Ihi Tb3 Bone

Front 1

who is most affected by acute suppurative osteomyelitis?

Back 1

children

Front 2

what is the most likely cause of acute suppurative osteomyelitis?

Back 2

bacteria

Front 3

which bacteria causes up to 90% of acute suppurative osteomyelitis?

Back 3

S. aureus

Front 4

what is the most common route by which bacteria seed bones in acute suppurative osteomyelitis?

Back 4

hematogenous spread

Front 5

other than hematogenous spread what are the other less common ways infectious organisms can reach bone to cause acute suppurative osteomyelitis?

Back 5

direct implantation, spread from a continguous site

Front 6

what can occur in adult acute suppurative osteomyelitis?

Back 6

it can complicate other conditions or comorbidities - diabetes, IV drug use, HIV

Front 7

what part of the bone is most often affected in neonatal actue suppurative osteomylitis?

Back 7

metaphysis and/or epiphysis

Front 8

what part of the bone is most often affected in actue suppurative osteomylitis in children?

Back 8

metaphysis

Front 9

what part of the bone is most often affected in actue suppurative osteomylitis in adults?

Back 9

epiphyseal and subcondral - due to closure of the growth plate

Front 10

what is the most common infectious agent of acute suppurative osteomyelitis in sickle cell patients?

Back 10

salmonella

Front 11

what is the most common infectious agent of acute suppurative osteomyelitis in neonates?

Back 11

GBS or H. influenzae

Front 12

What is the most common infectoius agent of acute suppurative osteomyelitis in IV drug users?

Back 12

psuedomonas, Klebsiella or E. coli

Front 13

What is the most common infectoius agent of acute suppurative osteomyelitis in those with genitourinary infection?

Back 13

psuedomonas, Klebsiella or E. coli

Front 14

what is the sequestrum?

Back 14

ischemic necrosis of bone - due to intense edema that compresses blood vessels

Front 15

what accompanies acute suppurative osteomyelitis?

Back 15

the suppurative inflammatory response is accompanied by intense edema resulting in compression of vessels and ischemic necrosis of bone (sequestrum)

Front 16

what happens if sinus tracts occur in acute suppurative osteomyelitis?

Back 16

sinus tracts to the periosteum or nieghboring joint spaces result in elevation of the periosteum or crippiling pyogenic arthritis

Front 17

what is the involucrum?

Back 17

reactive new bone that is laid down around the area of infection - may lead to bone deformity

Front 18

how does acute suppurative osteomyelitis present?

Back 18

fever along with pain, tenderness, swelling and erythema overyling the metaphyseal region of long bones - especially in children need to be worked up

Front 19

how should acute suppurative osteomyelitis be treated?

Back 19

early with appropriate antibiotics before necrotic bone develops

Front 20

what must be done if a sequestrum has formed in acute suppurative osteomyelitis?

Back 20

the pus and necrotic bone must be removed before healing can occur

Front 21

what causes tuberculous osteomyelitis?

Back 21

secondary spread of mycobacterium to the bones from the lungs or GI tract

Front 22

which bones are most commonly affected in acute suppurative osteomyelitis?

Back 22

long bones

Front 23

which bones are most commonly affected in tuberculous osteomyelitis?

Back 23

body of the vertebrae (thoracic or lumbar) and long bones (around the knee)

Front 24

when is tuberculous osteomyelitis mulitfocal?

Back 24

in immunocompromised patients

Front 25

which is more destructive tuberculous osteomyelitis or pyogenic osteomyelitis?

Back 25

tuberculous with infections spreading into large areas of the medullary cavity

Front 26

what is Pott disease?

Back 26

tuberculous osteomyelitis of the vertebral cloumn where the infection penetrates intervening intervertebral discs to involve other vertebrae and surrounding soft tissue

Front 27

Can tuberculous osteomyelitis be the ONLY presentation of a TB infection?

Back 27

yes!

Front 28

how is TB most commonly spread to the bones?

Back 28

hematogenous spread

Front 29

what consequences can result from pott disease?

Back 29

scoliosis or kyphosis

Front 30

where do osteomas primarily occur?

