Ch 20

Question 1

1. Musculoskeletal system aka ___
2. Tissues include (3)
3. Integrates with ___

Answer 1

1. Locomotor system
2. Osseous, muscular, and connective
3. Nervous System

Question 2

MSK has what three jobs?

Answer 2

Form, function, protection (kinetics/ biomechanical movement)

Question 3

MSK - ___ system and ___ storage

Answer 3

hematopoietic, mineral

Question 4

1. Define dysostosis

2. what are the four characteristics w/ it

Answer 4

1. developmental anomaly of bone
2. 1. abnormal mesenchymal migration
   2. defective ossification of fetal cartilage
   3. sporadic (isolated) or part of syndrome
   4. homeobox gene alterations

Question 5

Define homeobox gene

Answer 5

structural development during embryologic development

Question 6

What are three subtypes of dysostosis?

Answer 6

1. Aplasia
2. Supernumerary digits
3. abnormal fusion of bones

Question 7

Explain aplasia

Answer 7

absent of incomplete development, abnormal function

Question 8

1. Define Dysplasia

2. give examples of both bone and cartilage

Answer 8

1. mutations interfere with growth or homeostasis (dwarfism)

2. B = osteodysplasia, C = chondrodysplasia

Question 9

1. Dysostosis: ___ syndrome
2. it is ___ with ___
3. ___ deformity

Answer 9

1. Klippel Feil
2. idiopathic w/ congenital fusion (any 2 C vertebrae)
3. Sprengel’s

Question 10

Syndactyly: the MC ___

Answer 10

congenital malformation of the limbs

Question 11

1. Osteogenesis imperfecta aka ___
2. Mutations of ___
3. it is ___ dominant
4. abnormal collagen leads to ___
5. It can affect (5)

Answer 11

1. brittle bone disease
2. type 1 collagen
3. autosomal
4. premature breakdown
5. ECM :eyes, inner ear bones, skin, joints, and teeth

Question 12

O.I. - Range of severity has two types:

1. Type 1 = ___
2. Type 2 = ___

Answer 12

1. normal lifespan

2. lethal in utero (cerebral hemorrhage, respiratory failure)

Question 13

Type I of O.I. -

1. Abnormal collagen of ___
2. diagnosed in ___
3. what can occur (6)?

Answer 13

1. sclera
2. childhood
3. fractures, extremity bowing, scoliosis, ligamentous laxity (dislocations), hearing loss, short stature

Question 14

1. O.I. has what sign?

2. What were they treated with?

Answer 14

1. Zebra stripe

2. bisphosphonates (cyclical)

Question 15

What is the MC form of dwarfism?

Answer 15

Achondroplasia

Question 16

Achondroplasia -

1. decreased ___ equals decreased ___ (MC in (2))
2. ___ mutation which inhibits ___
3. % are spondaneous or autosomal dominant
4. What are four signs?

Answer 16

1. Cartilage synthesis, growth plate expansion, femur and humerus
2. Fibroblast growth factor receptor (FGFR3), epiphyseal (growth plate) chondrocytes
3. 75% and 25%
4. Short proximal extremities, lower extremity bowing, frontal bossing, midface hypoplasia (low nasal bridge)

Question 17

Causes of dwarfism (4)?

Answer 17

various

1. Turner syndrome
2. hypothyroidism
3. malnutrition
4. O.I.

Question 18

Achondroplasia -

1. ratio
2. What can happen to the spine (5)?
3. How can it cause death?
4. What is a sign of achondroplasia dealing with the hand?

Answer 18

1. 1: 10,000
2. hyper lordosis or kyphosis at birth, bullet vertebrae, scoliosis, spinal stenosis (foramen magnum stenosis, spinal canal stenosis)
3. Brain stem compression or cardiovascular abnormalities
4. trident hand

Question 19

1. What is the name given to the fatal type of achondroplasia?
2. Ratio?
3. Explain

Answer 19

1. Thanatophori dwarfism
2. 1: 20,000 births
3. extremely small thorax and shortened long bones (perinatal respiratory failure)

Question 20

Osteopetrosis -

1. Two ways of describing?
2. ___ stenosis leads to ___
3. ___ fills and leads to deranged ___
4. Treatment?

Answer 20

1. decreased osteoclast mediated bone resorption or skeletal sclerosis (stone like which increases fractures)
2. foraminal, cranial nerve palsies
3. medullary cavity, hematopoieses (hepatosplenomegaly or recurrent infections/anemia)
4. stem cell replacement

