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MSK Part 2 (nlg) > bone pathology > Flashcards

bone pathology Flashcards

1
Q

What is ESR?

A

erythrocyte sedimentation rate, RBC aggegation causes increased sedimentation (falls faster in test tube)

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2
Q

why does elevated ESR indicate inflammation?

A

inflammatory products (fibrinogen) coat RBC and cause aggregation –> falls faster in test tube

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3
Q

increased ESR in lab could mean…

A 
anemia
infection, inflammation
cancer
pregnancy
autoimmune(SLE)
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4
Q

SLE

A 
systemic lupus erythematous
autoimmune CT disease, chronic
antigen / Ab complex (tyoe 3 hypersensitivity)
malarbutterfly, discoid rash, oral ulcers, arthritis, raynauds , anemia, phenomenon
 childbearing aged women
imitates many diseases!
inflammation 
Not as damaging as RA.
\+ ANA/anti-sdDNA/anti Sm
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5
Q

what disease/gene causes impaired cartilage proliferation in growth plate (short extremities and normal head and chest?

A

achondroplasia

activating mutation –> overexpression of FGFR3

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6
Q

what type of bone formation does achondroplasia affect?

A

endochondral bone formation!

intramembranous is unaffected

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7
Q

what disease gives you normal size head and chest but small extremities?

how are mental function, life span, and fertility

A

achondroplasia

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8
Q

osteogenesis imperfecta

A

congenital defect of bone formation–> weak bone

defect in collagen type 1 synthesis

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9
Q

features of osteogenesis imperfecta

A

weak bone
multiple fractures (can mimic child abuse)
blue sclera - thinning to see choroidal veins
hearing loss - middle ear factures easily

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10
Q

abnormal bone resorption

  • -> abnormal thick heavy bone that fractures easily
  • poor osteoclast [ ]
A

osteopetrosis

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11
Q

what mutation occurs in osteopetrosis?

A

carbonic anhydrase II mutation –>leads to loss of acidic microenvironment and bone cannot be resorbed by osteoclasts

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12
Q

osteopetrosis treatment?

A

marrow transplant

osteoclasts form from monocytes

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13
Q

clinical features of osteopetrosis

A

anemia/thrombocytopenia due to bony replacement of marrow
vision and hearing impaired - cranial nerve impingement
hydrocephalus due to narrowing of foramen magnum
renal tubular acidosis- lack of carbonic anhydrase –>decreased HCO3 resorbtion

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14
Q

osteoblasts –> bone?

A

osteoblasts form osteoid which is then mineralized w calcium and phosphate to form bone

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15
Q

low vit D results in low serum —- & —-?

A

calcium and phosphate

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16
Q

rickets and osteomalacia are diseases that…

A

defective mineralization of osteoid due to low vitamin D

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17
Q

vitaminD sources and activation

A

diet and sunlight;

activated in liver (25 hydroxylation) and proximal tubule cells of kidney (1 alpha hydoxylation)

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18
Q

what does ACTIVATED vit D do?

A

raises serum ca and phosphate by increasing reabsorption in intestine, kidney,and bone

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19
Q

rickets

A

low vit D in children leading to low bone mineralization

arises <1yo, pigeon breast deformity, frontal bossing (osteoid deposit in forehead), rachitic rosary, bowing of legs

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20
Q

osteomalacia

A

low vit D leading to low bone mineralization in adults
weak bone with increased risk of fracture
LAB: decreased serum ca and phosphate and increased PTH and alkaline phosphatase

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21
Q

Lab: decreased serum ca and phosphate, increased PTH and alkaline phosphatase

A

osteomalacia

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22
Q

reduction in trabecular bone mass resulting in porous bone

A

osteoporosis

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23
Q

RANKL - what does it do and what is it a sign of

A

increase osteoclast activity;

osteoporosis

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24
Q

risk of Osteoporosis

A

mostly senile and postmenopausal
rate based on peak bone mass (30 yo) and rate of bone loss after (normally 1% a yr)
bone loss is more rapid with lack of weight bearing exercise, poor diet, and decreased estrogen

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25
Q

treatment for osteoporosis

A

exercise, vit D, calcium, bisphosphonates

not glucocorticoids!!

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26
Q

what do bisphosphonates do?

