Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
139 Cards in this Set
- Front
- Back
|
What are the different parts of a tubular bone?
|
Physis = growth plate
Diaphysis = shaft Metaphysis = flaredportion Epiphysis = end of bone, beyond the physis |
|
|
What are the different histologic types of bone?
|
Lamellar
-mature -perpendicular rows of collagen bundles Woven -immature |
|
|
When do you see woven bone?
|
Development and in pathological conditions!
|
|
|
What are the properties of cortical bone? Where is it found?
|
Dense, compact
Thickest in he shafts (diaphysis) of long bones |
|
|
What are the properties of cancellous bone? Whereis it round?
|
Spongy, trabecular
Compression resistant At the ends of long bones, also in vertabrae |
|
|
What type of bone is more active: cancellous or cortical bone?
|
Cancellous
|
|
|
What is the vascular supply to the bone?
|
Penetrating arteries
-Nutrient artery -Metaphyseal, epiphyseal arteries Periostealarteries -Augments the principal supply |
|
|
What part of bone is solid? Water?
|
92% solid
8% water |
|
|
What are the components of the bone matrix?
|
Type I collagen
|
|
|
What are the mineral components of bone?
|
Calcium hydroxyapatite
99% of body calcium, 85% of the phosphorus |
|
|
What are the cell types inside of bone? What is their function?
|
Osteoblast: forms osteoid
Osteocytes: Ca/PO4 homeostasis Osteoclasts: macrophages that resorb bone |
|
|
What is wolff's law?
|
It states that the internal structure of bone is altered in response to the magnitude of force placed upon it
More force, stronger bone! |
|
|
What is the embryonic origin of the skeleton?
|
Somites (which comes fromthe mesoderm), which divides intot he dermatomes, myotomes, and sclerotomes
Bone forms fromthe sclerotomes |
|
|
What is the process of bone formation in long bones? Flat bones?
|
Long bones (except for cranium, part of clavicle): from cartilage precursors through endochondral ossification
Flat bones: membranous ossification |
|
|
What are the four zones of bone growth?
|
Reserve
Proliferation Hypertrophy Ossification |
|
|
What is the definition of a dysotoses?
|
Localized problems in the migration or formation of bone
|
|
|
What are the most common causes of dysostoses?
|
Defects in nuclear proteins, TFs
|
|
|
What does someone look like who has dysostoses?
|
Missing, extra bones
Fusion of bones |
|
|
What is the definition of a dysplasia of bones?
|
Global skeletal abnormalities secondary to mutations of genes involved in regulation of skeletal development or structure
|
|
|
What gene is mutated in achondroplasia, hypochondroplasia, and thanatatophoric dwarfism?
|
FGFR3
Fibroglast growth receptor; functions in signal transduction |
|
|
What gene is mutated in osteogenesis imperfecta?
|
COL1A1
|
|
|
What does someone look like with Achondroplasia?
|
Short limbs, normally sized torso
|
|
|
What is the cause of achondroplasia?
|
Point mutation of FGFR3
|
|
|
What's the inheritance of achondroplasia?
|
Autosomal dominant
|
|
|
What is thanatophoric dwarfism?
|
Lethal form of dwarfism
Thorax can't develop-->no respiratory capacity |
|
|
What mutation occurs in thanatophoric dwarfism?
|
FGFR3 gain of function mutation
|
|
|
What mutation takes placein osteogenesis imperfecta?
|
Mutations impacting COL1 synthesis
|
|
|
What are the clinical manifestations of osteogeneis imperfecta?
|
1. Skeletal fragility
Blue sclera Small, brown-yellow teeth Hearing impairment |
|
|
What is osteopetrosis?
|
Genetic disease of osteoclasts!
|
|
|
What is the treatment of osteopetrosis?
|
Bone marrow treatment
CURATIVE |
|
|
What are the symptoms of osteopetrosis?
|
Diffuse, symmetric skeletal sclerosis
Brittle bones that can easily fracture Medullary cavity filed with immature bones Anemia, infections --> NO MARROW! |
|
|
What do the bones look like in osteopetrosis?
|
NO MARRO!
