Msi Week 1: Diseases Of Bone; Holliman

Front 1

What causative agent is most often identified in acute suppurative (pyogenic) osteomyelitis?

Back 1

Bacteria
(Staphylococcus aureus is responsible for up to 90% of cases)

Front 2

Who are most often affected by acute suppurative osteomyelitis? (adults or children)

Back 2

Children

Front 3

How are the infectious organisms that cause acute suppurative osteomyelitis most commonly spread?

What factor influences the location of the lesion?

Back 3

Hematogenous spread

*Location of lesion is influenced by the extent of vascular circulation

(Can also reach bone by direct implantation or spread from a contiguous site)

Front 4

With acute suppurative osteomyelitis, what are the most commonly affected sites in neonates? Children?

Back 4

Neonates = metaphysis and/or epiphysis

Children = metaphysis

(After growth plate is closed, the most common infections are epiphyseal and subchondral)

Front 5

Term used to describe a piece of dead bone that has become separated during the process of necrosis

Back 5

Sequestrum

Front 6

A suppurative inflammatory response is accompanied by intense edema. What is the result this?

Back 6

Compression of vessels and ischemic necrosis of bone (sequestrum)

Front 7

In acute suppurative osteomyelitis, what type of tracts may develop to allow escape of purulent exudate?

What is the result of these tracts?

Back 7

Sinus tracts

These tracts allow exudate to drain into periosteum or neighboring joint spaces, which results in elevation of the periosteum or crippling pyogenic arthritis.

Front 8

Why do bone deformities often result from acute suppurative osteomyelitis?

Back 8

The periosteum can be stripped off due to the accumulation of pus within the bone, so reactive new bone is laid down around the area of infection to form the involucrum which may lead to deformity.

Front 9

Term used to describe a new layer of bone that is laid down around an area of infection as a result of acute suppurative osteomyelitis.

Back 9

Involucrum

Front 10

If a child patient presents with fever along with pain, tenderness, swelling, and erythema overlying the metaphyseal region of long bones, what disease should you consider?

Back 10

Acute suppurative (pyogenic) osteomyelitis.

Front 11

A suppurative inflammatory response is accompanied by intense edema. What is the result this?

Back 11

Compression of vessels and ischemic necrosis of bone (sequestrum)

Front 12

In acute suppurative osteomyelitis, what type of tracts may develop to allow escape of purulent exudate?

What is the result of these tracts?

Back 12

Sinus tracts

These tracts allow exudate to drain into periosteum or neighboring joint spaces, which results in elevation of the periosteum or crippling pyogenic arthritis.

Front 13

Why do bone deformities often result from acute suppurative osteomyelitis?

Back 13

The periosteum can be stripped off due to the accumulation of pus within the bone, so reactive new bone is laid down around the area of infection to form the involucrum which may lead to deformity.

Front 14

Term used to describe a new layer of bone that is laid down around an area of infection as a result of acute suppurative osteomyelitis.

Back 14

Involucrum

Front 15

If a child patient presents with fever along with pain, tenderness, swelling, and erythema overlying the metaphyseal region of long bones, what disease should you consider?

How would you treat this disease?

Back 15

Acute suppurative (pyogenic) osteomyelitis.

The infection needs to be treated early with appropriate antibiotics before necrotic bone develops!
(If a sequestrum is formed, the pus and necrotic bone must be removed before healing can occur)

Front 16

What is the cause of tuberculous osteomyelitis?

Back 16

Caused by the secondary spread of Mycobacterium to the bone from the lungs or GI tract.

Front 17

What bones are most commonly affected in tuberculous osteomyelitis?

Back 17

1. Body of the vertebrae (usually thoracic and lumbar)
2. Long bones (usually knees)

Front 18

If a patient is immunocompromised, would you expect tuberculous osteomyelitis infection to be unifocal or multifocal?