A

induce apoptosis of osteoclasts

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27
Q

Lab for osteoporosis

A

ca, phosphotase, PTH, and allkaline phosphatase all NORMAL –> rules out osteomalacia
**measure bone density using DEXA

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28
Q

clinical features of osteoporosis

A

bone pain and fractures in weightbearing areas - vertebra, hip, distal radius
-lost of height from vertebra compression

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29
Q

paget disease

A

imbalance between osteoclast and osteoblast activity, in late adulthood
three stages - osteoclastic, mixed, and osteoblastic/sclerotic
results in thick, bone with lamellar cement lines (jig saw) that fractures easily due to rushed osteoblasts

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30
Q

does paget disease affect entire skeleton?

A

NO, just one or a few bones

-skull is common

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31
Q

clinical features of pagets disease?

A 
bone pain (microfractures), increasing hat size,
hearing loss (impinged cranial nerve), lion like facies,
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32
Q

Lab shows all normal except isolated elevated alkaline phosphotase

A

paget disease

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33
Q

treatment of pagets

A

calcitonin (inhibits osteoclasts)

bisphosphonates (osteoclast apoptosis)

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34
Q

two complications of pagets disease

A

osteosarcoma

AV shunts in bone –> cardiac failure

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35
Q

osteomyelitis

A

infection of marrow and bone, usually bacterial, hematogenous spread
kids>adults
pain with systemic signs of infection
lytic focus (abcess) surrounded by bone sclerosis (sequestrum surrounded by involucrum)

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36
Q

where does each form of osteomyelitis seed and in who?

A 
transient bacteremia (kids) - metaphysis
open wound bacteremia (adults) - epiphysis
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37
Q

most common cause of osteomyelitis (plus others)

A

**staph aureus - 90%
Ngonorrhoeae - sexually active young adults
salmonella - sickle cell
pseudomonas - diabetics or IV drug users
pasteurella - cat or dog bite
mycobacterium tuberculosis - involves vertebra

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38
Q

avascular aseptic necrosis vs osteomyelitis

A

similar presentation except aseptic necrosis is not caused by bactera

39
Q

avascular aseptic necrosis

A

ischemic necrosis of bone and marrow

caused by trauma, fracture, steroids, sickle cell anemia, and caisson disease (N gas in blood)

40
Q

whats a major complication of avascular necrosis?

A

osteoarthritis and fracture

41
Q

benign tumor of bone?
where do they arise mostly?
associated with?

A

osteoma
facial bones
gardner syndrome

42
Q

osteoid osteoma

A

benign tumor of osteoblasts(that produce oteoid) surounded by rim of reactive bone
<2cm bony mass in duaphysis cortex (surface) of long bones (femur) with radiolucent core

-young adults

43
Q

osteoid osteoma vs osteoblastoma

A

OO is 2cm, in vertebrae, and does NOT resolve w aspirin

44
Q

osteochondroma

A

tumor of cone with an overlying cartilage cap; most common benign tumor of bone
arises from lateral projection of growth plate (metaphysis) and continuous w marrow
*rarely metastasis to osteosarcoma

45
Q

malignant proliferation of osteoblasts, produces osteoid

A

osteosarcoma

46
Q

demographics of osteosarcoma?

A

teens>elderly

47
Q

where does osteosarcoma arise?

A

metaphysis of long bones in knee region (distal femur or proximal tibia)

48
Q

risk factors for osteosarcoma?

A

familial retinoblastoma, paget disease, radiation exposure

49
Q

three signs of osteosarcoma

A

bone pain with swelling or pathologic fracture
sunburst appearance
lifting of the periosteum (codman triangle)

50
Q

codman triangle

A

lifting of the periosteum as tumor of bone protrudes through cortex

51
Q

only tumor that grows in epiphysis?

A

giant cell tumor (epiphyses of long bones)

52
Q

giant cell tumor

A

multinucleate giant cells and stromal cells, “soap bubble” on xray
-young adults, knee region, epiphysis
-aggressive, can recur
-

53
Q

malignant proliferation of poorlydifferentiated cells from neuroectoderm, in diaphysis usually males <15

A

ewing sarcoma

54
Q

onion skin appearance on xray

A

ewing sarcoma

55
Q

where does ewing sarcoma develop?

A

diaphysis of long bone, usually in male kids <15

often metastasizes

56
Q

biopsy of ewing sarcoma shows?

what genetic defect causes it?