Erlenmeyer flask bones |
|
|
What are some of the acquired abnormalities of bone structure?
|
Osteoporosis (decreased bone mass)
Paget disease (increased bone mass) Abnormal mineral homeostasis -Rickets/osteomalacia (decreased vitamin D) -Hyperparathyroidism (decreased calcium-->increased osteoclast activity) -Renal osteodystrophy |
|
|
What happens to the bones in osteoporosis?
|
Reduced bone mass; "porpous" bones
|
|
|
What are the risk factors for osteoporosis?
|
Hereditary factors
Decreased physical activity Muscle strength Nutrition, Ca intake Drugs Hormones (esp. estrogen!) |
|
|
What does the histology of osteoporosis look like?
|
Bottom shows very POROUS bones
|
|
|
What happens to the vertebrae during osteoporosis?
|
Compression fractures!
|
|
|
What happens to the bones in Paget disease of bone?
|
Net gain in bone mass
|
|
|
What are the phases of paget disease of bone?
|
1. Osteolytic (osteoclastic)
2. Mixed osteoclastic/osteoblastic 3. Osteosclerotic |
|
|
What does the histopathology of Paget disease of bone look like?
|
Mosaic lamellar bone (prominent cement/bluish lines)
HUGE OSTEOCLASTS! Marrow fibrosis, hypervascularity |
|
|
What is the most likely cause of osteomyelitis?
|
Bacteria
Most likely S. aureus |
|
|
What kind of bacteria causes osteomyelitis in neonates?
|
H. influenza
Group B strep |
|
|
What kind of bacteria causes Osteomyelitis in people with sickle cell disease?
|
Salmonella
|
|
|
What are some different ways that ostomyelitis can get spread to the bone?
|
Hematogenous
Direct extension from a contiguous site -Diabetics with gangrenous digits -Decubitius ulcers Traumatic (direct) implantation |
|
|
What is a complication from osteomyelitis seen in kids?
|
The periosteum is loosely attached, so the growth can push it out
This then forms new bone, or an INVOLUCRUM |
|
|
What does the histology of osteomyelitis look like?
|
Dead, irregular bonewith pus
Dead osteocytes within the bone |
|
|
What is osteonecrosis?
|
Avascular necrosis/asepticnecrosis of the bonehead
|
|
|
What are the mechanisms that can causes osteonecrossi/
|
Trauma
Corticosteroids Thrombosis/embolism Vascular inury Alcoholism |
|
|
What is a common complication folowing osteonecrosis?
|
Secondary osteoarthritis
|
|
|
What is the common pathway for fracture healing in bone?
|
1. Hematoma
2. Inflammatory cell infiltration 3. Activation of osteoprogenitor cells 4. Granualtion tissue 5. Bony/hard callus 6. Remodeling and reconstitution |
|
|
What are some things that can cause a fracture not to fuse?
|
Poor immobilization
Infeciton Ischemia |
|
|
What are the different kinds of boneformingtumors?
|
Osteoid osteoma
Osteoblastoma Osteosarcoma |
|
|
What are the different types of cartilage forming tumors?
|
Osteochondroma
Chondroma Chondroblastoma Chondromyxoid fibroma Chondrosarcoma |
|
|
What are some of the miscellaneous tumors of bone?
|
Giant cell tumor
Aneurysmal bone cyst Non-ossifying fibroma Fibrous dysplasia Ewing sarcoma |
|
|
What are some of the hematopoietic tumors of bone?
|
Myeloma
Lymphoma |
|
|
What kind of a primary bone tumor is the most common?
|
Hematopoietic (40%)
Cartilage forming (22%) Bone forming (19%) |
|
|
What type of a person gets an osteoid osteoma?
|
Man (2:1 M:F) between 2nd and 3rd decate
|
|
|
Where in the bone do osteoid osteomas occur?
|
Inside the cortex
|
|
|
What bones do osteoid osteomas usually occur in?
|
Femur or tibia (50%)
|
|
|
What size are osteoid osteomas?
|
<2 cm
|
|
|
What is helps with the pain from osteoid osteomas? Why?
|
NSAIDS!
