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MSI > Bone Phys/path > Flashcards

Bone Phys/path Flashcards

0
Q

Inter-medullary callus

A
  • forms new bone from endochonral ossification following hematoma formation
  • soft callus -> hard callus
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1
Q

Vascular response in fracture repair

A
  • Bloodflow increased substantially peaks at two weeks

- Angiogenesis and vasodilation increases

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2
Q

Concave/convex remodeling

A
  • convex: electropositive->osteoclast

- concave: electronegative->osteoblast

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3
Q

Contact vs. gap healing

A
  • contact: allows for direct healing with lamellar bone

- gap: 200-500 nm: fill with woven bone, remodeled to lamellar

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4
Q

TGF in bone repair

A
  • induces the synthesis of cartilage specific proteoglycans and type II collagen
  • stimulates osteoblasts
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5
Q

BMP in bone repair

A
  • 1,2 and 3
  • 1: cleaves carboxy terminus of procallagen I,II and III
  • 2: induces endochonral ossification
  • 3: potent inducer of mesenchymal -> bone tissue
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6
Q

FGF in bone repair

A
  • acidic (FGF-1), basic (FGF-2)
  • proliferation of chondrocytes and osteoblasts
  • FGF2 stims angiogenesis
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7
Q

PDGF in bone repair

A
  • I and II
  • IGF-I induced by GH in liver
  • bone and collagen synthesis, osteoblasts proliferation and inhibits bone collagen degradation
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8
Q

Cytokines in bone repair: IL-1,4,6 and 11, CSF, TNF

A
  • Stimulates bone resorption: IL-1 most potent

- IL-1 and 6 inhibited by estrogen

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9
Q

Prostaglandins in bone healing

A
  • PGEs inhibit osteoclasts and stimulate bone formation

- leukotriens do the opposite

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10
Q

Hormones in bone repair: estrogen, thyroid, glucocorticoids

A
  • estrogen: stimulates fracture healing through IL I inhibitor
  • T3/4: stimulat osteoclast resorption
  • glucocorticoids: inhibits Ca absorption from gut -> increased PTH -> increases osteoclast activity indirectly
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11
Q

PEMF

A
  • Signals in 20 to 30 Hz range

- Shows efficacy in bone healing

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12
Q
  • Bluegray skin and yellow brown microscopic pigment
  • Presents with black urine
  • Associated with severe early-onset arthritis and spine and lower extremity joints
A
  • Alcaptonuria

- Results from homogentistate 1,2 deoxygenase deficiency -> Buildup of homogentisic acid

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13
Q

Anatomic sequelae of osteoarthritis

A
  • Joint space narrowed
  • sclerosis of subchondral
  • cystic degeneration of bone
  • osteophyte lipping
  • chronic pain and debilitation
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14
Q
  • Insidious onset of malaise fatigue and generalized musculoskeletal pain
  • This is followed by polyarticular joint pain in the hands and then the fee
A
  • RA

- Sequela a: destruction of ligaments tendons joint capsules-> deformities

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15
Q

RA immunopathenogenesis

A
  • HLA-DRB1 assoc
  • Activated CD4 stimulates macrophages and B cells
  • b cells contribute autoantibodies
  • TNF/IL1: Stimulates synoviocytes to make inflammatory mediators/mellatoproteases
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16
Q

Synovium and stroma consisting of inflammatory cells granulation tissue and fibroblasts which grow over articular cartilage

A
  • pannus

- sq: fiberous ankylosis, -> bony ankylosis

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17
Q

Fibrinoid necrosis surrounded by palisading rim of macrophages with no microbial infiltrates

A
  • Rheumatoid nodule
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18
Q
  • onset under age 16
  • arthritis present for 6 weeks, spiking fevers, malaise
  • rheumatoid nodules skin usually absent
  • rheumatoid factor usually negative
A

Juvenile idiopathic Rheumatoid arthritis

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19
Q
  • HLA-B27 assoc
  • oligoarthritis and tendinitis
  • immune-mediated disease
A
  • ankylosing spondylitis
  • reactive arthritis
  • psoriatic arthritis
  • arthritis assoc with chronic inflammatory conditions
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20
Q
  • Negatively biferingient crystals
  • hyperuricemia
  • tophi
A
  • gout/gouty arthritis
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21
Q

Mechanism for hyperuricemia

A
  • 90% due to decreased excretion of uric acid (upregulation of URAT1->increased resorption
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22
Q