A

small round blue cells that resemple lymphocytes

t(11,22) translocation

57
Q

chondroma

A

benign tumor of cartilage

medulla of hands and feet

58
Q

chondrosarcoma

A

malignant cartilage forming tumor

medulla of pelvis or central skeleton

59
Q

metastatic tumors

A

more common than primary tumors –> result in osteolytic (punched out) lesions
BUT prostatic carcinoma results in osteoblastic lesions

60
Q

osteoarthritis

A

progressive loss of articular cartilage due to wear and tear

stiffness in the morning that WORSENS during day

61
Q

most common arthritis

A

osteoarthritis

62
Q

risk factors for osteoarthritis

A

old age, obesity, trauma

63
Q

osteoarthritis affects what joints?

A

hips, lumbar, knees, DIP AND PIP

64
Q

what nodes develop at DIP and what at PIP?

A

DIP -> heberden nodes

PIP -> bouchard nodes

65
Q

pathologic findings of osteoarthtritis?

A 
disruption of articular surface (joint mice)
eburnation (polishing) ofsubchondral bone after it is exposed
osteophyte formation (reactive bony outgrowths) in DIP and PIP (heberden and bouchards)
66
Q

osteophyte

A

reactive bony outgrowth

happens in osteoarthritis

67
Q

rheumatoid arthritis

A

chronic, systemic, autoimmune
late bearing aged women
morning stiffness that IMROVES with activity

68
Q

morning stiffness - gets worse in day or better….2 conditions?

A

worse –> osteoarthritis

better –> rheumatoid arthritis

69
Q

disease associated with HLA-DR4?

A

rheumatoid arthritis

70
Q

synovitis leading to pannus (inflamed granulation tissue)?

A

rheumatoid arthritis

71
Q

what leads to joint space narrowing, loss of cartilage and destruction of joint, fusion (ankylosis)

A

rheumatoid arthritis

72
Q

what is usually spared in RA?

A

DIP

73
Q

symmetric involvement of PIP, wrists, elbows, ankles, and knees

A

Rheumatoid arthritis

74
Q

clinical features of RA

A

rheumatoid nodules
vasculitis
baker cyst
pleural effusions

75
Q

Lab findings of RA

A

IgM autoantibodies against FC portion of IGG

high neutrophils and high protein in synovial fluid

76
Q

IgM autoantibodies against Fc portion of IgG

A

Rheumatoid arthritis

77
Q

lack of rheumatoid factor
axial skeleton involvement
HLA-B27

A

seronegative spondyloarthropathies

78
Q

HLA-B27 association

A

seronegative spondyloarthropathies

79
Q

disease of vertebral column

A

seronegative spondyloarthropathies

80
Q

ankylosing spondyloarthritis

A

involvement of sacroiliac joints and spine –> leads to fusion of vertebrae
young adults usually males
presents with low back pain

81
Q

what can associate with uveitis and aoritis?

A

anklosing spondyloarthritis

82
Q

reiter syndrome

A

arthritis, urethritis, and conjunctivitis

arises in young male adult weeks after GI infection

83
Q

DIP of hands and feet are commonly affected (sausage fingers and toes)

A

psoriatic arthritis

84
Q

psoriatic arthritis due to?

A

N gonorrhoeae - sexually active young adults

staph aureus - older children

85
Q

usually involves a single joint, mostly knee

warm, erythematous limited ROM

A

psoriatic arthritis

86
Q

gout

A

deposition of MSU crystals in tissues, especially the joints

due to hyperuricemia

87
Q

hyperurimia and deposition of MSU crystals causes

A

gout

88
Q

leukemia and MPDs
lesch nyhan syndrome
renal insufficiency

A

secondary gout

89
Q

podagra

A

arthritis of big toe (acute gout)

90
Q

chronic gout

A

tophi- uric acid crystals in soft tissue or joints

renal failure - uric acid deposition in tubules

91
Q

yellow needle shaped crystals with negative birefringence under polarized light

A

chronic gout

92
Q

pseudogout

A

resembles gout
deposition of calcium pyrophosphate
rhomboid shaped crystals with weak positive birefringence

93
Q

gout vs pseudogout under polarized light

A

g- needle shaped, yellow, negative birefringence

ps- rhomboid, blue, positive birefringence

MSK Part 2 (nlg) (9 decks)

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