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81 Cards in this Set
- Front
- Back
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Inflammation phase of bone repair YANG LONG STYLE (9 forms)
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1. RUPTURE
2. HEMATOMA - PMNS, NEUTROPHILS AND LYMPHOCYTES APPEAR 3. TEARING PERISOTEUM 4. NECROSIS & MACS ATTACK 5. FIBRIN MESH 6. FIBROBLASTS SHOW AND TURN INTO CHONDROCYTES - BEGIN TO LAY DOWN CARTILAGE 7. NECROSIS AND MAC ATTACK CONT. 8. PROCALLUS BEGINS 9. MACS CONTINUE |
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Inflammation phase fx repair SHORT form:
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RUPTURE of blood vessels in soft tissue & bone
HEMATOMA caulks/coagulates gap TEARING of Periosteum immediate NECROSIS of bone and soft tissue MACROPHAGES begin cleaning FIBRIN MESH Fibroblasts move in, change to CHONDROCYTES and begin to lay down cartilage to form a PROCALLUS Macrophage activity continues. |
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REPARATIONS (reparative) phase of fx healing
It's a hazy shade of winter... |
Wide Class Nukes are Never Called to Blast!
HAZY cloud visible = repair WIDEned fx space may be visible on film due to osteoCLASSt and monoNUKElear cleaning. NE(VER)ovascularization CALLus forms osteoBLASTic activity increases now that neovasc. in place |
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re-MODELING the house phase of bone
a CALLUS SEAL and a CHANGED WOLFF CLASTED & BLASTED as they REMODELED my kitchen. |
A callus seal and a changed wolff clasted and blasted as they remodeled my kitchen.
Starts when callus SEALS bone model Bone changes according to WOLFF'S LAW (tensile & compressive forces cause new bone) Osteoblast and -clast activity increased IN RELATION TO normal bone activity |
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A
B C S |
Alignment
Bone Cartilage spaces Soft tissue |
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ALIGNMENT descriptors
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adjacent
separated ipsilateral contralateral continuous DISCONTINUITY straight CURVILINEAR (scoliosis) DISLOCATION LISTHESIS retro- antero- spondylo- VALGUS/VARUS kyphosis lordosis |
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Spondylosis
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Spondylosis is a term referring to degenerative osteoarthritis of the joints between the centra of the spinal vertebrae and/or neural foraminae. In this condition the facet joints are not involved. If severe, it may cause pressure on nerve roots with subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.
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an infection of the bone or bone marrow
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Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning marrow, and -itis meaning inflammation)
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BONE descriptors
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CLOSED (SIMPLE)
OPEN (COMPOUND) complete discontinuity incomplete discontinuity radiOPAQUE radioLUCENT (abnormal density = general osteopenia, focal radiolucency/localized DIAPHYSIS METAPHYSIS'EPIPHYSIS bumps and DIVOTS GROWTH PLATES malformation OSTEOPHYTES |
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When describing B of ABCS, define the __________
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density
(RADIOPAQUE, RADIOLUCENT) |
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When detailing the A of ABCS, does the bone have normal size, shape, appearance in how to bones ___________ as they form a join?
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align
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CARTILAGE words - (remember they describe JOINT SPACES, GROWTH PLATES, AND are there RADIODENSITIES in a normally radiolucent space?
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DECREASED joint space
INCREASED joint space (inflammation stage of fx) OSTEOPHYTE invasion EROSIONS of the margins chondrocalcinosis (densities in cartilage) |
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the S of ABCS words
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SOFT TISSUE:
calcifications radiodensities radiopacities GAS densities FAT pads |
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Inflammation stage lab 2 notes
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Inflammatory, Up to 7-10 days
• Hemorrhage • Hematoma • Tearing of Periosteum • Necrosis of bone and soft tissue • 2-5 days, fibrin mesh develops (leukocytes, macrophages, fibroblast and capillary buds. • 5-10 days, procallus forms (Ca+, osteoblast deposition) |
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Reparative stage lab 2 notes
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Reparative, from 1st week to 3 months
• Chondroblast make cartilage • Becomes fairly stable at 2-3rd week. • Boney callus develops • Increased neovascularization • Able to visualize on radiograph. |
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Remodeling stage lab 2 notes
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Remodeling, last up to years.