Back 30

flat bones of the head

Front 31

what tumor represents end stage of fibrous dysplasia or other fibro-ossesous lesions?

Back 31

osteoma

Front 32

histology:mature laminar bone with haversian systems and can have trabecular bone

Back 32

osteoma

Front 33

are osteomas usually solitary or mutiple?

Back 33

solitary

Front 34

when are osteomas clinically significant?

Back 34

when they obstruct the sinuses, impinge on the brain or eye, otherwise they are of little significance

Front 35

what is Gardner's polyposis syndrome?

Back 35

osteomas that arise in multiple locations

Front 36

radiology: well delinated sclerotic lesions with smooth borders

Back 36

osteoma

Front 37

what population is most likely to get osteomas?

Back 37

males - any age

Front 38

small benign bone tumor that is exceedingly painful espeically at night, the pain is relieved by aspirin

Back 38

osteoid osteoma

Front 39

what population gets osteoid osteomas?

Back 39

children and young adults

Front 40

which sex gets osteoid osteomas?

Back 40

males

Front 41

where do osteoid ostemoas arise?

Back 41

diaphyseal cortex of the femur or tibia

Front 42

radiology: sclerotic lesion with a central lucent nidus

Back 42

osteoid osteoma

Front 43

histology: well-circumscribed core of random interconneting woven and trabecular bone prominently rimmed by osteoblasts which is variably mineralized, no cartilage or signs of malignancy

Back 43

osteoid osteoma

Front 44

what is typical of osteoid osteomas?

Back 44

extensive reactive bone formation surrounding the tumor

Front 45

what is the treatment for osteoid osteomas?

Back 45

surgical removal

Front 46

what is similar to osteoid osteoma but larger, less likely to be painful and more frequenly found in flat bones?

Back 46

osteoblastoma

Front 47

is cartilage present in osteoid osteomas?

Back 47

no

Front 48

are features of malignancy seen in osteoid ostemoas?

Back 48

no

Front 49

what is a nidus?

Back 49

interlacing network of osteoid trabecular bone with calcification at the center

Front 50

histology: round to oval masses of hemorrhagic gritty tan tissue

Back 50

osteoid osteoma

Front 51

what bones are the pirmary site of osteoblastomas?

Back 51

vertebral column, mandible and skull

Front 52

is the pain associated with osteoblastoma relieved by aspirin like its cousin osteoid osteoma?

Back 52

no

Front 53

what is the most common non-hematologic malignant neoplasm of bones?

Back 53

osteosarcoma

Front 54

what age group is osteosarcoma most likley seen in?

Back 54

adolescents and another peak in the elderly

Front 55

what sex are osteosarcomas seen in more often?

Back 55

males

Front 56

what part of the bone is affected by osteosarcoma?

Back 56

metaphyses

Front 57

which bones are affected in osteosarcoma?

Back 57

distal femur and proximal tibia

Front 58

what are osteoblastomas associated with when seen in the elderly?

Back 58

paget disease, chronic osteomyelitis, a history of radiation

Front 59

when I say retinoblastoma, you say

Back 59

osteosarcoma

Front 60

what are many osteoblsatomas associated with as far as mutations are concerned?

Back 60

mutation of the retinoblastoma gene and p53 tumor suppressor gene

Front 61

malignant osteoblasts, pools of colloid and spicules of woven bone

Back 61

osteosarcoma

Front 62

what happens as osteosarcomas expand?

Back 62

they destroy the cortex and elevate the periosteum creating Codman's triangle on x-ray

Front 63

radiology: codman's triangle

Back 63

osteosarcoma

Front 64

what is an early presentation of osteosarcomas?

Back 64

pain accompanied by swelling and a rapidly increasing bone mass

Front 65

are metastases frequent at the time of diagnosis in osteosarcomas?

Back 65

yes - to the lungs. Poor prognostic sign

Front 66

what symptom is universally present with osteosarcomas?

Back 66

pain - although it may be intermittent

Front 67

histology: poos of osteoid, spindled cells, hypercellular, can have zones of chondroid

Back 67

osteosarcoma

Front 68

where in the bone do osteosarcomes reside?

