Unit 1 (Skeletal System)

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nenyabrooke
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194128
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Unit 1 (Skeletal System)
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2013-01-24 21:24:55
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Pathology
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Part 2 of Unit 1.
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  1. how many bones are in the body?
    • axial skeleton: 80 bones
    • appendicular: 126 bones
    • total: 206 bones
  2. list functions of the skeletal system:
    • body support
    • protection
    • movement
    • blood cell production
    • contains 98% of the body’s total calcium
    • contains 75% of the body’s total phosphorus
  3. what two types of tissue make up connective tissue of the bone?
    • compact: dense, the outer portion
    • cancellous: spongy, the inner portion called the medullary canal and contains bone marrow
  4. intricate, weblike bony structure visible on a properly exposed radiograph:
    • trabeculae
    • (bone marrow located between trabeculae)
  5. cancellous bone located within the skull:
    diploe
  6. give the location and function of red bone marrow:
    • located in the bones of the trunk
    • responsible for the production of bone erythrocytes and leukocytes
  7. bone forming cells responsible for bone growth and thickening, ossification and regeneration:
    osteoblasts
  8. where are osteoblasts located?
    they line the medullary canal and are interspersed throughout the periosteum
  9. specialized cells that break down bone to enlarge the medullary canal and allow for bone growth:
    osteoclasts
  10. production and breakdown of bone play an important role in:
    • serum calcium
    • phosphorus equilibrium
  11. classification of bone according to:
    shape (long, short, flat, irregular)
  12. shaft of a long bone:
    diaphysis
  13. expanded end portion of a bone:
    epiphysis
  14. growth zone between the epiphysis and diaphysis:
    metaphysis
  15. cartilaginous growth plate located between the metaphysis and epiphysis of a growing child:
    epiphyseal plate
  16. fibrous membrane that encloses all of the bone except the joint surfaces and is crucial to supplying blood to the underlying bone:
    periosteum
  17. primary site of calcification:
    diaphysis
  18. occurs when a bone is not allowed to bear weight and results in significant decalcification and thinning of the bone:
    disuse atrophy
  19. three types of joints:
    • fibrous/synarthrodial/non-movable 
    • cartilaginous/amphiarthrodial/slightly movable 
    • synovial/diarthrodial/freely movable
  20. located on the ends of bones composing a synovial joint:
    articular cartilage
  21. attaches bone to bone:
    ligament
  22. attaches muscle to bone:
    tendon
  23. lined by a synovial membrane that secretes a lubricating fluid containing mucin,
    albumin, fat, and mineral salts:
    joint capsule
  24. a lubricating fluid secreted by synovial membrane containing mucin, albumin, fat, and mineral salts:
    synovia
  25. the modality of choice for detection and staging of soft tissue tumors involving the extremities:
    MRI
  26. the modality mainly involved in skeletal imaging in cases of trauma:
    CT
  27. the modality with the advantage of the ability
    to look at the entire body at one time:
    nuclear medicine
  28. the modality used to evaluate osteoporosis:
    bone densitometry
  29. the modality that can also tell if a fracture is new or old:
    nuclear medicine
  30. show bone density by evaluating the bone mass of the distal radius, femoral neck, and lumbar spine:
    DEXA (Double-Energy X-Ray Absorbitometry / Bone Mineral Densitometry) Units
  31. give an example of how DEXA units are used:
    a “T-score” is used to reflect standard deviations above or below the 30 national reference population
  32. according to the world health organization criteria, give some important T-score levels:
    • T-score > -1.0 = normal
    • T-score < -1.0 but > -2.49 = osteopenia
    • T-score  < -2.5 = osteoporosis
  33. reports standard deviation above or below a population matched for age, sex, weight, and ethnicity:
    • the Z-score
    • (< -2 suggests bone disease)
  34. a disease in which the formation of osseous tissue is deficient and imperfect, leading to an abnormal fragility of bones:
    • osteogenesis imperfecta
    • aka brittle bone disease
    • ** destructive
  35. a form of "brittle bone disease" that is present at birth:
    osteogenesis imperfecta congenita
  36. a form of "brittle bone disease" in which fractures might not appear for some years after birth and stop once adulthood is reached:
    osteogenesis imperfecta tarda
  37. often noted with "brittle bone disease" is deficient and imperfect formation of:
    • osseous tissue
    • skin
    • sclera
    • inner ear (can affect hearing)
    • teeth
  38. the most common inherited disorder of the skeletal system:
    achondroplasia
  39. name three aspects of achondroplasia:
    • results in bone deformity and dwarfism.