• Continued osteoclastic and osteoblastic activity. • Bone adjust to strength and shape based on stresses put on it. • Cellular/chemical events include secretion of alkaline phosphatase due to osteoblast. Alk. Phos. activates collagen fibers to allow deposition of calcium salts. |
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Benign Bone Tumors
Characteristics - |
Well Demarcated
Sclerotic Borders Involve one tissue type Short zone of transition |
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Examples of benign neoplasias include: (4)
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Examples of benign neoplasias include:
Osteoma, Osteoid Osteoma, Giant Cell Chondroma. |
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Malignant Bone Tumors
Characteristics: |
Malignant Bone Tumors
Characteristics: Just shows up Involve multiple tissue types Disruption of Cortex Blastic Lesions or Lytic Lesions Long Zone of Transition |
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Examples of primary malignant neoplasias include: (3)
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Examples of primary malignant neoplasias include:
Osteosarcoma, Chondrosarcoma Fibrosarcoma |
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In some cases, benign bone pathologies can degenerate into a ________ _________ condition.
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malignant neoplastic
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Examples of primary malignant neoplasias include: (2)
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Examples of primary malignant neoplasias include:
Malignant Giant Cell, Pagetic Osteosarcoma |
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Bone tumors are either ______ or ________.
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primary or secondary
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________ bone tumors can be either benign or malignant.
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Primary
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Type of tumor which involves bone tissue only.
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Primary
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There are 5 cell types in which primary bone tumors can originate:
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There are 5 cell types in which primary bone tumors can originate:
bone cells, cartilage cells, fibroblastic cells, blood cells or vessel cells. |
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Primary bone cell neoplasias can be _____, _____ or both.
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blastic or lytic or both
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Primary malignant bone tumors evolve from ?
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no pre-existing condition, they just 'show-up!'
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A secondary __________, ___________ or __________ can develop from a pre-existing condition/pathology.
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A secondary osteosarcoma, chondrosarcoma, or fibrosarcoma can develops from a pre-existing condition/pathology.
For example, osteosarcoma following a chronic bone infection. Secondary bone tumors are metastatic disease only! |
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Secondary bone tumors are ________ disease, only!
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METASTATIC
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OSTEOID OSTEOMAS
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Benign tumors accounting for 2 to 3% of all bone biopsies.
As with most primary bony neoplasms, they occur most often in males, classically those under 25 years of age. 50% will occur in the femur or tibia. The clinical hallmark of these lesions is that they present with severe pain which worsens at night. The pain is dramatically relieved by aspirin. On x-ray, these are classically small radiolucent lesions with a sclerotic border |
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OSTEOSARCOMAS
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commonest of the primary malignant bone tumours. 50% cases are related to the knee, effecting the metaphyses and adjacent diaphyses of femur and tibia. They seem to arise in the long bones which show the greatest longitudinal growth. With large tumours, the site of origin is inferred from the centre of radius of the mass. The diaphyses are involved more extensively than plain films indicate. Joint involvement is rare.
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UNICAMERAL BONE CYSTS
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SOLITARY bone cysts are most commonly found in the upper humerus, as in this x-ray, or in the femur. They tend to occur in males under twenty years of age, and are thought to be due to a disturbance of bone growth with a superimposed trauma. The cysts may sometimes present as pathological fractures (not present in this case.)
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ABC...
ANEURYSMAL BONE CYSTS |
are rapidly growing, destructive lesions, with destruction of the cortex. They account for 2% of "bone tumors". Approximately 50% of these are associated with another bony lesion.
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BONE ISLANDS
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about 30% of bone islands will demonstrate increased uptake- particularly large lesions.
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What are the criteria for naming or identifying a neoplasia as a primary bone tumor?
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A:
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Explain the difference between a secondary bone tumor and a secondary malignant bone tumor
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A:
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3. You have a 67 year old male patient who was diagnosed with Pagets’ Disease fifteen years ago. He has just been diagnosed with a bone neoplasia in a bone that had been affected by Pagets’. Using the chart below, where would you place this type of neoplasia and why?
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A:
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Explain any similarities or differences on how infections and neoplasias spread in the body.
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A:
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GIANT CELL TUMOR
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1. Giant Cell Tumors - are benign tumors accounting for 2 to 3% of all bone biopsies. As with most primary bony neoplasms, they occur most often in males, classically those under 25 years of age. 50% will occur in the femur or tibia. The clinical hallmark of these lesions is that they present with severe pain which worsens at night. Aspirin dramatically relieves the pain. On x-ray, these are classically small radiolucent lesions with a sclerotic border.
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X-ray presentation of GIANT CELL TUMOR
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On x-ray, these are classically small radiolucent lesions with a sclerotic border.
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MULTIPLE MYELOMA
versus plasmocytoma D/dx? |
a plasma cell tumor of the bone marrow. If it is seen in just one bone, it is defined as an isolated plasmacytoma. If the patient demonstrates increased protein in either the urine or the blood, consistent with the excretion of the protein chains manufactured by the plasma cells, then the disease is considered multiple myeloma.
