Bone Pathology, Week 1, Pathophysiology Ii

Front 1

What are two infectious diseases of bone?

Back 1

1. Osteomyelitis

2. Pott's Disease

Front 2

What is osteomyelitis?

Back 2

Inflammation of bone and bone marrow

Front 3

What are two types of osteomyelitis?

Back 3

1. Non-bacterial osteomyelitis

2. Bacterial osteomyelitis

Front 4

What are three ways that non-bacterial osteomyelitis can develop?

Back 4

1. Viral

2. From sarcoidosis(Note: The inflammatory condition of sarcoidosis in the lung can become aggressive and spread over adjacent or neighboring bones/marrow)

3. Radiation (Note: radiation can weaken the immune system and also cause inflammatory reaction and microvascular damage in the bones/marrow)

Front 5

What are two types of bacterial osteomyelitis?

Back 5

1. Acute suppurative (pus-like) oteomyelitis

2. Chronic osteomyelitis

Front 6

What are two types of chronic osteomyelitis?

Back 6

1. Chronic non-specific osteomyelitis

2. Chronic specific osteomyelitis, such as TB

Front 7

What are the five stages of disease with osteomyelitis?

Back 7

1. Inflammation

2. Suppuration

3. Sequestrum

4. Involucrum

5. Resolution on progression to complications.

Front 8

What happens during Stage 1, Inflammmation?

Back 8

1. Vascular (vessels) congestion

2. Increased intra-osseous pressure (pressure within the bone)

Front 9

What happens during Stage 2, Suppuration?

Back 9

Pus within the bones forms a subperiosteal abscess in 2-3 days. (The periosteum is the outer covering of bones. The subperiosteal level is beneath the periosteum. An subperiosteal abscess is a collection of pus under the periosteum)

Front 10

What happens during Stage 3, Sequestrum?

Back 10

Dead pieces of bone develop due to lack of blood supply:

-There is a decrease or obstruction to the blood supply to the periosteum (outer membrane covering bone) and endosteum(tissue lining the bone's inner medullary cavity)

-This is caused by vascular obstruction and infective thrombus

-It results in bone necrosis (death) and

-Sequestrum formation in about 7 days

Front 11

What happens during Stage 4, Involucrum?

Back 11

This is new bone formationn from the stripped surface of periosteum.

Front 12

What happens during Stage 5, Resolution or progression to complications

Back 12

1. May resolve with antibiotics and surgical treatment early in the course of disease without complications

2. May progess to complications

Front 13

What is one possible complication of osteomyelitis? (#1 out of 5)

Back 13

Pathological fracture

Front 14

What is another possible complication of osteomyelitis? (#2 out of 5)

Back 14

Spread of infection into joint, muscle, neighboring structures, such as arthritis, myositis, neuritis

Front 15

What is another possible complication of osteomyelitis (#3 out of 5)

Back 15

Blood spread, such as toxemia (toxic) or septicemia (bacterial)

Front 16

What is another possible complication of osteomyelitis (#4 out of 5)

Back 16

Chronic suppurative(pus-filled) osteomyelitis

-Sequestrum formation

Front 17

What is another possible complication of osteomyelitis (#5 out of 5)

Back 17

Damage to the growth plate causing subsequent growth deformity

Front 18

What is Pott's disease?

Back 18

Tuberculosis of the spine, a type of tuberculous arthritis of the intervertebral joints (Note: because both the spine and lungs are very vascular, easy to spread from lungs to bones)

Front 19

What areas of the body are most impacted with Pott's disease?

Back 19

-Lower thoracic and upper lumbar vertebrae

Front 20

What are 6 symptoms of Pott's disease?

Back 20

1.Back pain

2.Fever

3.Night sweating

4.Anorexia

5. Weight loss

6. spinal mass that can cause weakness and paralysis of the legs

Front 21

How is Pott's disease diagnosed?

Back 21

1. Increased ESR (erythrocyte sedimentation rate)

2. Tuberculin skin tests

3.Spine radiographs

4. Bone scan

5. cat scan

6. Bone biopsy

7. MRI

Front 22

What are four complications of Pott's disease?

Back 22

1. Vertebral collapse resulting in kyphosis (humpback, convex curvative)

2. Spinal cord compression

3. Sinus formation

4. Paraplegia (lower extremity motor/sensory impairment)

Front 23

Where is tuberculous most common in long bones?

Back 23

-Knee area

-Affects metaphysis (between ends and shafts of bones) and epiphysis (ends of bones)

-Rarely affects diaphysis (shaft of bone)

-Well-defined lytic area (area of destructive lesion)

Front 24

Describe the areas and results of tuberculous arthritis.

Back 24

Areas: Hip and knee

Results: Joint space narrowing and erosions, possible extensive destruction of the articular cortex (the cover of the bone forming a joint)

Front 25

What are three hereditary bone disorders?