Question 21

Osteopetrosis has no ___ with ___ deformity

Answer 21

medulla, erlenmeyer flask

Question 22

Osteoporosis -

1. Most important form of ___
2. decreased ___ equals increased ___
3. What are the two categories?
4. Generalized has both primary and secondary subtypes, explain each
5. Basically the disease attacks more on the ___ and less on the __

Answer 22

1. osteopenia
2. bone mass, porosity (bony fagility/fractures)
3. Localized (disuse) and Generalized to entire skeleton
4. • primary = is the MC: senile, postmenopausal
   • secondary = various causes: neoplasia, hyperparathyroidism, nutrient deficiency, drug exposure (corticosteroids, alcohol, smoking)
5. inside, outside

Question 23

Osteoporosis -

1. MC impacts ____
2. What does it cause?
3. Locations?

Answer 23

1. trabecular bone (cancellous, spongy)
2. thinned cortex
3. VB, femoral neck, calcaneus

Question 24

Generalized Osteoporosis - Primary Osteoporosis:
SENILE
1. ___ related, normal phenomenon
2. decreased __/___activity
3. ___ retain normal activity causing an imbalance
4. % bone loss per year, beginning at what age?
POSTMENOPAUSAL
1. decrease ___ accelerates bone loss
2. % or P.M females, % of age matched males

Answer 24

1. age
2. GFs/osteoblast
3. osteoclasts
4. 0.5%, mid 20s
5. estrogens
6. 50%, 3%

Question 25

Osteoporosis - 1. Maximize bone density in ___ 2. What helps keep bone density? 3. What is MC decreased in females?

Answer 25

1. young adulthood 2. diet and regular exercise (resistance, athletics) 3. Ca++ and Vit. D supplementation

Question 26

Osteoporosis - 1. loss of ___ homeostasis 2. Risks (6) 3. asymptomatic until? 4. Where are two common fracture sites? 5. Explain each

Answer 26

1. osteoclast/blast 2. increased age, females, sedentary, family history, eating disorders, malnutrition/malabsorption 3. skeletal fragility 4. -Vertebral compression fracture (thoracolumbar): dowager's hump, kyphoscoliosis - Femoral Neck fracture: disabling, risk for pulmonary emboli

Question 27

What machine is used to measure osteoporosis?

Answer 27

DEXA - dual energy xray absorptiometry

Question 28

Osteoporosis - 1. ___ are not sensitive enough, explain 2. List three ways on how to prevent

Answer 28

1. X-rays, non diagnostic for osteoporosis and require 30-40% decreased bone mass 2. 1. Physical activity/ regular exercise (best prior to age 30) 2. dietary calcium and vitamin D 3. antiresorptive pharmacologic agents (bisphosphonates)

Question 29

Paget Disease - 1. otherwise known as? 2. __ phase leads to ___phase leads to exhaustion of cellular activity known as ___phase 3. basically means increased ___, weak, with a ___ appearance 4. regional ___ activity 5. Excessive ___ consisting of disorganized ___ bone making bone? 6. caused by?

Answer 29

1. osteitis deformans 2. lytic, mixed lytic and blastic, sclerotic 3. bone mass, shaggy 4. osteoclastic 5. bone formation, lamellar, enlarged and fragile 6. increased serum alkaline phosphatase (byproduct of osteoblast activity), idiopathic, paramyxoviridae antigens on osteoclasts

Question 30

Paget Disease - 1. MC associated with symptoms or assymptomatic (70-90%) 2. becoming less ___ and less ___ 3. features depend on (2), but may include (4)

Answer 30

1. asymptomatic (incidental x-ray findings, relatively benign) 2. common, severe 3. site and severity, bone pain (MC in neck and back), osseous deformation/fracture/increase vascularity), nerve compression (headache, visual/auditory), and 1% transition into sarcoma (poor prognosis)

Question 31

Paget Disease - 1. Lesions: solitary % and multiple % 2. % of cases involve the axial skeleton or femur including (3) 3. pathological ___ fractures or ___ 4. Adults: MC Dx at age ___ 5. Risks: males or females, parts of the world 6. treatment?

Answer 31

1. 15%, 85% 2. 80%, pelvis, sacrum, skull 3. "chalkstick", bowing 4. 70 5. males (2x), europe, new sealand, australia (U.S. only 1-3%) 6. bisphosphonates - intended to slow lytic phase

Question 32

What disease is related to mosaic pattern/jigsaw puzzle?

Answer 32

Paget Disease

Question 33

What three diseases can refer to "ivory vertebra sign"?

