Bone Path

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jlolson83
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133222
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Bone Path
Updated:
2012-02-06 15:12:36
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Bone Path
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Bone Path
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  1. Achondroplasia
    • Growth plate disease (most common)
    • Auto dom
    • FGF
    • Short prox extremities, normal truck, bulging forehead, depressed nose root
  2. Thanatophoric Dwarfism
    • Most common lethal form of dwarfism
    • Micromelic limbs, small chest, bell-shaped abdomen, frontal bossing
  3. Osteogenesis Imperfecta
    • Mutations in a1, a2 type 1 collagen
    • Fractures, blue sclerae, hearing loss, dental issues
    • Type 2 fatal
    • Type 1 normal life span, more kid fractures
    • Type 3 growth retardation, more adult fractures
    • Type 4 growth retardation, normal sclera
  4. Hyaline cartilage defects
    • Type 2, 10, 11 cartilage
    • Uncommon
  5. Mycopolysaccharidoses
    • Lysosomal storage disease
    • Affect chrondrocytes
    • Short stature, chest wall deformities, malformed bones
  6. Osteopetrosis
    • aka Marble bone or Albers-Schonberg
    • Osteoclasts dysfunction
    • Carbonic anhydrase II deficiency
    • No medullary canal and erlenmeyer flask deformity
    • Fractures, anemia, hepatosplenomegaly, CN deficites
  7. Osteoporosis
    • Incrases bone porosity, reduction of bone mass
    • Primary causes = age, post-menopause
    • Secondary = Endocrinopathies, cancer, GI, RA, drugs
    • .
    • Postmenopausal - dec estrogen, more osteoclasts, vertebrae
    • Senile - less osteoblasts
  8. Paget's
    • Osteitis Deformans
    • First osteolystic stage
    • End up with more bone - MOSAIC PATTERN
    • Painful if sever, bony overgrowth (leontiasis), bowing
  9. Rickets/Osteomalacia
    • Rickets = kids, osteomalacia = adults
    • Vit D deficiecy or abnormal metabolism
    • Leg bowing
  10. Hyperparathyroidism
    • Inc PTH stimulates osteoclasts
    • Affects more cortical than cancellous bone
    • BROWN TUMORES (histiocytes)
    • Severe = Generalized osteitis fibrosa cystica (von Recklinghausen)
  11. Renal osteodystropy
    • Phosphate retention, metabolic acidosis, Aluminium, and amyloid
    • Osteoclastic bone resorption, osteomalacia, osteosclerosis, growth retardation, osteoporosis
  12. Osteonecrosis
    • Ischemic infarction
    • Causes: trauma, corticosteroids, thrombosis/embolism, venous HTN, inc intraosseous P
    • Cartilage spared, but can collapse and cause osteoarthritis
    • Creeping subsitution
  13. Osteomyelitis
    • Bacterial infection of bone
    • Staph aureus, E. coli, sudomonas, klebsiella, H flu, group B strep, salmonella (w sickle cell)
  14. Sequestrum
    Bone necrosis
  15. Involucrum
    Deposit of reactive bone around dead stuff (sequestrum)
  16. Tuberculous Osteomyelitis
    • Usually solitary (except AIDS)
    • Vertebrae, knees, hips,
    • Potts: when spread from vertebrae into soft tissue
  17. Skeletal syphilis
    • Congenital - enchondral ossification and periosteum (edematous granulation tissue)
    • Acquired - Nose, palate, skull, extremeties (gummas)
  18. Osteoma
    • Skull and face
    • Middle aged adults
    • Woven and lamellar
    • Gardner sx: multiple
  19. Osteoid osteoma
    • Teens and 20s
    • Men
    • Appendicular
    • Worse at night
    • Relieved by aspirin
    • Tumor = nidus, small central round radiolucency
  20. Osteoblastoma
    • Spine
    • Not responsive to aspirin
    • Like osteoid osteoma
    • Tumor = nidus, small central round radiolucency
  21. Osteosarcoma
    • Ages 15,16,17, second peak in elderly
    • Long bones (around knee), older pts(flat bones of face and pelvis)
    • Rb, p53, MDM2
    • Can penetrate epiphyseal plate, invade joint
    • Codman triangle
  22. Osteochondroma
    • =exostosis
    • Multiple - auto dom
    • Enchondral origin bones (long bones by knee)
    • Benign mushroom growth with bony stalk
    • Late adolescence, early adult
  23. Chondroma
    • Benign tumors of hyaline cartlage
    • Enchondroma - in medullary cavity, on suface - subperiosteal
    • 20s-40s
    • Usually solitary on hands and feet
    • Muliple - Ollier, +hemangiomas - mafucci
    • O ring sign on xray
  24. Chondroblastoma