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Since is it more of a systemic disease, surgery does not play the primary role other than for diagnosis or in cases of pathologic fracture. The main treatment is chemotherapy
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MULTIPLE MYELOMA
**. In small lytic lesions, which are often seen in multiple myeloma, radiation is very effective |
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The plain films show purely lytic disease. The bone scan is often cold since there is very little osteoblastic stimulation
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MULTIPLE MYELOMA
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5 YEAR survival rate for multiple myeloma is _____%.
If patient has an isolated plamacytoma, what happens? |
The overall five-year survival for multiple myeloma is approximately 50%. In the case of an isolated plasmacytoma, 80% progress to multiple myeloma by five years.
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EWING'S SARCOMA
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primitive mesenchymal cell sarcoma. The pathologic findings include sheets of small round blue cells that stain positive for glycogen. It is a tumor most frequently seen in the first two decades of life, but occasionally it can be seen in patient's up to age 50. The pathology often appears similar to lymphomas
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D/dx between lymphoma and EWING'S SARCOMA?
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Special pathological markers are used to differentiate the two
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The treatment depends on the LOCATION. In expendable bones, the treatment is surgery and preoperative and postoperative chemotherapy. In bone that has a large amount of growth remaining, radiation can substitute for surgery and give similar results. In the pelvis, the best results have been achieved with chemotherapy, surgery and radiation.
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EWING'S SARCOMA
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Overall 5 year survival rate for EWING'S SARCOMA?
Other treatments? |
The overall five-year survival for Ewing's sarcoma is approximately 60%. For patients that have failed chemotherapy due to distant disease, bone marrow transplants are now experimentally being tried.
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METASTATIC DISEASE
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to the skeleton is an extremely common problem in the end-stage of most carcinomas. In multiple studies, it has been shown that up to 70-80% of patients that died of cancer will have metastatic skeletal disease at autopsy.
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to the skeleton is an extremely common problem in the end-stage of most carcinomas.
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METASTATIC DISEASE
In multiple studies, it has been shown that up to 70-80% of patients that died of cancer will have metastatic skeletal disease at autopsy. |
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Most common locations of METASTATIC DISEASE:
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SPINE
FEMUR PELVIS HUMERUS *Distal metastases to the hands and feet are relatively uncommon |
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In women the most common carcinomas with metastatic disease to bone are:
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• Breast carcinoma
• Lung carcinoma |
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• In men the most common carcinomas with metastatic disease to bone is:
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• Prostate carcinoma
• Lung carcinoma • Kidney carcinoma |
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HODGKIN'S LYMPHOMA
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A type of lymphoma wherein the cells of in the lymphatic system grow abnormally and can spread to other organs. As the disease progresses, the body is less able to fight infection.
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Cancers that develop in the lymphatic system
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Lymphomas
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Lymphatic vessels
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carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes.
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Small bean shaped organs that filter lymph
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NODES
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Where are lymph nodes found?
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Clusters of lymph nodes are found in the underarm, groin, neck and abdomen. Other parts of the lymphatic system are the spleen, thymus, tonsils and bone marrow.
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Healthy cells grow, divide and replace themselves in an orderly manner. This process keeps the body in good repair. In Hodgkin’s disease?
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cells in the lymphatic system grow abnormally and can spread to other organs. As the disease progresses, the body is less able to fight infection.
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Hodgkin's disease is rare. Who has it?
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rare. . It accounts for less than 1 percent of all cases of cancer in this country. It is most often seen in young people aged 15 to 34 and in people over the age of 55.
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HEMANGIOMAS
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cavernous type commonly found, 10% in autopsy series with the vast majority being small, asymptomatic and unable to be seen on plain films, most often in lumbar region and singular complications: compression fractures (occ. with cord compression), chronic hemorrhage -> blockage of spinal canal.
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Type of HEMANGIOMA most commonly found?
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C A V E R N O U S !!!!
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Describe x-ray presentation of an hemangioma:
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asymptomatic and unable to be seen on plain films, most often in lumbar region and singular complications: compression fractures (occ. with cord compression), chronic hemorrhage -> blockage of spinal canal
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Hemangiomas are asymptomatic - when do they occur?
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asymptomatic and unable to be seen on plain films, most often in lumbar region and singular complications: compression fractures (occur. with cord compression), chronic hemorrhage -> blockage of spinal canal
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OBJECTIVES: Explain the differences (either on gross slide or radiograph) between infections and primary and secondary bone neoplasias.
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A:
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OBJECTIVES: Explain the radiographic differences between primary malignant bone tumors and secondary bone tumors.
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A:
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Subluxation
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Eburnation
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polished
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Dislocation
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Osteophyte
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Syndesmophyte
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Anklyosis
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Pannus
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Geode
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Marginal erosion
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Juxta-articular osteoporosis
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Vacuum sign
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Subchondral sclerosis
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Rat bite lesion
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Chondrocalcinosis
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