Answer 33

1. paget disease 2. metastatic cancer (prostate) 3. lymphoma

Question 34

Vit D Deficiency - 1. defective ___ 2. hypocalcemia leads to ___ which demineralizes bone 3. Name when associated with children, explain 4. name when associated with adults, explain

Answer 34

1. mineralization (dietary/UV deficiency or abnormal metabolism) 2. PTH (unmineralized bony matrix: soft/brittle) 3. Rickets, poor growth plate mineralization, more severe 4. osteomalacia, remodeled bone is undermineralized, mild, similar to osteoporosis fractures, associated with hyperparathyroidism

Question 35

Hyperparathyroidism - 1. parathyroid glands secrete ___, maintains ___ 2. Explain primary hyperparathyroidism 3. explain secondary hyperparathyroidism 4. Excessive PTH: MC from ___ %, __ osteoclast activity, increased ___ 5. Dx : (2), MC nonmalignant cause of ___

Answer 35

1. PTH, serum Ca++ 2. autonomous PTH production 3. renal failure, mild 4. adenoma 80%, increased, renal tubule resorption of Ca++ and Vit. D synthesis 5. hypercalcemia, parathyroid immunoassay, hypercalcemia

Question 36

Hyperparathyroidism - 1. >50% are ___ 2. MC people who get this are ___ 3. excessive ___ activity impacts ___ 4. resorption of (2) bone 5. replaced by ___ 6. Possible ___

Answer 36

1. asymptomatic 2. post-menopausal women 3. osteoclast, skeletal homeostasis 4. cortical and trabecular 5. loose connective tissue 6. "brown tumor"

Question 37

Hyperparathyroidism - 1. What are four results? 2. Which is the MC? 3. Characterized by a "___", which are? 4. X-rays of this are termed ___

Answer 37

1. renal stones, peptic ulcers, pathologic fractures, bowing of long bones 2. renal stones 3. salt and pepper skull, small erosions 4. Rugger-Jersey spine

Question 38

Brown Tumor - 1. very ___ lead to ___ leads to ___ leads to ___ 2. Not a true ___

Answer 38

1. brittle/fracture, hemorrhage, macrophages, fibrosis | 2. neoplasm/tumor

Question 39

Hyperparathyroidism - 1. Features are ___ 2. list 8 3. treatment depends on ___ 4. list 3 5. reversible with ?

Answer 39

1. widespread 2. bone pain, fractures, deformation, kidney stones, nausea, anorexia, fatigue, decreased cognition 3. cause 4. drinking water, physical activity, avoidance of diuretics (water pills) 5. normalization of PTH levels

Question 40

Fractures - 1. ___ osseous pathology 2. What are the five categories?

Answer 40

1. commone 2. -complete vs incomplete - closed - compound (open) - comminuted - displaced

Question 41

Fractures - Categories 1. Complete vs incomplete: MC among ____ 2. closed: overlying tissue is ___ 3. compound (open): skin is ___, risk for ___ 4. comminuted: means? 5. displaced: ___ segment is ___

Answer 41

1. children 2. intact 3. ruptured, infection 4. fragmented/splintered 5. distal, malaligned

Question 42

Fractures - 1. pathological fracture is ___ 2. list three examples 3. Explain a stress fracture, MC where? 4. What is overloading?

Answer 42

1. site of disease 2. bone cyst, tumor, brown tumor 3. develops slowly over time (repetitive injury), MC in the lower legs and feet esp tibia 4. micro fractures accumulate

Question 43

Fractures - Repair 1. Ruptured vessels lead to ___ lead to ___ lead to ___ 2. woven bone leads to ___ in (time___) 3. endochondral ossification leads to ___(time___) leads to ___(time____)

Answer 43

1. fibrin mesh, inflammation of cells and fibroblasts, soft tissue callus, noncalcified (1 week) 2. chondroblasts in 2-3 weeks 3. bony callus (6-8 weeks), continual remodeling (lifetime)

Question 44

Fractures - | 1. What are six factor of delayed healing?

