pannus is associated with what joint condition?
RA
Swan neck deformity and ulnar deviation are associated with what joint condition?
RA
Which joint condition has relatively symmetric defects?
RA
What is a condition that is similar to RA but shows up negative for RF and positive for HLA-B27 (seronegative)?
Seronegative spondyloarthropathies
What is the unique location for the inflammation seen with seronegative spondyloarthropathies?
Sacroiliitis, spinal ligaments (syndesmophytes)
What are the categories of seronegative arthropathies?
Psoriatic arthritis (psoriasis), enteropathic arthritis (IBD), ankylosing spondylitis, reactive arthritis
What is the most common diagnosis when a negative test for RF is seen?
Juvenile rheumatoid arthritis
What gender is more likely to develop juvenile rheumatoid arthritis?
females
What is the most common age for juvenile rheumatoid arthritis to be causing pain?
1-6
What is Still’s disease?
Spiking fever, rash, pericarditis
In what location does inflammation typically occur with juvenile rheumatoid arthritis?
Large joints like the knee and hip leading to dysfunction
What is the other name for ankylosing spondylitis (AS)?
Marie-Strumpell disease
What part of the skeleton is affected by ankylosing spondylitis?
Axial skeleton
Where do you see referred pain with ankylosing spondylitis?
gluteal region
What is the actual pain in ankylosing spondylitis?
Sacro iliac joint
Bamboo spine is associated with what joint condition?
Ankylosing spondylitis
What is the typical onset age for ankylosing spondylitis?
before age 40
Characteristic morning stiffness after thirty minutes of being awake is associated with what joint condition?
Ankylosing spondylitis
Nocturnal low back pain that is unrelieved when lying down is associated with what joint condition?
Ankylosing spondylitis
95% of ankylosing spondylitis cases test positive for what test?
HLA-B27
Where is a secondary location for ankylosis in patients with ankylosing spondylitis?
rib joints
Syndesmophytes are indicative of what general joint condition?
Seronegative spondyloarthropathies
Trolley track sign and dagger sign on X-ray is indicative of what condition?
Ankylosing spondylitis
What are the effects of ankylosing spondylitis?
Decreased flexion and lordosis leaded to a hunched appearance
What condition is an abnormal purine metabolism leading to uric acid accumulation?
gout
Red meat and alcohol can be risk factors for what condition due to purine emphasis?
gout
When uric acid accumulates in gout, what do they become?
Monosodium urate crystals (tophus/tophi)
What occurs with gout?
Recurrent acute joint inflammation leading to destruction and fibrosis
Over 90% of the cases of gout is what kind?
Primary - hyperuricemia
What is the hypothesized cause of primary gout?
enzyme defects
With primary gout, what accumulates in the blood?
uric acid
What is secondary gout?
Gout that is secondary to another disease or from drug exposure
What are examples of some causes of secondary gout?
Renal disease leukemia, multiple myeloma, diuretics
What is the cause of the inflammation of gout?
failed crystal phagocytosis
What is the usual age of those with gout?
over 30
Gout usually occurs among which gender?
males
What is the most common location for gout inflammation?
Hallux (MTP) aka podagra
About what percent of the population is affected by gout?
1%
The historical name, “Kings Disease”, is associated with what condition?
gout
Monoarticular inflammation is characteristic of what condition?
gout
What is the first stage of gout?
Asymptomatic hyperuricemia
What is the second stage of gout?
Acute gouty arthritis causing erythema
What is the third stage of gout?
Repeated chronic tophaceous arthritis that fails to resolve itself between cycles
20% of those with gout die from what issue?
renal failure
What are other names for pseudogout?
Chondrocalcinosis or Calcium Pyrophosphate Deposition Disease (CPDD)
What causes pseudogout?
Altered pyrophosphate metabolism
Are most cases of pseudogout inherited?
no most commonly sporadic
What is the usual location for pyrophosphate crystal deposition of pseudogout?
Knee, wrist, shoulder, hip, elbow, ankle
Only about how many cases of pseudogout lead to destruction of joints from inflammation?
50%
After what age is pseudogout seen among half of the population?
over the age of 85
What is the usual onset age for pseudogout?
over 50
What is the treatment for pseudogout?
Palliative medicine (NSAIDs or corticosteroids)
What specific location in the wrist is common for pseudogout to occur?
Triangular fibrocartilage complex
What is hydroxyapatite deposition disease usually called?
calcific tendonitis
What is the sign of calcific tendinitis on X-ray?
Soft tissue opacities from ossification
What is the most common location for calcific tendinitis?
rotator cuff muscles
What is the age of onset for calcific tendinitis?
40-70
What is the most common muscle affected by calcific tendinitis?
supraspinatus
Adhesive capsulitis (frozen shoulder) and increased age are risk factors for what condition?
calcific tendonitis
What is the other name for diffuse idiopathic skeletal hyperostosis?
Forestier disease
What ligament is affected in the cervical and thoracic spine in DISH?
anterior longitudinal ligament (ALL)
What is the usual spinal location for DISH?
T7-T11
What is the most common age for DISH?