Back 18

Infections are frequently multifocal in immunocompromised patients

Front 19

Which is more destructive-- pyogenic osteomyelitis or tuberculous osteomyelitis?

Why?

Back 19

Tuberculous osteomyelitis

*Infections spread into large areas of the medullary cavity

Front 20

What is Pott disease?

Back 20

Tuberculous osteomyelitis of the vertebral column where the infection penetrates intervening intervertebral discs to involve other vertebrae and surrounding soft tissue.

Front 21

Name 2 inflammatory diseases of bone.

Back 21

1. Acute suppurative (pyogenic) osteomyelitis
2. Tuberculous osteomyelitis

Front 22

What bacteria is responsible for tuberculous osteomyelitis?

Back 22

Mycobacterium

Front 23

What are the 5 parameters that must be considered before you can accurately diagnose bone neoplasms?

Back 23

1. Age of patient
2. Bone involved
3. Specific area within bone
4. Radiographic appearance
5. Microscopic appearance

Front 24

A benign tumor usually arising from flat bones of the head.

Back 24

Osteoma

Front 25

What is the microscopic appearance of an osteoma?

Back 25

Mature, lamellar bone.

Front 26

Osteomas are usually solitary, but what is the name of the syndrome which involves multiple osteomas?

Back 26

Gardner's syndrome

Front 27

T or F.

Unless osteomas cause problems b/c of their location, they are inconsequential.

Back 27

TRUE
(they are benign)

Front 28

This is generally a small, benign, but exceedingly painful tumor of children and young adults.

Back 28

Osteoid osteoma

Front 29

Osteoid osteomas frequently arise within which bones?

Back 29

Femur or tibia
(within the diaphyseal cortex)

Front 30

Characteristically, the pain caused by osteoid osteomas can be relieved by taking what medication?

Back 30

Aspirin

*This is an important characteristic of the disease. Also, patients might tell you that the pain is worse at night

Front 31

A radiograph depicting a sclerotic lesion with a small translucent center (<1.5 cm) could be indicative of what disease?

Back 31

Osteoid osteoma
(tumor has a core of woven trabecular bone which is variably mineralized)

Front 32

What is the treatment of choice for an osteoid osteoma?

Back 32

Surgical excision.

Front 33

What is the difference between osteoblastomas and osteoid osteomas?

Back 33

Osteoblastomas are histologically similar, but they are:
1. Larger in size
2. Less painful
3. More frequently found in skull, mandible and spine
(Remember osteoid osteomas are typically found in the femur or tibia)

Front 34

What is the most common non-hematologic malignant neoplasm of bone?

Back 34

Osteosarcoma

Front 35

What people are more at risk for developing an osteoid osteoma?

Back 35

Children and young adults
(males)

Front 36

Where do osteosarcomas most often develop?

Back 36

Metaphyses of:
1. Distal femur
2. Proximal tibia

(*Usually in adolescents; male predominance)

Front 37

What 2 gene mutations are often associated with osteosarcomas?

Back 37

1. Retinoblastoma gene
2. p53 tumor supressor gene

Front 38

What are osteosarcomas composed of?

Back 38

1. Malignant osteoblasts
2. Pools of osteoid material
3. Spicules of woven bone

Front 39

If "Codman's triangle" is depicted in a radiograph, what disease is most likely indicated?

Back 39

Osteosarcoma
(when tumor expands, it destroys the bone cortex and elevates the periosteum so that it becomes triangular-shaped).

Front 40

Osteosarcomas often metastasize to what organ?

Back 40

Lungs (through hematogenous metastases)

*Often present at time of diagnosis and is a poor prognosis.

Front 41

Name 3 bone-forming tumors.

Back 41

1. Osteoma
2. Osteoid osteoma
3. Osteosarcoma

Front 42

Name 4 cartilage-forming tumors

Back 42

1. Osteochondroma (exostosis)
2. Chondroma/ enchondroma
3. Chondroblastoma
4. Chondrosarcoma

Front 43

This is a pedunculated benign neoplasm which protrudes outward from the metaphyseal surface of long bones and consists of a cartilaginous cap overlying bone.