Answer 44

1. nonunion 2. comminuted fracture 3. inadequate immobilization 4. infection 5. nutritional deficiencies 6. advanced age

Question 45

Fractures - Delayed Healing 1. Nonunion: ___ formation 2. Comminuted fracture: ___ of fragments 3. Inadequate immobilization: disrupts ___ 4. infection: MC occurs with ___, requires ___ 5. nutritional deficiencies: list three examples

Answer 45

1. large callus 2. resorption 3. callus formation, too mobile 4. compound (open) fractures, microbial eradication 5. Ca+++, phosphorus, Vit D

Question 46

Avascular Necrosis - 1. Aka ___ 2. ___ leads to ____ 3. MC cause ___ via ___ 4. list 5 other causes 5. can be ___ or ___ 6. it gets worse with (3)

Answer 46

1. AVN, osteonecrosis 2. ischemia leads to bony necrosis (infarction) 3. vascular disruption, fracture 4. corticosteroids, embolism (sickle cell, bends), vasculities, irradiation, idiopathic 5. asymptomatic (inside of bone) or painful (outside of bone) 6. time, physical activity, pathologic fracture

Question 47

Avascular necrosis - 1. Subchondral areas (5) 2. may preserve ___ 3. possible ___: risk for ___ 4. eventual new bone growth: "___"

Answer 47

1. hip, knee, shoulder, wrist, ankle 2. cortex 3. collapse, OA 4. "creeping substitution"

Question 48

AVN - 1. may be __ or ___ 2. joint called ___

Answer 48

1. subchondral or medullary | 2. osteochondritis dissecans

Question 49

Osteomyelitis - 1. AKA "____" 2. ___ infection 3. ___ destroy bone 4. ___ is MC but also can be ___ 5. What are the three modes of infection?

Answer 49

1. "bone-marrow-inflammation" 2. marrow 3. leukocytes 4. acute, chronic 5. hematogenous (sepsis), adjacent infection, or traumatic implantation

Question 50

Osteomyelitis - Modes of infection 1. hematogenous (sepsis): is it very rare or MC? 2. adjacent infection: affects (2) 3. traumatic implantation: results in (2) 4. ___ means orthopedic instrumentation

Answer 50

1. MC 2. joint, soft tissue 3. compound fracture or surgery 4. iatrogenic

Question 51

Osteomyelitis - 1. symptoms (3) 2. What are the two categories? 3. mixed ___ 4. % unable to identify agent 5. considered to be ___, which means? 6. What are three types of pyogenic? Which is MC

Answer 51

1. acute fever, malaise, throbbing pain 2. Pyogenic bacteria and mycobacterium tuberculosis 3. bacterial infection 4. 50% 5. pyogenic, pus forming bacteria 6. Staphylococcus aureus (MC), Neonates ( E. coli and Group B streptococci), sickle cell disease (salmonella spp)

Question 52

Pyogenic osteomyelitis - 1. features (3) 2. How do you find it? 3. explain involucrum 4. explain sequestrum 5. explain draining sinus

Answer 52

1. acute fever, malaise, and throbbing pain 2. radiography, biopsy, blood culture 3. reactive woven/lamellar bone, surrounds infected bone 4. dead bone at site of infection 5. ruptured periosteum leads to an abscess in the surrounding soft tissue

Question 53

Tuberculous Osteomyelitis - 1. AKA ___ 2. % of ___ TB cases 3. Found in ___ 4. associated with ___ 5. bony destruction leads to ___

Answer 53

1. skeletal TB 2. 3%, pulmonary 3. recent immigrants and immunocompromied, developing countries 4. caseous granulomas 5. sever deformation

Question 54

Tuberculous osteomyelitis - 1. How is it spread? Which is MC 2. multifocal = ___ 3. solitary = (2) 4. ___ disease leads to ___

Answer 54

1. hematogenous (MC), and lymphatic 2. immunodeficiency 3. long bones and vertebrae 4. Pott, neurologic deficits

Question 55

Bone Tumors (primary bone tumors) - 1. Is it more common to spread to bone or to originate from bone? 2. explain what it means by diverse features 3. Features include (8), Which is the MC? 4. Nomenclature includes (3)

Answer 55

1. spread there 2. benign or aggressively malignant 3. bone pain, gradually increases (MC), fatigue, pyrexia, cachexia, anemia, pathological fracture, unexplained bony mass (superficial) 4. bony matrix, cartilaginous, fibrous tissue

Question 56

Bone Tumors - 1. List 6 characteristics of low back pain from cancer 2. combination of (3) 3. % sensitivity, % specificity

Answer 56

1. -> 50yo - history of cancer - unexplained wt loss (cachexia) - failure to improve > 1 mo conservative care - unrelieved with bed rest - pain duration > 1 mo 2. > 50, history of cancer, and cachexia 3. 100%, 60%

Question 57

Bone Tumors - 1. (2) producing tumors are MC 2. ___ tumors are MC than ___ 3. What are two examples of tumors? 4. Primary bone cancer is called ___ 5. list three examples 6. elderly have __ risk of bone CA

Answer 57

1. matrix and fibrous 2. benign, malignant 3. osteochondroma and fibrous cortical defects 4. sarcomas 5. osteosarcoma, chondrosarcoma, and Ewing sarcoma 6. increased