Back 68

in the cortex - they may extend into the medullary cavity

Front 69

what is histiological finding is vital to the diagnosis of osteosarcoma?

Back 69

osteoid pools

Front 70

pedunculated benign neoplasm which protrudes outward from the metaphyseal surface of long bones

Back 70

osteochondroma (exostosis)

Front 71

which bone are primarily effected by osteochondromas?

Back 71

around the knee

Front 72

what tumor has a cartilaginous cap overlying bone

Back 72

osteochondroma (exostosis)

Front 73

which population is osteochondroma most frequently found in?

Back 73

young adults

Front 74

what is the most common benign tumor of bone?

Back 74

osteochondroma (exostosis)

Front 75

what is the common site of origin for osteochondromas?

Back 75

metaphysis

Front 76

are osteochondromas solitary or mutiple?

Back 76

solitary

Front 77

what tumor minic the appearance of epiphysela plate and is continuous with the parent bone?

Back 77

osteochondroma (exostosis)

Front 78

do osteochondromas evolve into osteosarcoma?

Back 78

no usually - only 10% will

Front 79

what is the clinical significance of osteochondromas?

Back 79

very little but they can cause some pain

Front 80

what is multiple hereditary cartilaginous exostosis?

Back 80

an inherited condition that is associated with numerous exostoses (osteochondromas) that have a definite potential for malignancy

Front 81

does multiple hereditary cartilaginous exostosis have a potential to develop malignancies

Back 81

yes - much higher than with solitary osteochondromas

Front 82

radiology: looks like mushroom growing off a long bone, flaring of metaphysis of long bones

Back 82

osteochondroma (exostosis)

Front 83

is there cellular atypica in osteochodromas?

Back 83

no, they look like epiphyseal plate with maturation

Front 84

benign tumor of hyaline cartilage that occurs intramedullary (deep) within trabecular bone

Back 84

chondroma/enchondroma

Front 85

tumors at the metaphyses of small tubular bones of the hands and feet

Back 85

chondroma/enchondroma

Front 86

what age group is chondroma/enchondroma most common in?

Back 86

young adults

Front 87

are chondromas/enchondromas solitary or multiple?

Back 87

solitary

Front 88

what is the clinical significance of chondromas/enchondromas?

Back 88

generally they are asymptomatic - some may be erosive and cause pain, swelling or pathologic fractures

Front 89

what are multiple enchondromas associated with?

Back 89

inhertied syndromes - Ollier's disease and Maffucci's syndrome - may have increased risk of malignancy

Front 90

what is ollier's disease?

Back 90

an inherited syndrome associated with multiple enchondromas

Front 91

what is maffucci's syndrome?

Back 91

an inherited syndrome associated with multiple enchondromas

Front 92

is the an increased risk of malignancy of enchondromas seen in ollier's or maffucci's?

Back 92

yes

Front 93

histology: hypocellular with blue-gray cartilagenous mixture with no cellular atypia

Back 93

chondroma/enchondroma

Front 94

what tumor is associated with joint pain in adolescents?

Back 94

chondroblastoma

Front 95

histology: scattered multinuclear giant cells in a sea of mononuclear cells with pink-purple fibrinous islands

Back 95

chondroblastoma

Front 96

calcification in a chicken wire pattern

Back 96

chondroblastoma

Front 97

where do chondroblastomas usually originate?

Back 97

epiphyses

Front 98

which bones are primarily affected with chondromblastomas?

Back 98

long bones, proximal humerous and around the knee

Front 99

there is a tumor in the proximal humerous, what is it most likley to be?

Back 99

chondroblastoma

Front 100

radiology: small well defined (sharp margins) lucency with spotty calcification and sclerotic rim

Back 100

chondroblastoma

Front 101

malignant tumor of chondroblasts

Back 101

chondrosarcoma

Front 102

when is the peak incidence of chondrosarcomas?

Back 102

middle age - males

Front 103

which bones are primarily affected by chondrosarcomas?