    • the cartilage located in the epiphyses of the long bones does not convert to bone in the normal manner
    • trunk size is normal and extremities are shortened
  40. list some physical manifestations of achondroplasia:
    • adults usually no more than 4 feet in height
    • lower extremities usually less than half the normal length
    • extreme lumbar spine lordosis
    • bowed legs
    • bulky forehead
  41. terms used to characterize a variety of disorders involving an increase in bone density and defective bone contour,where bones are abnormally heavy and compact, but brittle:
    • osteopetrosis/"marble bone"/skeletal modeling
    • ** additive
  42. disorders characterizing osteopetrosis:
    • osteoscleroses: hardening of the bone
    • craniotubular dysplasias
    • craniotubular hyperostoses
  43. all bones are affected by osteopetrosis, but the
    most significant changes occur in the long bones of the extremities, vertebrae,
    pelvis and base of the skull.
    the long bones of the extremities, vertebrae, pelvis and base of the skull
  44. benign, hereditary skeletal anomaly that involves increased bone density in conjunction with fairly normal bone contour, a fairly common form of osteosclerotic osteropetrosis:
    albers-schoonberg disease
  45. a group of hereditary diseases mainly
    resulting in abnormal or defective bone contour of the cranium and long bones:
    craniotubular dysplasias
  46. a disease that includes a variety of fairly rare hereditary diseases, causing both an increase in bone density and abnormal bone modeling; present in childhood; health is generally good, but bony overgrowth
    may entrap cranial nerves, resulting in some dysfunction such as facial palsy or deafness:
    craniotubular hyperostoses
  47. failure of the fingers or toes to separate and the digits have a webbed appearance, occurs during fetal development and can be surgically corrected:
    syndactyly
  48. the presence of extra digits:
    polydactyly
  49. a congenital malformation of the foot that prevents normal weight-bearing and turns the foot inward at the ankle and can be corrected by casting or splinting:
    • talipes (clubfoot)
    • more common in males
  50. a condition where the head of the femur is displaced superiorly and posteriorly, most often from incomplete formation of the acetabulum and can be corrected by casting or splinting:
    • congenital hip dislocation
    • more common in females
  51. abnormal lateral curvature of the spine:
    • scoliosis
    • 80% of cases are idiopathic
    • more common in females
  52. complications that can arise from scoliosis:
    • cardiopulmonary complications
    • degenerative spinal arthritis
    • fatigue
    • joint dysfunction syndromes
  53. an extra vertebra that takes on the characteristics of both vertebrae on each side of a major division of the spine and usually occurs between the thoracic and lumbar spine or between the lumbar spine and sacrum:
    transitional vertebra
  54. if cervical ribs are present, where will they most likely be?
    • usually at C7
    • may exert pressure on the brachial nerve plexus or the subclavian artery
  55. incomplete closure of the vertebral canal at the lamina, common in the lumbosacral area:
    spina bifida
  56. a condition where there is a small defect or gap in a few of the small bones (vertebrae) that make up the spine, but the cord and nerves are normal, with no visible abnormality in back or neurological deficit, but demonstrated radiographically:
    spina bifida occulta (hidden spina bifida)
  57. a condition where the meninges (protective coverings of the spinal cord) and spinal nerves come through the open part of the spine; serious condition that can cause nerve damage and more severe disabilities:
    myelomeningocele (sever form of spina bifida)
  58. a condition where the protective coatings (meninges) come through the open part of the spine like a sac that is pushed out, cerebrospinal fluid is in the sac, and there is usually no nerve damage, though it may cause minor disabilities:
    meningocele (form of spina bifida)
  59. the premature or early closure of any of the cranial sutures, usually causes an overgrowth of the unfused sutures to accommodate brain growth, thus altering the shape of the head:
    craniosynostoses
  60. a congenital abnormality in which the brain and cranial vault do not form, the facial bones may develop, and results in death shortly after birth:
    anencephaly
  61. an infection of the bone and bone marrow, most often caused by staphylococcus delivered via the bloodstream, and generally develops at the ends of the long bones of the lower limbs in adults and the metaphysis in children:
    • osteomyelitis
    • (treated with antibiotic)
  62. a condition where there is an abscess leading to an inflammatory reaction with the bone, in which bone necrosis occurs within 24 to 48 hours:
    osteomyelitis - acute stage
  63. a condition characterized by extensive bone destruction with irregular, sclerotic reaction throughout the bone, though an accurate diagnosis is needed to distinguish it from a neoplastic bone disease:
    osteomyelitis – chronic stage
  64. devascularized bone that appears very dense:
    sequestrum
  65. a shell of new supporting bone laid down by the periosteum around a sequestrum:
    • involcrum
    • (the sclerotic part)
  66. how is osteomyelitis – chronic stage -  best diagnosed?