Question 58

Bone Tumors - 1. list 6 additional risks 2. MC: ___ development, age?, benign or malignant, symptomatic or asymptomatic? 3. Speed of growth?, which bones are affected, causes? 4. determine type based on (2) 5. osteosarcoma: age and location 6. osteoma: age and location

Answer 58

1. RB or TP53 mutations, AVN, chronic osteomyelitis, Paget disease, irradiation, orthopedic hardware 2. early,

Question 59

Bone forming tumors - 1. ___ growth (___ producing) 2. ___ bone, variable ___ 3. benign or malignant? 4. how to we find them? 5. List the 3 main types and whether they are benign or malignant

Answer 59

1. bony, matrix 2. woven, mineralization 3. both 4. biopsy 5. osteoma B, osteoid osteoma and osteoblastoma B, osteosarcoma M

Question 60

Osteoma - 1. developmental ___ 2. ___ growth, very similar to ___ 3. exophytic, ___ and ___ 4. Completely ___, meaning> 5. MC locations 6. age range? 7. list three concerns

Answer 60

1. anomaly 2. reactive, normal bone 3. solitary and slow growing (superficial and hard) 4. benign, noninvasive (woven/lamellar obone) 5. head (skull, facial) and neck 6. middle age 40-50yo 7. cosmetic, local mechanical problems, sinus obstruction

Question 61

Osteoid osteoma and osteoblastoma - 1. benign or malignant 2. vary by (2) 3. Who is at risk (sex and age) 4. ___ lesion, meaning? 5. List two examples 6. list a very important feature

Answer 61

1. benign 2. size and location 3. male (2X) age 10-20yo 4. bound to oval, near cortex and well circumscribed 5. Central "nidus" (radiolucent) and rim of sclerosis (prominent in osteoid osteomas) 6. localized nocturnal pain

Question 62

Osteoid osteoma and osteoblastoma - * osteoid osteoma* 1. size 2. location with 2 examples 3. pain? 4. does asprin help? * osteoblastoma* 1. size 2. location 3. Pain? 4. does asprin help 5. treatment

Answer 62

1. small 2. near cortex of long bones, proximal femur, tibia 3. well localized nocturnal 4. yes 1. large 2. vertebral process: spinous, transverse 3. mild and poorly localized 4. no 5. excision, possible irradiation (malignant transformation is very rare)

Question 63

Osteosarcoma - 1. benign or malignant 2. ___ producing sarcoma (mesenchyme) 3. MC ___ 4. Risks: (age and sex) 5. If young explain 6. if older explain

Answer 63

1. aggressive malignancy 2. bone 3. primary bone CA 4. adolescents, male (1.5X) 5. 10-20yo (75%) (any age sarcoma) 6. >40, comorbid bone pathology (paget disease, AVN and irradiation)

Question 64

Osteosarcoma - 1. metaphysis of ___ bones 2. list three examples 3. ___ reaction, explain 4. immature bone - explain

Answer 64

1. long 2. knee 60%, hip 15%, shoulder 10% 3. periosteal, destroys cortex "sunburst" 4. mineralized or unmineralized (osteoid formation)

Question 65

Osteosarcoma - 1. it is very ___ 2. size, mixes __ and ___ lesion 3. ___ and ___ mass 4. (2) distruction 5. list two characteristics 6. risk for ___

Answer 65

1. aggressive 2. large, lytic and blastic 3. painful, rapidly enlarging 4. periosteal and medullary 5. codman triangle, sunburst, spiculations 6. pathological fractures

Question 66

Osteosarcoma - 1. % have mets to ___ at finding 2. ___ gene mutations 3. ___ syndrome: 1000 increased risk

Answer 66

1. 10-20%, lungs 2. sporadic RB gene or TP53 3. retinoblastoma

Question 67

Osteosarcoma - 1. ___: primary osteosarcoma 2. age 3. % long term survival rate 4. treatment 1. ___: secondary osteosarcoma 2. age 3. related diseases (2) 4. how does it respond to therapy 5. outcome

Answer 67

1. typical 2. 10-20 3. 60-70% 4. amputation or chemotherapy 1. co morbid 2. >40 3. paget disease, multiple myeloma 4. poorly 5. typically fatal

Question 68

What is it called when they amputate a limb but reattach a prosthetic backwards?

Answer 68

Rotationplasty or Van-Ness rotation

Question 69

Cartilage-forming tumors - 1. What two types of cartilage? 2. benign or malignant 3. What are the three main parts?