Back 25

1. Achondroplasia

2. Osteogenesis imperfecta

3. Osteopetrosis

Front 26

What is another term for achondroplasia?

Back 26

Dwarfism

Front 27

Describe physical traits associated with achondroplasia?

Back 27

-Large head with prominent forehead

-Normal sized torso with short arms and legs

-Long bones are short and thick

-Normal intelligence, life span and reproductive ability

Front 28

Describe the bone structure of osteogenesis imperfecta.

Back 28

Osteopenia (brittle bones), recurrent fractures and skeletal deformity

Front 29

Describe the sclera (white of eyes) of osteogenesis imperfecta.

Back 29

Abnormally thin sclera with blue color

Front 30

Osteogenesis imperfecta - joints?

Back 30

Joints are lax and hypermobile, leading to more dislocations

Front 31

Osteogenesis imperfecta - hearing?

Back 31

Pathology of the bones of the inner and middle ear produces deafness

Front 32

Osteogenesis imperfecta - teeth?

Back 32

Deficiency of dentin leads to small, fragile, and discolored teeth.

Front 33

Osteogenesis imperfecta - skin?

Back 33

Thin and easily bruised.

Front 34

What is osteopetrosis?

Back 34

-A hereditary defect leading to high-density, thick sclerotic bones (sclerotic means thickened and hardened)

-The bones are brittle and fracture easily.

Front 35

What is an Erlenmeyer flask deformity?

Back 35

An Erlenmeyer flask is narrow on one end and wide at the other end. In Osteopetrosis, the long bone may broaden at the end near the metaphysis. This results in an Erlenmeyer flask shape.

Front 36

What is osteoporosis and why does it occur?

Back 36

-Increased abnormal porosity of the skeleton. (Porosity is the condition of having tiny spaces or holes through which air and liquid can bass)

-Occurs due to loss of organic bone matrix and minerals.

Front 37

Describe osteoporotic bones.

Back 37

-Thin, fragile, easily fractured

-Decreased bone mass and density

-Decreased thickness of cortical (outer) and trabecular (spongy) bone

Front 38

What are two types of osteoporosis?

Back 38

-Localized

-Generalized

Front 39

Give an example of localized osteoporosis.

Back 39

Disues of a limb

Front 40

Give two examples of primary osteoporosis.

Back 40

-Old age (senile)

-Estrogen deficiency (postmenopausal)

Front 41

Give two examples of secondary osteoporosis.

Back 41

-Cushings disease

-Drugs (Heparin and Steroids)

Front 42

How does estrogen deficiency lead to postmenopausal deficiency?

Back 42

-It increases resorption of bone by osteoclasts

-It decreases formation of bone by osteoblasts.

Front 43

What are the signs and symptoms of osteoporosis?

Back 43

-Bone pain

-Weight-bearing bones:

Compression of vertebrae

Colles fracture of distal radius (wrist)

Fracture femoral neck (end of thigh)

-Loss of height and kyphosis (humpback)

Front 44

How is osteoporosis diagnosed?

Back 44

A DEXA scan (Dual energy Xray Absorptiometry)

Front 45

What is osteonecrosis or avascular necrosis?

Back 45

Ischemic infarction of bone and bone marrow. (Note: An infarction is an area of tissue that undergoes death due to a local lack of oxygen. Ischemia is a decrease in the blood supply to a bodily organ, tissue, or part). So this is a condition of bone/bone marrow death due to lack of blood flow.

Front 46

Where is osteonecrosis most likely to occur?

Back 46

The femoral head (highest part of thigh bone) and scaphoid bone (wrist)

Front 47

What are two causes of osteonecrosis?

Back 47

-Corticosteroids (long-term steroid treatment)

-Fracture

Front 48

What is Paget's disease?

Back 48

A localized disorder that involves abnormal bone destruction and regrowth

Front 49

What occurs in Paget's disease?

Back 49

There is excessive bone resorption (abnormal breakdown of bone tissue in certain areas.

This is followed by disorganized bone replacement (abnormal bone formation).

Results in thick but weak bones that are susceptible to deformity and fracture.

Front 50

What are the 4 stages of Paget's disease?

Back 50

1. Increased resorption by osteoclasts

2.Both osteoclasts and osteoblasts (bone building cells )

3. Osteoblastic hyperactivity - they try to compensate for the increased resorption by an excessive amount of building new bone

4. This results in disorganized and abnormal bone. (too large, more blood vessels)

Front 51

What are the symptoms of Paget's disease?

Back 51

-In most cases, no symptoms

-Bone pain and deformities

Frequent fractures

-Warmth of overlying skin due to too many blood vessels (hypervascularity)

Front 52

What is the difference between monosteotic and polyosteotic?

Back 52

Monosteotic is involving one bone.

Polyosteotic is involving multiple bones.

(Pagets disease: 15% monosteotic; 85% polyosteotic)

Front 53

What are common body areas for Paget's disease?

Back 53

Skull, pelvis, femur, and vertebrae.