    by nuclear medicine or MRI because it is not visible radiographicaly until there is a lot of bone destruction
  67. a chronic inflammatory disease of the bone, usually more advanced, often, long untreated and most commonly affects the hip, knee, and spine:
    tuberculosis
  68. tuberculosis of the spine:
    • pott's disease
    • not to be confused with pott's fracture (of the ankle where both malleoli are fractured and ankle joint is dislocatedP
  69. a condition where the ends of the long bones display a “worm eaten” appearance:
    tuberculosis
  70. collective term to denote disorders of the joints including, but not limited to, arthritis, bursitis, tendonitis, and tenosynovitis:
    arthropathy
  71. joint inflammation, acute or chronic:
    arthritis
  72. bacterial causes of infectious arthritis:
    • stapylococcus aureus (staph)
    • streptococci (strep)
    • neisseria gonorrhea
  73. clinical symptoms of acute bacterial infectious arthritis:
    • sudden pain: dolor
    • redness: rubor  
    • swelling: edema
    • fever: pyrexia
  74. radiographic changes due to infectious arthritis:
    • soft tissue swelling
    • joint effusion narrowing visible only about two weeks after the infection.
    • re-calcification and sclerosis is seen during  healing stage 
  75. a condition that affects primarily distal interphalangeal joints (DIP) of hands and feet, with asymmetric destruction, ankylosis of the interphalangeal joints of hands and feet, and reabsorption of the terminal tufts of the distal phalanges:
    psoriatric arthritis
  76. a varient of rheumatoid arthritis that occurs most commonly in young males where the SI joints, calcaneus, and toes are generally affected, and may be referred to as “lover’s heel”:
    reiter's syndrome
  77. a chronic, inflammatory destructive, and sometimes deforming collagen disease that has an autoimmune component triggered by exposure of an immunogenetically susceptible host to an arthritogenic antigen:
    • rheumatoid arthritis
    • usually occurs between 30 and 40 years of age.
    • three times more common in women than men
  78. a condition where synovial tissues proliferate and destroy the cartilage, bone and supporting structures, and a blood test can be used to identify the presence of an autoantibody against gamma globulin, also known as the serologic rheumatoid factor:
    rheumatoid arthritis
  79. symptoms of rheumatoid arthritis:
    • pain, swelling and stiffness of the affected joint
    • periods exacerbations and remissions
    • begins in the peripheral joints
    • life expectancy is reduced by 3 –7 years 
  80. radiographic appearance of rheumatoid arthritis:
    • early in the disease there is soft tissue swelling and osteoporosis
    • later in the disease, cortical erosion with joint space narrowing
    • severe damage – the joint is unstable, may dislocate
    • eventually joints become ankylosed
  81. Criteria for RA diagnosis
    • morning stiffness in and around joints
    • simultaneous soft tissue swelling or fluid of at least three joint areas lasting for 6 weeks 
    • arthritis of the hand joints at least one area swollen in a proximal interphalangeal joint, metacarpophalangial joint, or wrist joint for at least six weeks
    • symmetrical arthritis for at least six weeks rheumatoid nodules or lumps of tissue abnormal levels of serum  radiographic changes demonstrating bone erosion or decalcification
  82. criteria for juvenile rheumatoid arthritis “still’s disease”:
    younger than 16 years at the onset.

    • swelling and effusion in one or more joints
    • for at least six weeks.

    the onset can be assigned to one of three JRA onset types:

    • pauciarticular
    • polyarticular
    • systemic
  83. progressive form of arthritis, mainly involving the spine, in which joints and articulations become ankylosed, especially the SI joints:
    • ankylosing spondylitis (bamboo spine)
    • tends to affect males between the ages of 20 and 40 years with the first symptom as low back pain
  84. a disease of cartilage, resulting from a noninflammatory deterioration of the joint
    cartilage that occurs with the normal wear and tear of aging:
    • osteoarthritis/degenerative joint disease/DJD
    • affects males and females equally
    • patients are usually asymptomatic until 50’s
  85. what is the most common form of arthritis?
    osteoarthritis
  86. radiographic appearance of osteoarthritis:
    • loss of cartilage demonstrates a narrowed joint space.
    • overgrowth of cartilage occurs on the peripheral surfaces of the joint and often calcifies, which results in osteophytes or bone spurs. The spurs help distinguish it from other forms of osteoarthritis.
