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Random First Aid Sections > Bone and CT > Flashcards

Bone and CT Flashcards

1
Q

Bones of the axial and appendicular skeleton + base of the skull are formed via what process?

A

Endochondral ossification

Cartilage model (chondrocytes) → Woven bone (Osteoclasts/blasts)

Later remodel to Lamellar bone

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2
Q

When do you see woven bone in adults?

A

After fx and Pagets disease

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3
Q

What bones are formed by membranous ossification?

A

Calvarium and facial bones - no cartilage model

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4
Q

What do osteoblasts differentiate from?

A

Mesenchymal stem cells - secrete collagen and catalyze mineralization

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5
Q

What do osteoclasts differentiate from?

A

Monocytes/Mφ

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6
Q

Chronic ↑PTH has what effect on bone?

A

Catabolic - osteitis fibrosa cystica

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7
Q

Estrogen has what effect on bone?

A

⊣ apoptosis in osteoblasts

→ apoptosis in osteoclasts

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8
Q

What causes Achondroplasia?

A

Constit active FGFR3 - inhibit chondrocyte proliferation

Sporadic - adv. paternal age

some AD inheritance

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9
Q

S/S of Achondroplasia?

A

Failure of longitudinal long bone growth (endochondral ossification)

Short limbs, large head

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10
Q

How do you diagnose osteoporosis?

A

DEXA ≤ -2.5

Normal bone mineralization and lab values

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11
Q

What are indications of type 1 (post-men) osteoporosis?

A

Femoral neck fx & distal radius fx

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12
Q

How do you treat osteoporosis?

A

Bisphosphonates

PTH - intermittant

SERMs

Denosumab - anti-RANKL

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13
Q

SS of Osteopetrosis?

A

Thickened dense bones prone to fx

Pancytopenia and EM hematopoiesis

Cranial nerve impingement and palsies

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14
Q

What drives the symptoms of osteopetrosis? What can cure it?

A

Mutations in carbonic anhydrase II
Osteoclasts can’t make enough acid

BMT - OC are from monocytes

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15
Q

What effect does vitamin D deficiency have on bone?

A

↓ mineralization/calcification of osteoid

*hyperactivity of osteoblasts - ↑ALP

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16
Q

What is the only lab value that is incresaed in Paget disease of bone?

A

ALP

Ca, PO4 and PTH are nomral

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17
Q

What are other symptoms of Paget disease of bone?

A

↑Hat size and Hearing loss

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18
Q

What isthe most common site for AVN?

A

Femoral head - insufficiency of medial circumflex femoral a.

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19
Q

What causes AVN?

A

Trauma, high-dose corticosteroids, alcoholism, sickle cell

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20
Q

What are the 2 benign primary tumors of bone?

A

Giant Cell tumor

Osteochondroma

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21
Q

A 25 yo man has a tumor in the epiphyseal end of a long bone with a soap bubble appearance on XR - what is it?

A

Giant cell tumor - locally aggressive, benign

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22
Q

Osteochondroma

A

Mature bone w/ cartilaginous cap, rarely transforms

Males < 25

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23
Q

What is the 2nd most common 1˚ malignant tumor of bone? What does imaging show?

A

Osteosarcoma

codman triangle or sunburst on XR

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24
Q

Who gets an osteosarcoma and where does it occur?

A

Bimodal - 10-20 and >65

Metaphysis of long bones, often around knee

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25
Q

What predisposes to osteosarcoma?

A

Pagets disease of bone

Bone infarcts

Radiation

Familial retinoblastoma

Li-Fraumeni syndrome

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26
Q

Who gets Ewing Sarcoma? Where does it occur?

A

Boys < 15

Diaphysis of long bones, pelvis, scapula, and ribs

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27
Q

Ewing Sarcoma

A

Small blue malignant tumor

Onion skin appearance of bone

t(11;22)

28
Q

Where do chondrosarcomas occur? Who get them?

A

Pelvis, spine, scapula, humerus, tibia, or femur (diaphysis)

Men 30-60 yo

29
Q

An expansive glistening mass within the medullary cavity is a description of what?

A

Chondrosarcoma

30
Q

How do you distinguish between osteoarthritis and RA?

A

OA: Pain after use or at end of day

RA: Morning stiffness > 30min, improve w/ use

31
Q

What is RA mediated by?

A

Type III and IV hypersensitivity

Cytokines

32
Q

What antibodies can be seen in RA? What predisposes to it?

A

⊕ rheumatoid factor (IgG)

Anti-cyclic citrullinated peptide Ab = more specific

HLA-DR4

33
Q

What are examples of disease modifying agents used to treat RA?

A

MTX

Sulfasalazine

TNF-α inhibitors

34
Q

S/S of Sjogren syndrome

A

Xerophthalmia = ↓ tear producition → corneal damage

Xerostomia = ↓ saliva prodcution → dental caries

Bilateral parotid enlargement

35
Q

What might a unilateral parotid enlargement in a patient with Sjogren syndrome suggest?

A

MALT-oma

36
Q

What antibodies are seen in Sjogren? (2)

A

Antinuclear antibodies

SS-A = anti-Ro

SS-B = anti-La

37
Q

What is the most common cause of gout?