    • Rare
    • Teens
    • Knee
    • Cellular sheets of compact polyhedral chondrocytes
    • Chicken wire pattern of calcification
    • Scattered osteoclasts-type giant cells
  25. Chondromyxoid Fibroma
    • Rarest
    • Teens and twenties
    • Long bones
    • Nodules of formed hyaline cartilage and myxoid tissue with fibrous septae
  26. Chondrosarcoma
    • 40s and older
    • Conventional (pelvis, shoulder, ribs)
    • Clear cell (younger, makes bone, EPIPHYSIS long bone, knee)
    • Mesenchymal (mixed histo)
  27. Fibrous cortical defect
    • Dev defect
    • Around knee
  28. Nonossifying fibroma
    • Larger than fibrous cortical defect
    • Usually asx, resolve spontaneously
  29. Fibrous Dysplasia
    • Benign
    • No rimming, woven bone
    • Marrow replaced by fibrous tissue
    • CHINESE LETTER
    • Monostonic (ribs>femur>tibia>jaw)
    • Polystotic (femur>skull>tibia>humerus)
    • Poly with endocrinopathies (McCune-Albright) Cafe au lait
  30. Fibrosarcoma
    • Middle aged - eldery
    • Herringbone
    • Usually soft tissue, can be bone
  31. Malignant fibrous histiocytoma
    • Middle aged and elderly
    • Higher grade fibrosarcoma
    • Long bones, pelvic flat bone
  32. Ewing sarcoma
    • =PNET Primitive Neuroectodermal Tumor (when cells neural diff)
    • Ages 10-15
    • t(11;22)(q24;q12)
    • ONION SKIN, but no rimming, surround by soft tissue mass
    • Homer-Wright rosettes - small round blue
  33. Giant Cell Tumor
    • =Osteoclastoma
    • 20s-40s
    • Brown tumor
    • Around knee
  34. Metastatic bone cancer
    • Most common
    • Prostate - blastic
    • Kidney, lung, GI, melanoma - lytic
  35. Osteoarthritis
    • =DJD degenerative joint disease
    • no inflammation
    • progressive erosion of articular cartilage
    • Increased cellularity of articular cartilage, leads to bone eburnation
    • Primary - aging, oligoarticular
    • Secondary - trauma, mono/few joints
    • Women: knees and hands, Men: hips LARGE JOINTS first
    • Osteophyes
    • Synovium congested and fibrosed
    • Dull, achy pain worse with use
    • Heberden's nodules
  36. Rheumatoid Arthritis
    • Proliferative non-suppurative synovits
    • Women, autoimmune
    • Synovial hyperplasia with chronic inflam infiltrate, fibrin leaks in, ankylosis
    • Pannus
    • Rheumatoid nodules in skin, vasculitis
    • Joints swollen, warm, painful, better with use
    • SMALL JOINTS first
    • RF = IgG
  37. JRA
    • Juvenile Rheumatoid arthritis
    • systemic presentation before 16yo
    • Oligoarthritis
    • No RF, yes to ANA
  38. Ankylosing spondylitis
    • Seronegative spondyloarthropathy
    • "Marie-Strumpell, rheumatoid spondylitis"
    • boys
    • HLA-B27
    • Like RA - chronic synovitis leading to bony ankylosis
    • Complications: uveitis, aoritis, amyloidosis
  39. Reactive arthritis
    • Seronegative spondyloarthropathy
    • Prior infection
    • Reiter syndrom: arthrits, non-gonococcal urethritis or cervicitis, and conjunctivitis
    • Men 20s-30s
    • HLA-B27
    • Ankle, knee, feet
    • Tendon sheath synovitis - sausage fingers
  40. Psoriatic arthrits
    • Seronegative spondyloarthropathy
    • 5% pts with psoriasis
    • 35-45yo
    • Large joints: ankles, knees, hips, wrists
    • Sausage fingers
  41. Infectious arthritis
    • Gonococcus
    • Stpah
    • Strep
    • H. flu
    • Fram neg bacilli
    • Salmonella
  42. Tuberculous arthritis
    • Granulomatous synovitis with pannus formation
    • Joint destruction and fibrous ankylosis
    • Hips, knees, ankles
  43. Lyme arthritis
    • Borrelia burgdorferi (spirochete)
    • Migratory and remitting arthitis of large joings: knees, shoulders, elbows, ankles
  44. Gouty arthritis
    • hyperuricemia
    • monosodium urate crystals (thin)
    • distal extremities
    • tophi
  45. Pseudogout
    • Calcium pyrophosphate
    • Elderly
  46. Ganglion vs synovial cysts
    • Ganglion - not continuous with joint capsule
    • Ganglion - pea-sized translucent nodule
    • Ganglion - cystic/myxoid degeneration of connective tissue
    • Synovial - Herniation of synovium
  47. Giant Cell Tumor (of tendon sheath)
    • aka PVNS pigmented villonodular synovitis
    • 20s-40s
    • GCT: nodules (fingers/wrists)
    • PVNS: tangled mat of red-brown folds and finger-like projections (knee/hip/ankle/feet)

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