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Y2 Patho > Bone & Joints > Flashcards

Bone & Joints Flashcards

1
Q

Name the 4 big categories of diseases of bones & joints.

A
  1. Inflammatory diseases
  2. Infections
  3. Metabolic bone diseases
  4. Neoplasms
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2
Q

Name the key inflammatory diseases of bones & joints:

A
  1. Osteoarthritis (degenerative)
  2. Rheumatoid arthritis (autoimmune)
  3. Crystal arthropathies (crystal deposition, e.g. gout)
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3
Q

Types of infections of the bone and joints:

A
  1. Osteomyelitis
  2. Chronic osteomyelitis
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4
Q

Name the 4 metabolic bone diseases.

A
  1. Osteoporosis
  2. Osteomalacia & rickets (Vit D deficiency)
  3. Hyperparathyroidism (excess PTH)
  4. Paget’s disease (uncoordinated osteoclasts n osteoblast activity)
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5
Q

How are neoplasms categorised?

A
  1. Benign or malignant
  2. Primary vs metastatic
  3. Prognosis of malignant bone tumours
  4. Type of tumour (bone forming vs chondroid/cartilage forming)
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6
Q

Name the 7 key types of neoplasms.

A
  1. Osteosarcoma (malignant)
  2. Ewing sarcoma (malignant)
  3. Chondrosarcoma (malignant)
  4. Benign chondroid tumours
  5. Giant cell tumours (benign)
  6. Fibrous tumours (benign)
  7. Fibro-osseous tumours (benign)
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7
Q

Name the 2 complications of degenerative disc herniation/bulging

A
  1. Myelopathy
    - compresses posteriorly, causing injury to spinal cord
    - aka the upwards one, to the back of spine
  2. Radiculopathy
    - compresses postero-laterally, causing injury to nerve roots
    - aka the sideways one
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8
Q

Osteoarthritis is..

A
  • the chronic progressive destruction of articular cartilage (aka thinning, erosion & fibrillation ‘cracking;)
  • leads to narrowing of joint space
  • degenerative in nature, all elderly will get it as they age
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9
Q

Rheumatoid arthritis is..

A
  • multi-systemic, chronic inflammatory autoimmune disease affecting many tissues but principally attacking the joints
  • commonly involved the small joints (e.g. PIP & MCP joints of the hands, wrists, elbows & knees)
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10
Q

Rheumatoid arthritis occurs more commonly in..

A

More common in
1. Women
2. Small bones/joints
3. Younger pxs

*as compared to osteoarthritis

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11
Q

Differences between Osteoarthritis & Rheumatoid arthritis:

A

Osteo
1. Usually affects larger joints that support a lot of weight
E.g. hips & knees
2. Occurs in older pxs (degenerative nature)

Rheumatoid
1. Usually affects smaller joints
E.g. metacarpal joints in hands
2. Occurs younger pxs (autoimmune nature)

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12
Q

Cervical spondylosis spinal nerve compression is due to..

A
  • arthritis occurring in the neck
  • special emphasis as it compresses on the spinal nerves
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13
Q

Seropositive (rheumatoid) arthritis tells us..

A

The arthritis is due to presence of several autoantibodies are produced in RA (70-80%)

Impt ones for diagnostic purposes: (via blood test)
1. Rheumatoid factor (RF)
2. Anticitrullinated protein antibody (ACPA)

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14
Q

Mechanism of Seropositive Rheumatoid Arthritis? What happens?

A
  • cytokine driven process induces pannus formation
  • pannus: specialised granulation tissue that is destructive
  • pannus destroys articular cartilage
  • scar tissue replaces space, aka fibrosis occurs
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15
Q

What is eburnation and thickening of subarticular bone?

A

Occurs due to degenerative osteoporosis

  1. Eburnation: exposed bone
    - bone exposed as smooth polished surface due to constant friction of bone surfaces (cuz cartilage is gone)
  2. Formation of subchondral cyst
    - thickening of subarticular bone to compensate for lack of cartilage at area
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16
Q

What is Paget’s disease?