Back 103

limb girdles, vertebrae and ribs

Front 104

what genetic mutation is found in higher grade chondrosarcomas?

Back 104

over-expression of p53

Front 105

how are chondrosarcomas usually treated?

Back 105

by wide resection

Front 106

what is the site of origin of chondrosarcomas?

Back 106

metaphyses or diaphyses

Front 107

radiology: prominent endosteal scalloping

Back 107

chondroblastoma

Front 108

developmental defects in the ossification of bone

Back 108

fibrous cortical defects

Front 109

which population is fibrous cortical defects most commonly seen in?

Back 109

male children and adolescents

Front 110

what portion of the bone do fibrous cortical defects most commonly affect?

Back 110

metaphyseal cortex of long bones

Front 111

which bones are most affected by fibrous cortical defects?

Back 111

distal femur and proximal tibia

Front 112

are fibrous cortical defects bilateral?

Back 112

yes - 1/3 to 1/2 of the time

Front 113

histology: spindle cell lesions with benign fibroblasts and histiocytes; no cellular atypia

Back 113

fibrous cortical defects

Front 114

what is the natural course of fibrous cortical defects?

Back 114

most ossify and spontaneously resolve with maturity of bone but a few may persist and increase in size resulting in pathologic fractures

Front 115

what are nonossifying fibromas?

Back 115

persistent fibrous cortical defects

Front 116

radiology: sharply demarcated lesion surrounded by thin scleroizing zone

Back 116

fibrous cortical defects

Front 117

replacement of portions of bone with fibrous tissue

Back 117

fibrous dysplasia

Front 118

is fibrous dysplasia solitary or multiple?

Back 118

70% - monostotic, the rest are polyostotic

Front 119

what age groups are affected by fibrous dysplasia?

Back 119

children and young adults

Front 120

histology: spindle cell stroma with irregular (fishhook) trabeculae of osteoid

Back 120

fibrous dysplasia

Front 121

which bones are involved in fibrous dysplasia?

Back 121

ribs femur and tibia

Front 122

lamellar bone never forms

Back 122

fibrous dysplasia

Front 123

what are the consequences of fibrous dysplasia?

Back 123

bowing or pathologic fracture

Front 124

radiology: lytic ground glass like densities in the metaphysis of diaphysis

Back 124

fibrous dysplasia

Front 125

histology: proliferating fibrolasts in dense collage matrix trabeculae haphazad arrangment, with absent osteoblastic rimming

Back 125

fibrous dysplasia

Front 126

what is polyostotic fibrous dysplasia?

Back 126

fibrous dysplasia that is usually unilateral in multiple sites that is associated with endocrine dysfunction and areas of hyperpigmentation that can cause severe deformity and has an increased risk of malignancy

Front 127

what bones are affected in polyostotic fibrous dysplasia?

Back 127

femur skull and tibia

Front 128

what risk factors increase the incidience of malignancy with polyostotic fibrous dysplasia?

Back 128

increasing age and history of radiation

Front 129

what is McCune albright syndrome?

Back 129

polyostotic fibrous dysplasia, precocious puberty, café-au-lait spots, short stature, hyperthyroidism and pituitary somatostatinomas = that usually occurs in young girls

Front 130

what population si McCune albright syndrome seen in?

Back 130

young girls

Front 131

what are the most common sites for malignant transformation seen in polyostotic fibrous dysplasia?

Back 131

skull, hemerus and femur

Front 132

histology: malignancy with cells that tend to show fibroblastic differentiation with collagen secretion in a herring bone pattern

Back 132

fibrosarcoma

Front 133

where do fibrosarcomas arise from?

Back 133

pelvic bones and the metaphyses of long bones - tibia and femur

Front 134

what population do fibrosarcomas affect?

Back 134

middle aged to elderly adults

Front 135

tumors that arise in the setting of a bone infart or paget disease of bone

Back 135

fibrosarcoma

Front 136

tumor that arises in patient with a history of radiation?

Back 136

fibrosarcoma

Front 137

what determines prognosis in fibrosarcomas?