    • no stopping the progression
    • pain  and stiffening of the joints
    • joint replacements relieve pain
  87. cystic swelling that develops in connection with a tendon sheath, usually on the back of the wrist:
    ganglion
  88. inflammation of soft tissue stuctures may be caused by:
    • acute or chronic trauma (house maids knee)
    • acute or chronic infection
    • inflammatory arthritis
    • gout
    • rarely – pyogenic or tuberculous organisms
  89. treatments for bursitis and tendonitis:
    • nonsteroidal antiinflammatory agents
    • analgesics
    • severe cases – corticosteroid injecitons
    • surgery – tendons and bursae ossify
  90. inherited metabolic disorder in which excess amounts of uric acid are produced and deposited in the joint and adjacent bone:
    • gouty arthritis
    • occurs more in males
    • commonly affects the metatarsophalangeal joint of the great toe
  91. be familiar with gouty arthritis: bony changes, long-term complications, treatment
    • bony changes: nerosion with overhanging edges
    • long-term complication: kidney stones (appear radiolucent radiographically)
    • treatment: medication for excretion of uric acid by the kidneys or to inhibit the production of uric acid
  92. a radiographically visible decrease in bone density that occurs as a result of osteoporosis or osteomalacia:
    osteopenia
  93. soft tissue neck injuries from a variety of causes, loss of lordosis is a common indication:
    whiplash
  94. a cleft, or breaking down, of the body of a
    vertebra between the superior and inferior articular processes:
    spondylolysis
  95. appears radiographically as a “collar” or “broken neck” of the scotty dog (pars interarticularis):
    spondylolysis
  96. forward slippage of the vertebral column off a vertebra occurs because of spondylolysis:
    spondylolisthesis
  97. neoplastic disease can be a benign disease or malignant, and diagnosis of bony abnormalities are made on the basis of:
    • patient’s age
    • pattern of bone destruction
    • location of the tumor
    • tumor position within the bone
  98. the most common benign tumors:
    • osteoma
    • osteochondroma
    • giant cell tumor
  99. the most common benign bone tumor, affects males 3 times more often than females, and rises from the metaphysis:
    osteochondroma “exostosis”
  100. a condition where excessive bone growth may appear as singular or multiple lesions and are normally diagnosed in childhood or adolescence:
    exostoses
  101. a group of tumors with numerous multinucleated osteoclastic giant cells that may be benign or malignant. 35% recur after surgical excision and 15% are aggressively malignant from the beginning:
    • giant cell tumor/osteoclastoma
    • produces the classic "soap bubble" look
  102. a slow-growing benign tumor composed of cartilage that grows in the marrow space appears as radiolucent lesions containing small, stippled calcifications:
    endochondroma
  103. slow-growing benign multiple growths composed of cartilage, may occur in childhood and may turn malignant:
    endochondromatosis
  104. a wall of fibrous tissue filled with fluid that frequently occurs in long bones of children, most commonly in the humerus and proximal femur, and appears as a radiolucent lesion with well defined margins from the normal bone surrounding the lesion:
    simple bone cyst
  105. an idiopathic condition that is not a true bone cyst, but occurs in metaphysis of long bones in pts under age 20 and consists of numerous blood filled arteriovenous communications:
    • aneurysmal bone cyst
    • slow growing
    • treated by surgery or radiation therapy for difficult areas (like vertebral column)
  106. benign tumor of the skeletal system that is less than 2 cm in dimension, produces a lytic lesion called a nidus, and is very distinctive because it has an area of erosion surrounded by a zone of dense, sclerotic bone:
    osteoid osteoma
  107. benign tumor of the skeletal system that is similar to the osteoid osteoma, but larger and frequently involve the spine and pain may not be present, but not associated with a marked bony reaction:
    osteoblastoma
  108. primary malignant tumors:
    • osteosarcoma
    • ewing’s tumor
    • multiple myeloma
  109. the most common primary malignancy of the skeleton except for myeloma, it arises from osteoblasts and is most frequently found in the metaphyses of long bones, and about 50% affect the knee. it can occur at any age, but 75% occur under 20 years of age:
    osteosarcoma/osteogenic sarcoma
  110. condition that radiographically gives an appearance of a sunray or sunburst, and radiographic findings vary greatly in appearance:
    osteosarcoma/ osteogenic sarcoma
  111. a primary malignant bone tumor that occurs between the ages of 5 to 15 years and rarely after age 30, it is more common in males than in females and more common in whites and has a radiographic “onion skin or laminated appearance”:
    ewing's sarcoma
  112. a malignant tumor of cartilaginous origin and is composed of atypical cartilage:
    chondrosarcoma
  113. the most common malignant tumor of the skeleton:
    • metastatic disease from carcinomas
    • with secondarybone tumors of any origin far outnumbering primary bone tumors
  114. primary vs. secondary lesion:
    • primary: periosteal response; soft tissue masses; lesion longer than 10cm; tumors that expand bone; solitary lesion
    • secondary: lesion between 2 & 4cm; multiple lesions
  115. common primary sites for metastatic bone cancer:
    • breast
    • lung
    • prostate
    • kidney
    • thyroid
    • bowel

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