A
  • Uncontrolled, excess bone resorption + uncoordinated osteoblastic response (bone formation)
  • results in: rapid turnover of ‘poorly made’ bone
  • more common in elderly
17
Q

Gout is characterized by..

A
  • increased serum uric acid and urate crystals deposition
18
Q

Causes of Gout..

A

Primary or Secondary

Primary
- gout is mostly primary
- idiopathic
- associated w obesity, alcohol, hypertension & fatty diet

Secondary
- due to known conditions that promote hyperuricemia
- e.g. specific drugs, renal failure, familial juvenile hyperuricaemic nephropathy & congenital enzyme defects

19
Q

Long term complications of gout if not treated?

A
  • deposition of crystals => forms deformities
  • can cause kidney failure

Notes:
- deformities
- erosion of joints
- kidney disease (stones)
- renal failure

20
Q

Diagnosis of Gout via..

A

Examination of synovial fluid using Polarized light under microscope

  • key point: not normal light microscope! (common exam qns)
21
Q

Name the 2 shapes of Calcium pyrophosphate crystals.

A

Examination under polarized light reveals

  1. Strongly birefringent, needle shaped crystals
    => Gout
  2. Weakly birefringent, rhomboid-shaped crystals
    => Pseudogout
22
Q

What is Sequestrum?

A

Native necrotic bone causing deformities
- that has become separated from normal/sound bone during the process of necrosis
- complication of osteomyelitis

23
Q

What is involucrum?

A

Sleeve of reactive woven bone tissue
- secreted by periosteum
- periosteum continues laying down bone in the pocket below even though bone is dead

24
Q

What is Tuberculous osteomyelitis?

A
  • extrapulmonary tuberculosis via hematogenous dissemination (blood borne/lymphatic drainage)
  • specific type of chronic osteomyelitis
  • highly destructive w extensive necrosis, difficult to treat
25
Q

What is Osteoporosis?

A
  • issa diagnosis
  • characterised by reduced bone mass, leading to fragility & susceptibility to fractures
  • no defined cause as it is simply a diagnosis
26
Q

What are some causes of Osteoporosis?

A

Commonly 1. Primary/idiopathic
- due to postmenopausal condition in older females, due to estrogen deficiency
- or idiopathic (no known cause)

  1. Secondary (less common)
    - endocrine
    - GIT disturbance (malnutrition, reduced Ca intake)
    - drugs (corticosteroids, chemotherapy
    - immobilisation
27
Q

What is Osteomalacia?

A

Osteomalacia: defect in matrix mineralisation (calcification) due to abnormal VitD metabolism or deficiency <= clear cause unlike in osteoporosis

28
Q

What is the difference btw Rickets and Osteomalacia?

A
  1. Rickets
    - in children => that are still developing
    - lack of calcium => inability to form bone
    - developing bone remains as cartilage => easily bendable
    - presents as bone deformities & microfractures
  2. Osteomalacia
    - in adults
    - bones are alr fully developed
    - thus, osteomalacia only presents as microfractures, no bending
29
Q

Manifestations/symptoms of Rickets are..

A
  1. Severe bowing of leg
  2. Bossing: distortion of skull
  3. Rachitic Rosary: when rib cartilage undergoes hypertrophy but no calcification, so ribs appear enlarged w beadlike prominences

Due to:
- disturbance of endochondral ossification => overgrowth of epiphyseal cartilage => failure of cartilage cells to mature

30
Q

What is Osteitis Fibrosa Cystica?

A

Osteitis Fibrosa Cystica: excessive osteoclastic activity due to hyperparathyroidism

=> leads to hypercalcaemia & low level serum phosphate
=> loss of bone mass due to bone resorption (osteoclastic giant cells removing bone) => lytic lesion
=> fibrous tissue replaces bone (peritrabecular fibrosis)

31
Q

What is Brown Tumour?

A
  • ‘tumoral’ form of osteitis fibrosa cystica
  • composed of accumulation/solid mass of osteoclastic multinucleated giant cells

Y2 Patho (9 decks)

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