They produce prostaglandins, which cause pain |
|
|
What's the treatmnet for osteoid osteomas?
|
Radioablation is curative!
|
|
|
What kind of a person gets an osteoblastoma?
|
Man(2.5:1 M:F) in 2nd-3rd decade
|
|
|
Where do osteoblastomas usually occur?
|
medulla
posterior spine, sacrum (50%) Jaws |
|
|
How large are osteoblastomas?
|
>2 cm (< 2 cm is by definition an osteoid osteoma)
|
|
|
What are the symptoms of osteoblstomas?
|
Pain that's NOT relieved by NSAIDs
|
|
|
What's the treatment of osteoblastomas?
|
Curettage/excision
|
|
|
What's the most common primary malignancy of bone?
|
Osteosarcoma
|
|
|
What are the risk factors for an osteosarcoma?
|
Radiation
Paget's diseaseof bone INfarct |
|
|
What is the most typical person to have an osteosarcoma?
|
Man (1.5:1 M:F) in second decade
|
|
|
How does someone with an osteosarcoma present?
|
Pain +/-a palpable mass
Much less commonly, they'll present with a pathologic fracture |
|
|
What's the treatment for an osteosarcoma?
|
Chemo followed by a biopsy to see how much the tumor is undergoing necrosis
If a lot of necrosis is happening, then there's a good prognosis Also, resection of the tumor and masses |
|
|
Where do osteosarcoma metsmostoftengo?
|
The lung
Other bones |
|
|
Where are osteosarcomas foundin the bone?
|
90% metaphysis
10% in the diaphysis Most are in the medulla of the bones |
|
|
What is an osteochondroma?
|
It's a growth plate that has found itself in the wrong place and all of a sudden starts growing
|
|
|
What type of a person most commonly gets an osteochondroma?
|
Man (3:1 M:F) in 2nd -3rd decade
|
|
|
What bones are most commonly involved in an osteochondroma?
|
Distal femur (30%)
Proximal tibia (15%) Proximal humerus (15%) |
|
|
What does someone with an osteochondroma present like?
|
Palpable mass or asymptomatic
|
|
|
What's the treatment of an osteochondroma?
|
Excision is curative!
|
|
|
What is an enchondroma?
|
A piece of the growth plate that has wound up within the medulla of a bone
|
|
|
What kind of a person gets an endhondroma?
|
Male or female (1:1) in 3rd - 4th decade
|
|
|
What'e the most usual place to find an enchondroma?
|
Hands/feet (50%)
|
|
|
What's the treatment for enchondroma?
|
Observation or curettage
|
|
|
What is it called if you have multiple enchondromas? How about multiple enchondromas + hemangiomas?
|
Multiple = Ollier
Multiple + hemangiomas = Maffucci |
|
|
What kind of a person gets a chondroblastoma?
|
Male (2:1 M:F) in 2nd decade
THE SKELETON IS IMMMATURE |
|
|
Where do chondroblastomas take place?
|
Long bone epiphyses
-Femur, tibia, humerus -Talus, calcaneus |
|
|
What types of cells are inside chondroblastomas?
|
Giant cells
|
|
|
What types of tumors of bone show giant cells? Which happens in what types of populations?
|
Chondroblastoma: kids
Giant cell tumor: adults |
|
|
What's the treatment for chondroblastoma?
|
Curettage: scooping it out!
|
|
|
Where do chondrosarcomas metastasize to?
|
Lungs
|
|
|
What are the properties of a giant cell tumor of bone?
|
Giant cells!
Benign but locally aggressive |
|
|
Where do you find a giant cell tumor of bones?
|
Ends of longbones
-Distal femur -Proximal tibia -Distal radius -Proximal humerus |
|
|
What are the sympoms of a giant cell tumor of bone?
|
Pain
Swelling Fracture |
|
|
What's the treatment for a giant cell tumor of bone?
|
SURGERY
|
|
|
What is the problem with giant cell tumors of bone?
|
They recur!
1/4 to 1/2 will do this. |
|
|
What is the most typical person to get a giant cell tumor of bone?
|
Female (1:1.5 M:F) in 3rd - 4th decade
|
|
|
What occurs in a fibrous dysplasi/
|
Benign
Normal medulla is replaced by abnormal fibro-osseous tissue |
|
|
What ages is a fibrous dysplasia most common in?
|
Broad range
Peak from 2nd-3rd decade |
|
|
What bones most commonly show fibrous dysplasi?
|
Craniofacial, long bones, ribs
|
|
|
What is the most common form of fibrous dysplasia?
|
Monostotic (70%)
|
|
|
What is the least common type of fibrous dysplasia?
|
McCune-Albright syndrome:
-Precocious puberty -Cafe-au-lait pigmentation |
|
|
What mutation is behind fibrous dysplasia?
|
Gain of function in GNAS1
|
|
|
What is the pathology that happens in Ewing's sarcoma?
|
Malignant "small round blue cell" sarcoma with SOFT TISSUE INVOLVEMENT
|
|
|
Where does Ewing sarcoma happen?
|
Diaphysis of long bones
-Pelvis -Ribs |
|
|
What kind of a person gets a Ewing sarcoma?
|
Kids!