Answer 69

1. hyaline or myxoid 2. both, MC benign 3. osteochondroma, chondroma, chondrosarcoma

Question 70

Osteochondroma (exostosis) - 1. benign or malignant 2. ___ outgrowth 3. ___ cartilage 4. who is at risk (sex and age) 5. rare or common?

Answer 70

1. benign 2. cartilage- capped 3. hyaline 4. males (3X) 10-30yo 5. common (incidental finding)

Question 71

Osteochondroma - 1. What are the two types? 2. Solitary: ___, and MC in what age group 3. Multiple hereditary osteochondromas: genetic ___, ___ onset 4. this causes an increased risk for ___

Answer 71

1. solitary and multiple hereditary osteochondromas 2. sporadic, adolescence/young adults 3. mutated TSGs, childhood 4. sarcomas (little chance for transition into chondrosarcoma)

Question 72

Osteochondroma - 1. Originate on metaphysis of ___ bones, near ___ 2. List five examples and point out the MC 3. size 4. characteristics (2) 5. growth rate 6. rare after ___ 7. ___ merges with ___, may be ___

Answer 72

1. long, growth plate 2. Knee MC, pelvis, scapula, ribs, hands/feet 3. 1-20cm 4. sessile or pedunculated 5. slow growing 6. skeletal maturity 7. cortex, host bone, painful (fracture or impingement)

Question 73

Chondroma - 1. benign or malignant? 2. ___ cartilage 3. What are the two types based on location? 4. age 5. ___ lesions, metaphysis, meaning? 6. ___ lesions = ____ disease, AKA ___ or ____, MC uni or bilateral?

Answer 73

1. benign 2. hyaline 3. enchondroma (medullary) and juxtacortical chondroma (bone surface) 4. 20-50 5. solitary, tubular bones of hands (MC) and feet 6. multiple, Ollier, multiple enchondromas or enchondromatosis, unilateral

Question 74

Chondroma - 1. describe 2. size 3. ___ lucency 4. "___" sign 5. Center? 6. symptoms or asymptomatic, or possible pathologic ___ 7. MC found ___ 8. % of knee MRIs 9. % of all benign bone tumors

Answer 74

1. gray-blue, translucent (hyaline) nodules | 2.

Question 75

Chondrosarcoma - 1. ___ common than osteosarcomas 2. sex and age 3. location 4. expansile "___" 5. (2) cartilage 6. may thin or thicken?

Answer 75

1. less 2. males (2X) and 40-60 3. intramedullary (MC) or jextacortical, pelvis, shoulder, ribs, prox femus, rare in distal extremities 4. glistening mass 5. neoplastic hyaline and myxoid 6. thicken or erode cortex

Question 76

Chondrosarcoma - 1. ___ mass 2. (2) cartilage expanded within the ___, formed a sessile (paracortical) mass

Answer 76

1. sessile | 2. hyaline and myxoid, medulla

Question 77

Chondrosarcoma - 1. ___ mass 2. Two types 3. Low-grade: it is the ___, ___ growing (indolent), size, reactive ____ of cortex, ___ survival rate 4. High-grade: cortical ___, size, soft tissue mass of ___, % mets (2 locations), survival rate 5. treatment 6. high ___= high risk of ___

Answer 77

1. painful 2. low-grade and high-grade 3. MC, slow, small, thickening, 80-90% 5 year survival 4. erosion, large, cartilaginous, 70%, lungs (MC) or other bones, poor prognosis 5. wide excision, chemotherapy 6. radiolucency, high-grade

Question 78

Miscellaneous Bone tumors - 1. ___ variety 2. List two fibrous and fibro-osseous tumors 3. list 2 bone tumors with unique cells

Answer 78

1. wide 2. Fibrous cortical defect (nonossifying fibroma), Fibrous Dysplasia 3. Ewing Sarcoma (primitive neuroectodermal tumor (PNETs)) and Giant cell tumor of bone

Question 79

FCD and NOF - 1. ___ lesions: (2) 2. reaction to ___ injury 3. not a true ___ 4. who gets this 5. % of benign bone tumors 6. ___ radiolucency, thin ___ 7. MC size? 8. NOF size

Answer 79

1. benign, fibroblasts and macrophages 2. periosteal 3. neoplasm 4. 30-50% of all children > 2 years, adolescents 5. 5% 6. well-defined, sclerosis 7. small 8. larger lesion

Question 80

FCD and NOF - 1. location 2. % are multiple 3. MC symptomatic or asymptomatic 4. ___ is rare, possible with pathologic ___ 5. how long does it last 6. biopsy is not generally required except if ____