Back 43

Osteochondroma

Front 44

Osteochondromas are most frequently found on what bones?

Back 44

Metaphyses of:
1. Distal femur
2. Upper tibia

Front 45

Name the inherited condition that is associated with numerous osteochondromas.

Back 45

Multiple hereditary cartilaginous exostosis

(Remember that typically, osteochondromas are isolated lesions that have little significance. But not in this case!)

Front 46

This is a benign tumor of hyaline cartilage that occurs deep within trabecular bone.

Back 46

Chondroma/ Enchondroma

Front 47

Chondromas are most common within which bones?

What type of people are most at risk--children, young adults, adults?

Back 47

Small tubular bones of the hands and feet
(particularly in the metaphyses)

*Typically seen in young adults

Front 48

Typically chondromas are solitary, but multiple chondromas can be associated with inherited syndromes. Name 2 examples of these syndromes.

Back 48

1. Ollier's disease
2. Maffucci's syndrome

*These conditions carry an increased risk of malignant transformation

Front 49

This is a rare benign tumor of adolescents that arises in the epiphyses of long bones. Clinical symptomatology is frequently related to joint pain, swelling, and mobility.

Back 49

Chondroblastoma

Front 50

Malignant tumor of chondroblasts.

Back 50

Chondrosarcoma

Front 51

What type of people are more at risk for chondrosarcomas?

Back 51

Middle age males

Front 52

Chondrosarcomas are typically found where?

Back 52

1. Limb girdles
2. Vertebrae
3. Ribs

Front 53

What's the difference between low grade and high grade tumors?

Back 53

Low grade = small and slow-growing
High grade = large and more aggressive

Front 54

Over-expression of which gene is often found in high-grade chondrosarcomas?

Back 54

p53

Front 55

These lesions are very common and are felt to represent developmental defects in the ossification of bone.

Back 55

Fibrous cortical defects

Front 56

Fibrous cortical defects are most often found within which bones?

Back 56

Metaphyseal cortex of long bones
(mostly distal femur and proximal tibia)

Front 57

T or F.

Fibrous cortical defects are almost never bilateral.

Back 57

FALSE.

30-55% are bilateral

Front 58

What are fibrous cortical defects composed of (histologically)?

Back 58

1. Benign fibroblasts
2. Histiocytes

Front 59

If a lesion caused by a fibrous cortical defect persists, what is it termed as?

Back 59

Nonossifying fibroma

(Typically the lesions will ossify and spontaneously resolve with maturity of the bone, but a few may persist and increase in size--->
*result in pathologic fractures)

Front 60

Bone malignancy that consists of cells that show fibroblastic differentiation with collagen secretion.

Back 60

Fibrosarcoma

Front 61

Fibrosarcomas usually affect which bones?

What age-group of people are most often affected?

Back 61

1. Pelvic bones
2. Metaphyses of long bones (tibia, femur)

*Middle-aged to elderly adults

Front 62

What is the most common precursor event for the development of fibrosarcoma?

Back 62

Radiation therapy.

(Can also occur in the setting of a bone infarct or in Paget disease of the bone)

Front 63

What is the second most common bone sarcoma in children?

Back 63

Ewing's sarcoma
(PNET: primitive neuroectodermal tumors)

Front 64

In what bones do Ewing's sarcomas (PNETs) most often arise from?

Back 64

Arise from the bone marrow cavity in:
1. Diaphysis of long bones
2. Pelvic bones

Front 65

What type of tumor histologically appears as highly cellular tumor composed of tightly packed small cells with hyperchromatic nuclei and very little cytoplasm?

Back 65

Ewing's sarcoma (PNET)
("small blue cell tumors of childhood")

Front 66

List 2 helpful diagnostic features seen in Ewing's sarcomas (PNETs).