50-70
What are risks for DISH?
Diabetes and HLA-B27
What is the most common cause of infectious arthritis?
bacteria
What occurs with infectious arthritis?
Rapid joint destructions within days
What is the treatment for infectious arthritis?
Based on microbial agent: IV antibiotics and analgesics
What is the name of the pus forming infectious arthritis?
Suppurative arthritis
What is the most common location for suppurative arthritis?
knee
90% of suppurative arthritis involve how many joints?
one
Which microbe is the most common agent involved with suppurative arthritis among children under 2 years of age?
Haemophilus influenzae
Which microbe is the most common agent involved in suppurative arthritis among children older than 2 years of age and adults?
Staphylococcus aureus
Which microbe is the most common agent involved in adolescents and young adults?
Neisseria gonorrhoeae
Who is at a higher risk for neisseria gonorrhoeae causing infectious arthritis?
sexually active females
What is the most common microbe at fault for infectious arthritis among those with sickle cell anemia?
salmonella
Are primary joint neoplasms rare or common?
rare and most commonly benign
Which is more common: tumor like lesions or neoplasia in joints?
tumor like lesions
What makes up a ganglion?
degenerative CT
What is the name of a synovial cyst in the popliteal region?
bakers cyst
What is the difference between a ganglion and a synovial cyst?
Communication with the synovium is present in synovial cysts only
What is the typical age for tenosynovial giant cell tumors?
20-50 years old
What joint condition involves an aggressive benign tumor?
Tenosynovial giant cell tumor (TGCT)
What is the type of TGCT that is larger?
Diffuse TGCT (pigmented villonodular synovitis)
Which type of TGCT is smaller and involved with the tendon sheaths?
Localized TGCT
What is the common location for diffuse TGCT?
knee
What is the common location for localized TGCT?
hand
What is the most common soft tissue tumor of the hand?
localized TGCT
Tumors of adipose, fibrous, muscle, vessels, or the PNS are what kind of tumors?
Soft tissue tumors
Are soft tissue tumors usually benign or malignant?
benign (100X)
If a soft tissue tumor is malignant, what is it called?
soft tissue sarcoma
What is the most common area for a soft tissue tumor or sarcoma?
thigh
What is the exception for a location where soft tissue tumors are more likely to be malignant than benign?
skeletal muscle
What is a malignant tumor of adipocytes?
liposarcoma
What is the most common type of soft tissue tumor of adults?
lipoma
What type of soft tissue tumor is likely to be encapsulated?
lipoma
What is the usual age range for liposarcomas?
40-50
What is the location for possible metastasis for a liposarcoma?
lungs
What is the usual location for liposarcomas?
Retroperitoneum, thigh
What is the genetic factor of liposarcomas?
Degraded p53 resulting from a translocation of chromosomes 12 and 16
What is the term for a reactive fibroblastic mass?
Nodular fasciitis
What is the usual location for a nodular fasciitis?
Volar (Palm-side) of arm, chest, back
Nodular fasciitis tends to result from what kind of event?
trauma (10-15%)
What is the term for reactive metaplastic bone?
Myositis ossificans
What is the most common location for myositis ossificans?
proximal extremity muscles
A hard, painless mass is characteristic of what kind of fibrous tumor like mass?
Myositis ossificans
What condition should you attempt to rule out when suspicious of myositis ossificans due to their similarities in appearance?
osteosarcoma
Myositis ossificans is common among what group of people?
adolescent athletes
What type of fibrous like tumor mass is benign but locally invasive that tends to commonly recur?
fibromatosis
Dupuytren contracture and Peyronie disease are examples of what kind of fibromatosis?
superficial
What is the most common age for superficial fibromatosis?
40-70
What another term for deep fibromatosis?
desmoid tumor
Where are desmoid tumors or deep fibromatoses most commonly found?
abdominal area
Which type of fibromatosis is associated with Gardner Syndrome?
deep
What is the term for a slow growing, malignant fibrous like tumor mass?
fibrosarcoma
What are the usual locations for fibrosarcomas?
Thigh, retroperitoneum, knee
What is the most common age for fibrosarcomas?
35-55
Neoplastic fibroblasts and anaplastic spindle cells are associated with what kind of fibrous like tumor mass?
fibrosarcomas
25% of fibrosarcomas metastasize hematogenously to what location, most commonly,
lungs
Herringbone pattern is associated with what fibrous like mass tumor?
fibrosarcomas
What are skeletal muscle precursors?
Rhabdomyoblasts
What is the term for a malignant and aggressive skeletal muscle tumor?
Rhabdomyosarcoma
What is the most common location generally and specifically for rhabdomyosarcomas?
Generally in areas with little skeletal muscle. Specifically in the areas of the head and neck
What is the most common pediatric soft tissue sarcoma?
Rhabdomyosarcoma
What changes with the prognosis for adults with rhabdomyosarcomas?
Poor prognosis (2/3 of pediatrics will be 100% cured)
What is the term for a benign smooth muscle tumor?
leiomyoma
What is the term for a malignant smooth muscle tumor?