Answer 80

1. eccentric, metaphysis (knee: distal femur (MC), proximal tibia) 2. 50% 3. asymptomatic 4. pain, fracture 5. self resolve within 2-3 years 6. fractured NOF

Question 81

Fibrous dysplasia (FD) - 1. ___ lesion, failure of ____ 2. well ____, location, size 3. possible ___ 4. List the 3 categories, all from ___ mutations 5. Monostotic: ___ involvement 6. Polyostotic: ___ involvement 7. Polyostotic + café-au-lait spots and endocrinopathy: AKA ___

Answer 81

1. benign, bony differentiation (arrested development of bone) 2. circumscribed, intramedullary, variable 3. osseous deformation 4. Monostotic, polyostotic, polyostotic + café au lait spots and endocrinopathy 5. single bone 6. multiple bone 7. McCune-Albright syndrome

Question 82

Monostotic FD - 1. % 2. age 3. found (6) 4. symptomatic or asymptomatic 5. found how 6. minimal bony ____

Answer 82

1. 70% 2. 10-30 3. ribs, femur, tibia, jawbones, calvaria, humerus 4. asymptomatic 5. incidental finding6. distortion/enlargement

Question 83

Polyostotic FD - 1. % 2. No _____ 3. Age 4. severe ___, ___ is common 5. found (5) 6. ___ involvement: % of cases 7. ____ margins, ____ appearance 8. treatment

Answer 83

1. 27% 2. endocrinopathy 3. late childhood/adolescence 4. deformation, pathologic fracture 5. femus, calvaria, tibia, humerus, pelvis 6. craniofacial, 50% 7. well defined, fround glass 8. excision, ortho hardware

Question 84

McCune-Albright Syndrome - 1. % of FD cases 2. affects (3), explain 3. ___ hyperfunction (3) 4. ___ severity 5. skin and bony lesions are commonly uni or bilateral, (2)

Answer 84

1. 3% 2. skeletal, skin, and endocrinopathy, café au lait spots, precocious puberty (MC females) 3. endocrine, hyperthyroidism, pituitary adenoma, adrenal hyperplasia 4. variable 5. unilateral, femur and tibia

Question 85

Ewing Sarcoma and Primitive Neuroectodermal Tumor (PNET) - 1. variants of the same ____ 2. t___ or t___ 3. "___" of bone 4. What happens 5. location

Answer 85

1. malignant tumor 2. (11:22) or (21:22) 3. small round cell tumor 4. hemorrhage and necrosis 5. medulla and cortex

Question 86

Ewing Sarcoma - 1. undifferentiated or neural differentiation 2. % of primary bone CA 3. 2nd MC ____

Answer 86

1. undifferentiated 2. 10% 3. pediatric bone CA

Question 87

PNET - 1. undifferentiated or neural differentiation 2. AKA ___

Answer 87

1. neural differentiation | 2. homer-wright rosettes

Question 88

Ewing Sarcoma and PNET - 1. MC age? 2. sex and race risks 3. ___ mass, location, example 4. mimics infection by (3) 5. Periosteum: "___" or "___" 6. % survival rate, % complete remission 7. may invade surrounding___, means?

Answer 88

1. 10-20 2. Males, Caucasians (9X) 3. painful enlarging, long bone diaphysis, femur (MC) or pelvis 4. pyrexia, leukocytosis, increased ESR 5. onion-skinning or sunburst 6. soft tissues, worse prognosis

Question 89

Secondary metastasis to bone - 1. color? 2. Location 3. MC forms in adults (3) 4. MC forms in children (5)

Answer 89

1. lytic (dark black), blastic (bright white), mixed (MC) 2. axial skeleton, proximal femur/humerus, red marrow (statsis, nutrient rich) 2. prostate (blastic), breast (lytic), lung 3. neuroblastoma, Wilms tumor, osteosarcoma, Ewing Sarcoma, rhabdomyosarcoma

Question 90

Joints - 1. ___ variety 2. list 5 types of arthritis

Answer 90

1. wide | 2. degenerative (OA, DJD), Immune-mediated (RA, AS), Metabolic (gout, pseudogout (CPDD)), infectious, and neoplastic

Question 91

Oseoarthritis (OA, DJD) - 1. often confused with ___ 2. __ joint disorder 3. Major sours of ___ in ___ 4. degeneration of __ cartilage (__) 5. decreased __ = ___ breakdown 6. not necessarily ___ 7. subchondral changes are ___ 8. mechanical wear and tear (___) 9. ___ influence

