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Pathology > Bone and Joint Pathology > Flashcards

Bone and Joint Pathology Flashcards

1
Q

Describe osteogenesis imperfecta

A

Disorder of type 1 collagen resulting in abnormal bone formation and mineralisation. Leads to fractures and progressive deformity (A.K.A. Brittle bone disease)

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2
Q

List the pathological features of OA

A
  • Breakdown and loss of articular cartilage
  • Loss of joint space
  • Reparative bone response
  • Capsular fibrosis
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3
Q

List the radiological features of OA

A
  • Loss of joint space
  • Osteophyte formation
  • Juxta-articular sclerosis
  • Subchondral cysts
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4
Q

What happens to cartilage composition with ageing

A

Reduced proteoglycans leads to reduced water-binding capacity resulting in a thinner, stiffer cartilage

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5
Q

Where is the most common site of initial RA presentation

A

Foot

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6
Q

What part of the joint does RA affect

A

Synovial membrane

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7
Q

What gene is associated with RA

A

HLA-DR4

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8
Q

What does Rheumatoid factor antibody target

A

Fc portion of autologous IgG

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9
Q

List the radiological features of RA

A
  • Loss of joint space
  • Periarticular erosions
  • Joint-line thickening
  • Juxta-articular osteoporosis
  • No osteophytes
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10
Q

Where does Gout typically effect

A

Metatarsophalangeal joint of the great toe (>50% of cases)

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11
Q

What causes gout

A

Crystallisation of monosodium urate in the joint

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12
Q

What causes secondary gout

A
  • Medications (thiazides)
  • Myeloproliferative/Lymphoproliferative disorders
  • Renal failure
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13
Q

Describe gout crystals

A

Negatively birefringent needle-shaped crystals

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14
Q

List the radiological features of gout

A
  • Punched-out erosions that start near joint margins with classic overhanging sclerotic margin
  • Cartilage destruction can cause joint space narrowing in the long-term and is rare
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15
Q

Describe osteochondritis dissecans

A

Disease where bone under the articular cartilage dies due to lack of blood flow

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16
Q

What are the clinical features of osteochondritis dissecans

A
  • Pain worse with activity
  • Swelling and joint effusions
  • Loose bodies/locking/giving way of the joint
17
Q

Define Osteoporosis

A
  • Increased porosity of bone leading to decreased bone density of normally mineralised bone matrix
  • Bone density >2.5 SD below normal range for young adults
18
Q

When is peak bone mass reached

A

25-30

19
Q

What common drug can cause osteoporosis

A

Heparin

20
Q

List the risk factors for osteoporosis

A
  • Reduced physical activity
  • Smoking and alcohol
  • Low weight
  • Early menopause
  • Genetic
21
Q

In what conditions are DEXA scans not required to diagnose osteoporosis and treatment should be commenced straight away

A

NOF fractures

22
Q

What is the treatment of osteoporosis

A
  • Calcium and vitamin D supplementation

- Alendronate (1st-line)

23
Q

What can be used as an alternative to bisphosphonates in osteoporosis in those intolerant

A

Strontium ranelate and raloxifene

24
Q

Describe osteomalacia (Rickets in children)

A

Deranged vitamin D absorption/metabolism leading to the impaired mineralisation of bone (osteoid)

25
Q

What risks inadequate synthesis of vitamin D

A
  • Inadequate exposure to light
  • Dietary deficit
  • Poor maternal nutrition
  • Dark skin
26
Q

What conditions decrease the absorption of vitamin D

A
  • Cholestatic liver disease
  • Pancreatic insufficiency
  • Biliary tract obstruction
  • Small bowel disease (e.g. Coeliac’s, Crohn’s)
27
Q

Which drugs increase the degradation of vitamin D

A
  • Phenytoin
  • Phenobarbital
  • Rifampicin
28
Q

What are the clinical features of Rickets in the non-ambulatory stage

A
  • Flattening of the occipital bones
  • Inward buckling of parietal bones
  • Frontal bossing
  • Square head
  • Pigeon chest
  • Prominent costochondral junctions
29
Q

What are the clinical features of Rickets in the ambulatory child

A
  • Increased lumbar lordosis and thoracic kyphosis
  • Bowing of the legs
  • Slipped capital epiphysis
  • Fractures
30
Q

What are Looser’s lines

A

Collections of osteoid producing ribbon-like zones of incomplete radiolucency

31
Q

What are the typical biochemical findings in Rickets

A
  • Low calcium
  • Low phosphate
  • Increased ALP
32
Q

How is osteomalacia treated

A

Vitamin D and calcium supplements

33
Q

Describe Paget’s disease

A

A disease of increased and uncontrolled bone turnover

34
Q

What is the cause of Paget’s disease

A

Thought to be primarily a disorder of osteoclasts with excessive osteoclastic resorption followed by increased osteoblastic activity

35
Q

What predisposes to Paget’s disease

A
  • Increasing age
  • Male sex
  • Northern latitude
  • Family history
36
Q

What are the clinical features of Paget’s disease

A
  • Bone pain
  • Bowing of tibia
  • Bossing of skull
37
Q

What are the complications of Paget’s

A
  • Deadness (cranial nerve entrapment)
  • Bone sarcoma
  • Fractures
  • Skull thickening
  • High-output cardiac failure
38
Q

Treatment of Paget’s

A
  • Bisphosphonates (oral risedronate or IV zoledronate)

- Calcitonin

Pathology (7 decks)

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