80% are in people under 20 |
|
|
What is the mutation found in Ewing sarcoma?
|
t(11;22)(q24;q12) - 85%
A fusion of two genes |
|
|
What's the prognosis for Ewing sarcoma?
|
GREAT!
75% 5 year survival |
|
|
What's more common: metastatic or primary bone tumors?
|
METS!
They're usually multifocal |
|
|
In adults, what are common metastatic bone tumors?
|
Breast
Prostate Lung Kidney Thyroid |
|
|
What are common metastatic bone tumors in kids?
|
Neuroblastoma
Ewing sarcoma Wilms tumor Rhabdomyosarcoma Osteosarcoma |
|
|
What are possible signs of mets to bone?
|
Pain
Pathological fracture Hypercalcemia Marrow replacement |
|
|
What is the nomenclature of the different soft tissue tumors?
|
|
|
|
What is the most common type of soft tissue tumor?
|
Lipomas
|
|
|
Are most soft tissue tumors benign of malignant?
|
Most are benign.
|
|
|
What can a fibromatosis cause?
|
Trigger finger!
|
|
|
What are the different types of fibromatosis?
|
Superficial
-Dupuytren (palmar) -Plantar -Penile Deep -Locally aggressive -3 types |
|
|
What mutations are deep fibromatosis associated with?
|
FAP
|
|
|
Where are leiomyomas found?
|
All over the place!
-Skin -Deep soft tissue -GI tract -GU tract 3/4 of women have uterin leiomyomas (FIBROIDS!) |
|
|
What should you think of if someone has multiple cutaneous leiomyomas?
|
Underlying RCC
-There's a germline syndrome for this. |
|
|
What is a neurofibroma?
|
Benign tumor of a peripheral nerve sheath
|
|
|
What is the most common type of a neurofibroma?
|
Cutaneous, solitary (90%)
|
|
|
If there are multiple, plexiform neurofibromas, what should you thin?
|
NF1
|
|
|
What is a schwannoma?
|
Benign tumor of the peripheral nerve sheaths
|
|
|
What condition should you think of if there is a bilateral schwannoma of CNVIII?
|
NF2
NF2 mutation on chromosome 22 |
|
|
What is the most common person to get a soft tissue sarcoma?
|
Man around the age of 65
It's the 4th most common malignancy of kids! |
|
|
Where are the most common places to find a soft tissue sarcoma?
|
Extremities
Trunk Retroperitoneum |
|
|
Who has liposarcomas?
|
Adults, not kids!
|
|
|
What are the different types of liposarcomas?
|
Well-differentiated (resemble lipomas)
Myxoid/round cell Pleomorphic |
|
|
Who gets leiomyosarcomas?
|
Adults; F>M
|
|
|
Where do leiomyosarcomas arise from?
|
Skin, deep soft tissue
GI tract GU tract |
|
|
Who's at risk of a leiomyosarcoma from a parenchymal organ? What causes this?
|
Immunosuppressed people
EBV |
|
|
What's the most common type of soft tissue sarcoma in kids/adolescents?
|
Rhabdomyosarcoma
|
|
|
What are the different types of rhabdomyosarcoma?
|
Embryonal (most common type)
Alveolar (2nd most common) Pleomorphic |
|
|
What are the most common sites for childhood rhabdomyosarcoma?
|
Head/neck
Extremities GU |
|
|
What is a unique variant of an embronal rhabdomyosarcoma?
|
Botryoid embryonal rhabdomyosarcoma
Arise from beneath the mucosal epithelial surface -Bladder -Biliary -Vagina -Pharynx -Conjunctiva -Ear -Nose |
|
|
Where do alveolar rhabdomyosarcomas form? When?
|
At the extremities
Occurs at an older age than the embryonal |
|
|
What types of rhabdomyosarcomas have the worst prognosis? The best?
|
Superior: embryonal, botryoid variant
Intermediate: conventional embryonal Poor: alveolar RMS, pleomorphic |
|
|
What makes a RMS prognosis favorable?
|
Infants/kids
Orbit, GU <5 cm Botryoid Localized |
|
|
What makes a RMS prognosis unfavorable?
|
Adults
Non-orbital/GU >5cm Alveolar, pleomorphic Invasive Incomplete initialresection |