A

Underexcretion of uric acid - 90%

EtOH consumption - metabolites compete w/ uric acid for excretion

38
Q

Gout

A

Precipitation of monosodium urate crystals

Needle-shaped ⊖birefringent (yellow under parallel)

Red, swollen, painful joint

Tophus in external ear, olecranon bursa, achilles tendon

39
Q

How do you treat an acute gout attack? Chronic?

A

Acute = NSAID, glucocorticoids, colchicine

Chornic = allopurinol, febuxostat

40
Q

What types of crystals are seen in pseudogout?

A

Calcium pyrophosphate

Basophilic rhomboid, weakly ⊕ birefringent (blue when parallel)

41
Q

What diseases might be associated with pseudogout?

A

Hemochromatosis

HyperPTH and Hypo PTH

42
Q

What are the 3 most common causes of infectious arthritis? In sexually active people?

A

S. aureus, Streptococcus, N. gonorrhoeae

N. gonorrhoeae

43
Q

What are the 4 seronegative spondyloarthropaties - what are they associated with?

A

PAIR - HLA-B27

Psoriatic arthritis

Ankylosing spondylitis

IBD - w/ ankylosing spondylitis or peripheral arthritis

Reactive Arthritis

44
Q

Psoriatic Arthritis

A

Dactyitis (sausage fingers)

Pencil in cup

45
Q

Ankylosing Spondylitis

A

CID of spine and sacroiliac joints

Ankylosis - stiff spine - bamboo spine

Uveitis

Aortic Regurgitation

46
Q

Reactive Arthritis (Reiter syndrome)

A

Conjunctivis, urethritis, arthritis

Post GI - Shigella, Salmonella, Yersinia

Post Chlamydia

47
Q

What is the classic presentation of Lupus (SLE)

A

Rash, joint pain, and fever in a female of reproductive age and African descent.

48
Q

What antibodies are sensitive for SLE? Drug-induced lupus?

A

ANA - sensitive not specific

Antihistone = drug induced

49
Q

What antibody is both specific for SLE and associated with poor prognosis?

A

Anti-dsDNA

Poor prognosis associated with renal disease

50
Q

Anti-Smith antibodies

A

Specific for SLE

against snRNPs

51
Q

Lupus nephritis (type III) can cause which 2 diseases?

A

Nephritic: Diffuse proliferative glomerulonephritis

Nephrotic: Membranous glomerulonephritis

52
Q

What do you use to treat SLE?

A

NSAIDs, steroids, immunosuppressants, hydroxychloroquine

53
Q

Widespread noncaseating granulomas in a black female is indicative of what?

A

Sarcoidosis

54
Q

What 2 enzymes are elevated in Sardoidosis?

A

ACE

1α-hydroxylase (Mφ)

55
Q

Polymyalgia rheumatica

A

Pain/stiffness in hips/shoulders + fever, malaise, and weight loss

↑ESR, CRP, normal CK

Responds to low-dose corticosteroids

56
Q

How do you treat fibromyalgia?

A

Regular exercise

Antidepressants - TCA, SNRI

Anticonvulsant

57
Q

What is polymyalgia rhematica associated with?

A

Temporal (giant cell) arteritis

58
Q

Endomysial inflammation with CD8 T cells is characterisitic of what?

A

Polymyositis: progressive symmetrical proximal weakness

**shoulders**

59
Q

Perimysial inflammation and atrophy with CD4 Tcells?

A

Dermatomyositis: Malar rash, “shawl and face” rash, heliotrope rash, Gottron papules, mechanic’s hands

↑ risk of occult malignancy

60
Q

↑CK, ⊕ANA, ⊕anti-Jo-1, ⊕anti-SRP, and ⊕anti-Mi- antibodies are indicative of what?

A

Polymyositis/Dermatomyositis

61
Q

How can you differentiate Mysathenia Gravis and Lambert-Eatin myasthenic syndrome?

A

MG = worsens w/ use, improves with AChE inhibitor

Lambert-Eaton = improves with use, no response to AChEi

62
Q

Myasthenia Gravis

A

Auto-Antibody to postsynaptic ACh receptor

Ptosis, diplopia, weakness

Associated w/ thymoma, thymic hyperplasia

63
Q

Lambert-Eaton myasthenic syndrome

A

Auto-antibodies to presynaptic Ca channel → ↓ACh release

Proximal muscle weakness, autonomic symptoms (dry mouth, impotence)

Small cell lung CA

64
Q

Myositis ossificans

A

Metaplasia of sk. muscle to bone following trauma

65
Q

Scleroderma

A

Excessive fibrosis and collagen deposition throughout body

66
Q

Diffuse Scleroderma

A

Widespread skin involvement, rapid progression, early visceral involvement

Anti-Scl-70 antibody - DNA-topo I

67
Q

Limited scleroderma

A

Limited skin - fingers and face only

CREST - antiCentromere antibody

Calcinosis

Raynaud phenomenon

Esophageal dysmotility

Sclerodactyly

Telangiectasia

Random First Aid Sections (16 decks)

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