Back 66

1. Presence of cytoplasmic glycogen
2. Pseudorosettes surrounding a central blood vessel

Front 67

Radiographically, a "sunburst" appearance is typical of what type of tumor?

Back 67

Ewing's sarcoma (PNET)

Front 68

What do genetic studies reveal about Ewing's sarcomas?

Back 68

Genetic relevance: 11;22 chromosomal translocation

Front 69

In which bones do most giant cell tumors occur?

Back 69

Usually in the long bones around the knee
(in the epiphyses or metaphyses)

Front 70

Contracts - Applicability of Statute of Frauds

SMART FLYS must be written

Back 70

SURETY
MARRIAGE
ANSWER
REAL ESTATE
TESTAMENTARY
FINDERS FEE
LEASES
YEAR
SALES

Hint 70

Surety contracts
Marriage contracts (prenup)
Answer for debts discharged in bankruptcy
Real estate contracts
Testamentary promises in NY
Finders fee arrangements
Leases longer than 1 year
Year-contracts not capable of complete performance w/in year
Sales contracts under UCC for sales of goods over $500

Front 71

Giant cell tumors are believed to be derived from what cell lineage?

Back 71

Monocyte-macrophage lineage
(result of fusion between mononuclear cells)

Front 72

What type of tumors are more common in bone-- primary or metastatic?

Back 72

METASTATIC
*Bone is a common site of disseminated cancer

Front 73

How are metastases most commonly spread to bone?

What bones are they most commonly found in?

Back 73

Hematogenous spread

Frequently seen in vertebrae

Front 74

Name 5 visceral cancers that tend to metastasize to bone

Back 74

1. Breast carcinoma
2. Prostatic carcinoma
3. lung carcinoma
4. renal carcinoma
5. thyroid carcinoma

Front 75

Which two bacteria commonly cause pyogenic osteomyelitis in neonates?

Back 75

1. H. influenzae
2. Group B streptococci

(Remember that in general, pyogenic osteomyelitis is most commonly caused by S. aureus)

Front 76

Where is the most common lesion site of pyogenic osteomyelitis in neonates?

Back 76

Metaphysis, epiphysis of bones (or both)

Front 77

Where is the most common lesion site of pyogenic osteomyelitis in children?

Back 77

Metaphysis of bone

Front 78

Where is the most common lesion site of pyogenic osteomyelitis in adults?

Back 78

Epiphysis and subchondral regions of bone

Front 79

What disease may develop in 1-3% of patients with pulmonary or extrapulmonary TB?

Back 79

Tuberculous osteomyelitis

Front 80

Scoliosis or kyphosis are deformities that are sometimes seen with the development of which bone disease?

Back 80

Tuberculous osteomyelitis--Pott disease
(mycobacteria break through intervertebral discs to infect multiple vertebrae and surrounding soft tissue)

*Can also lead to neurological problems due to compression of spinal cord

Front 81

What type of bone lesions generally occur within flat bones of the skull?

Back 81

1. Osteomas
2. Osteoblastomas

Front 82

T or F.

Once growth plates have formed (as in adults), any evidence of woven bone is pathological.

Back 82

TRUE

Front 83

Osteochondroma is also called...

Back 83

Exostosis

Front 84

What would you expect to find, radiographically, with the presence of osteochondroma?

Back 84

Projection or growth seen forming from surface of bone (peduncle).
(usually seen on distal femur or proximal tibia)

Front 85

T or F.

Chondromas often present with numerous symptoms.

Back 85

FALSE.

Chondromas/ enchondromas are most typically asymptomatic

Front 86

Are chondrosarcomas generally found in younger or older individuals?

Back 86

Older
(peak incidence in 4th-7th decades)

Front 87

Are fibrosarcomas generally found in younger or older individuals?

Back 87

Older
(middle-aged or elderly adults)