Leiomyosarcoma
What is the most common location for a leiomyoma?
uterus (often called fibromas)
What population is more at risk for leiomyosarcomas?
Adult females
What is a unique common area for leiomyosarcomas?
inferior vena cava
Spindle cells and cigar shaped nuclei are associated with what kind of smooth muscle tumor?
Leiomyosarcoma
What makes up 10% of all soft tissue sarcomas?
Synovial sarcomas
What is the most common age range for synovial sarcomas?
20-40
What is the unique pattern of growth associated with synovial sarcomas?
Cells grow in solid cords or aggregates
What is the most common location for a synovial sarcoma?
knee
What is the treatment for synovial sarcomas?
Limb-sparing surgery and chemotherapy
What is the usual survivability for those with synovial sarcomas?
10 year survivability of 10-30%
Can stress fractures be visible on X-rays?
no microfractures occur
What causes the bony necrosis with AVN?
ischemia
What is the most common cause of AVN?
vascular disruption via fracture
What is the most common form of osteomyelitis?
acute
What condition is known as “bone-marrow-inflammation”?
Osteomyelitis
What is specifically infected in osteomyelitis?
bone marrow
What are signs and symptoms of osteomyelitis?
Acute fever, intense malaise, throbbing pain
What is usually the bacterial cause of osteomyelitis?
pyogenic bacteria
What is the most common pyogenic bacteria to cause osteomyelitis?
Staph aureus
Possible collapse with AVN creates a risk for what condition?
OA
What is another name for tuberculous osteomyelitis?
skeletal TB
What is the most common form of spread in tuberculous osteomyelitis?
Hematogenous (other form would be lymphatics)
Which is more common: secondary or primary bone tumors?
secondary
What six factors indicate a larger risk of a bone tumor being the cause of low back pain?
50 years of age or older, history of cancer, unexplained weight loss, failure to improve after a month of conservative care, unrelieved with bed rest, and pain duration longer than one month
What category of fibrous dysplasia is most commonly represented?
Monostotic (70%)
What category of fibrous dysplasia is asymptomatic and results in minimal bony distortion or enlargement?
monostotic
When does polystotic fibrous dysplasia typically develop?
Late childhood and adolescence (earlier than monostotic)
Craniofacial involvement is present in about half of the cases of which category of fibrous dysplasia?
polystotic
What is the metastatic pathway of sarcomas?
Hematogenous
What is the metastatic pathway of carcinomas?
lymphatic
What is the most common type of secondary metastasis to bone?
Mixed- both osteoblastic and osteolytic
What are the most common forms of secondary metastasis to bone in adults?
Prostate (blastic), breast (lytic), lung
In pyogenic osteomyelitis, what is the reactive woven/lamellar bone that surrounds the infected bone called?
Involucrum
In pyogenic osteomyelitis, what is that dead bone seen at the site of infection?
Sequestrum
In pyogenic osteomyelitis, what is the ruptured periosteum that leads to an abscess in the surrounding soft tissue?
Draining sinus
What is fibrous dysplasia?
Arrested development of bone resulting in a benign lesion (failure of bone differentiation)
McCune-Albright syndrome is part of what category of fibrous dysplasia?
Polystotic + café-au-lait spots & endocrinopathy
What is the age range of monostotic fibrous dysplasia?
10-30
The “ground glass” appearance on X-ray is characteristic of what bone condition?
Fibrous dysplasia
How can you distinguish Paget’s disease from fibrous dysplasia on X-ray?
Fibrous dysplasia tends to be focused on the proximal region of the bone, while Paget’s disease is throughout the entire bone
What is the treatment for fibrous dysplasia?
Excision, othropedic hardware
McCune-Albright syndrome is more common among what gender?
females
What types of endocrine hyperfunction is associated with McCune-Albright syndrome?
Hyperthyroidism, pituitary adenoma, and adrenal hyperplasia
Are the skin and bony lesions of McCune-Albright Syndrome commonly unilateral or bilateral?
unilateral
What is PNET?
Primitive neuroectodermal tumor
What causes Ewing sarcoma or PNET?
Translocations of genetic bits of information
“Small round cell tumors of bone” is associated with what bone condition?
ewing sarcoma or PNET
What is the appearance of the cells involved with an Ewing sarcoma?
highly primitive and undifferentiated
What is the second most common pediatric bone cancer (#1 osteosarcoma)?
Ewing sarcoma
What is the difference between Ewing sarcoma and PNET?
PNET has some neural differentiation while Ewing sarcoma is virtually completely undifferentiated
What is the most common age range of Ewing sarcoma and PNET?
10-20
What race is more likely to be affected by Ewing sarcoma or PNET?
caucasians (9X)
What gender is at a greater risk for Ewing sarcoma and PNET?
males
What is the most common location of bone for Ewing sarcoma or PNET?
femur
What effect does an Ewing sarcoma or PNET mimic?
That of infection: pyrexia, leukocytosis, increased erythrocyte sedimentation rate
What is the most common mode of infection with osteomyelitis?
Hematogenous (sepsis)
“Onion-skinning” appearance of the periosteum is associated with what bone condition?
ewing sarcoma