Answer 91

1. RA 2. MC 3. morbidity in elderly 4. articular, collagen 5. proteoglycans, matrix 6. inflammatory 7. secondary 8. age 9. genetic

Question 92

Osteoarthritis - 1. Primary OA: explain 2. Secondary: explain 3. % of OA occurs in __, secondary OA 4. common locations include (4) 5. Female common locations 6. male common locations

Answer 92

1. insidious, oligoarticular (few), no trauma, adults 2. predisposing injury or deformity, trauma (obesity), deformity, systemic disease 3. 5. children 4. spine (C and L), DIP joints, 1st MCP joint, 1st TMT joint 5. knees and hands 6. hips

Question 93

Osteoarthritis - 1. degeneration of __, explain 2. explain 5 steps of what is happening 3. ___ may develop, secondary to degeneration 4. __ leads to ___ leads to ___ 5. possible joint ___, means

Answer 93

1. cartilage matrix, chondrocytes: limited capacity for growth 2. matrix cracks, softening/degradation (chondromalacia), exposure of subchondral bone, sclerosis of bone (eburnation), oseophytosis 3. inflammation 4. subchondral fractures, exposure to synovial fluid, subchondral cysts 5. mice, joint locking and pain

Question 94

Osteoarthritis - 1. list two functions of articular cartilage 2. require (2) 3. made of (2) 4. ___ disrupts chondrocyte function 5. ___ resilience of cartilage 6. define degeneration

Answer 94

1. decreased friction and load distribution (decreased shock) 2. elasticity and tensile strength 3. proteoglycans and type II collagen (healthy chondorcytes) 4. OA 5. decreased 6. inability to adapt to stress (decreased normal cartilage)

Question 95

Oseoarthritis - 1. Risks (5), not simply wear and tear 2. features 5 3. generally ___ progressive 4. osteophytes may impinge ___ 5. causes (3) 6. treatment

Answer 95

1. mechanical stress, age 50-60, genetics, increased bone density and estrogen 2. insidious, deep/achy pain, crepitus, decreased ROM, worse in morning 3. slowly 4. nerve roots 5. radiculopathy (pain, weak, numb), spasm, atrophy 6. palliative: ice, heat, NSAIDS, adjust, joint replacement

Question 96

Oseoarthritis - 1. loss of ___ because of ___ 2. no ___ 3. MC sex? 4. (2) nodes

Answer 96

1. joint space, dehydration 2. ankylosis 3. Female 4. heberden's and bouchard's

Question 97

Rheumatoid Arthritis (RA) - 1. ___, ___ autoimmune disease 2. consist of (4) 3. Joints: increase (2) activity 4. HLA ___ 5. ___ peptides (___ antibodies), % of cases, inflammation due to (2) 6. ___ autoantibodies: %, includes (2) 7. symptoms (8)

Answer 97

1. systemic, chronic 2. CD4+, T cells, cytokines, macrophages 3. collagenase and osteoclast activity 4. DRB1 5. anti-cyclic citrullinated, anti-CCP, 70%, smoking and infection 6. IgM, 80%, RF and IgG immune complex 7. weakness, malaise, low grade fever, cachexia, insidious, aching, joint stiffness, decreased ROM

Question 98

RA - 1. ___, __ joints 2. affects (6) 3. MC affects (2) 4. "____ swelling" 5. what happens to the spine? 6. explain 7. # years 8. two special features 9. eventual ___

Answer 98

1. symmetric, small 2. hands, feet, ankles, wrists, elbows, knees 3. MCP and PIP (Bouchard's) 4. fusiform 5. 30% have atlanto-axial instability 6. pannus, articular destruction/disability 7. 10-15 8. ulnar deviation and swan neck deformity 9. ankylosis

Question 99

RA vs OA - 1. no ankylosis 2. inflammatory 3. autoimmune 4. ankylosis 5. degenerative 6. non-inflammatory

Answer 99

1. OA 2. RA 3. RA 4. RA 5. OA 6. OA

Question 100

Additional immune-mediated injury - 1. Juvenile rheumatoid arthritis (JRA, JIA): ___ conditions 2. group of ___ disorders, MC ___ 3. age 4. symptoms for ___ 5. list two subcategories 6. inflammation? 7. ___ joints, (2) examples 8. what sex is more likely to develop?

Answer 100

1. autoimmune 2. multifactorial, neg for RF 3. 6weeks 5. oligoarthritis/polyarthritis and Still's disease (spiking fever, rash, pericarditis 6. pronounced inflammation, produces dysfunction 7. large, knees and hips 8. girls 2-3X