Back 137

histologic grade of the tumor

Front 138

large eccentrically located tumor that is purely lytic with no/minimal sclerosing, periosteal reaction is uncommon

Back 138

fibrosarcoma

Front 139

poorly marginated tumor with destruction cortex and soft tissue invasion

Back 139

fibrosarcoma

Front 140

how do most fibrosarcomas present?

Back 140

pain of the pelvic gridle or long bones

Front 141

where does growth of the tumor occur in fibrosarcomas?

Back 141

at the edges of the tumor

Front 142

where does ewing sarcoma arise from?

Back 142

bone marrow cavity of the diaphysis of long bones and in pelvic bones. Especially the femur and flat bones of the pelvis

Front 143

11;22 translocation

Back 143

ewings sarcoma

Front 144

small blue cell bone tumor of childhood

Back 144

ewings sarcoma

Front 145

histology: highly cellular tumor comprised of tighlty packed small cells with hyperchromatic nuclei and very little cytoplasm

Back 145

ewings sarcoma

Front 146

what is a helpful cellular feature to diagnose ewings sarcoma?

Back 146

the presence of cytoplasmic glycogen surrounding central blood vessels = pseudorosettes

Front 147

pseudorosettes

Back 147

ewings sarcoma

Front 148

radiology: sunburst

Back 148

ewings sarcoma

Front 149

what is the initial symptom of ewings sarcoma?

Back 149

when they obstruct the sinuses, impinge on the brain or eye, otherwise they are of little significance

Front 150

is metastasis common in ewings sarcoma?

Back 150

yes - early widespread metastasis is common

Front 151

what population is affected by ewings sarcoma?

Back 151

boys less than 15

Front 152

is there new bone formation in ewings sarcoma?

Back 152

yes - prominent periosteal new bone formation

Front 153

when are giant cell tumors seen?

Back 153

early to middle aged adults

Front 154

where do most giant cell tumors arise?

Back 154

epiphyses or metaphyses of long bones - especially around the knee

Front 155

radiology: cystic lesions

Back 155

giant cell tumors

Front 156

histology: multinucleated osteoclast-like giant cells that arise from a background of proliferating neoplastic monocytes, many mitosis, NO matrix production

Back 156

giant cell tumors

Front 157

tumor that is derived from monocyte-marcophage linage

Back 157

giant cell tumors

Front 158

how do giant cells tumors usually present?

Back 158

as joint pain

Front 159

what is most important in determining the prognosis of bone sarcomas?

Back 159

histologic grade of the tumor

Front 160

what are risk factors that show increased incidience of bone neoplasia?

Back 160

bone infarcts, chronic osteomyelitis, paget disease, radiation, metal prosthesis

Front 161

histology: abundant chondroid material, binucleation frequent, highly cellular

Back 161

chondrosarcoma

Front 162

where do the giant cells of giant cells tumors arise from?

Back 162

the fusion of mononuclear cells

Front 163

are giant cells tumors more inclined to metastasize?

Back 163

no, a small percentage are overtly malignant with potential for distant metastasis; otherwise the prognosis is good

Front 164

do giant cell tumors recur

Back 164

yes - locally

Front 165

what is the most common site of disseminated cancer?

Back 165

bone

Front 166

which is more common - metastatic disease or primary bone tumors

Back 166

metastatic disease

Front 167

how do metastatic diseases reach the bone

Back 167

hematogenous spread

Front 168

which bones are most often affected by metastatic diseases?

Back 168

vertebrae

Front 169

which cancers tend to spread to bones?

Back 169

breast, prostatic, lung, renal and thyroid

Front 170

what is the most common intrasseous cartilage tumor

Back 170

enchondroma

Front 171

what is the most common malignant tumor of non-marrow origin?

Back 171

osteosarcoma

Front 172

is a tumor in a older patient more likely to be benign or malignant?

Back 172

malignant, if in a younger patient more likely to be benign

Front 173

tumor in a boy less than 15

Back 173

ewings sarcoma

Front 174

tumor in an elderly patient

Back 174

fibrosarcoma or osteosarcoma

Front 175

nidus

Back 175

osteoid osteoma