HGPRTase deficiency

A
  • overproduction of uric acid due to lacking purine salvage pathway
  • Lesch-Nyhan syndrome
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23
Q

Mechanism for acute gouty arthritis

A
  • hyperuricemic conditions addressed by neutrophils which phag the crystals. They aren’t broken down and destroy the neutrophils releasing inflammatory cytokines.
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24
Q

Positive biferingient rhomboid crystals and assoc mutation

A
  • pseudo gout: Calcium pyrophosphate accumulation

- associated with AD mutation of ANKH gene

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25
Q

Infectious arthritis: epidemiology

A
  • H. flu: under age 2
  • S. aureus: older kids and adults
  • N. gonorrhea: late adolescence and younger adults
  • salmonella: sickle cell
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26
Q

-Insidious onset of worsening pain resulting from caseating granulomatous inflammation often times within the spinal column

A
  • osteomyelitis from infectious TB
  • Potts disease
  • hips>knees>ankles
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27
Q

Arthritis associated with cross reactive Borrelia antigens

A
  • infectious arthritis

- silver stain positive in only 25%

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28
Q

Ganglion cyst

A
  • 1-2 centimeter translucent cyst not communicating with the joint space and has no cellular lining
  • excision is curative
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29
Q 
Lipoma/liposarcoma
Fibromatoses/fibrosarcoma
Rhabdomyoma/rhabdomyosarcoma
Leiomyoma/leiomyosarcoma
Hemangioma/angiosarcoma
A
  • Benign/malignant adipose tumor
  • Benign/malignant fibrous tissue tumor
  • Benign/malignant skeletal muscle tumor
  • Benign/malignant smooth muscle tumor
  • Benign/malignant vessel tumor
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30
Q

Lipoma versus angiolipoma

A

Lipoma: more common, painless, Subcubitus extremities and trunk
- Well differentiated circumscribed adipocytes
Angiolipoma: Male predominance subcutaneous often painful
- Well differentiated adipocytes and capillary sized vessels with thrombi

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31
Q

MDM2 amplification, lack of p53 inhibition
TLS-CHOP
Pleomorphic
- lipoblasts (lipid vacuoles, scalloping nucleus) with atypical lymphocytes

A
  • MDM2: Well differentiated, best prognosis for liposarcoma
  • myxoid morphology
  • pleomorphic: Liposarcoma with poorest prognosis
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32
Q
  • Rapidly expanding subcubitus mass muscle of forearm or trunk
  • Immature tissue culture would fibroblasts and myofibroblasts high cellularity
A
  • Nodular fasciitis
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33
Q

Aggravating deforming fibrous lesion in 3 superficial location
- Fascicles of mature myofibroblasts with dense collagen

A
  • Palmer (dupuytrens contracture),
  • plantar (ledderhose disease),
  • penile (peyronie disease)
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34
Q

Locally aggressive infiltrating disfiguring mass
Associated with deep proximal structures
Long fascicles of bland fibroblasts infiltrating surrounding tissue
Associated with the B-catenin/APC gene

A
  • Desmoid tumor (deep fibromatosis)

- abdominal (anterior wall) extra abdominal, intra abdominal

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35
Q

Infiltrated fleshy masses with hemorrhaging and necrosis

Herringbone pattern of fascicles of malignant spindle cells

A
  • Fibrosarcoma
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36
Q

The most common sarcoma in kids

  • Cluster of grapes
  • t2;13, PAX3-FOXO1A
  • Atypical bizarre tumor cells
A

Rhabdomyosarcoma

  • botryoid and embryonal (best prognosis) bladder, vagina, nasopharynx
  • alveolar in extremities, adolescents (worst prognosis)
  • pleomorphic
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37
Q

HOXD-13 mutation

A
  • sympolydactyly
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38
Q

FGFR 3 mutation

A
  • achondroplasia

- thanatotropic dwarfism

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39
Q

COL1A1 mutation

A

Osteogenesis Imperfecta

40
Q

Synpolydactyly

A
  • HOXD-13 mutation
  • Extra third digit and fuse third and fourth
  • homeobox genes associated with absent/extra bones and acrodactyly
41
Q

Decrease of normal chondrocyte proliferation at growth plate

A

Achondroplastic dwarfism

42
Q

Osteogenesis Imperfecta types

A

Defective synthesis of type I collagen: too little bone density

  • type I mild: normal lifespan
  • type II: non-survivable
  • type III/IV: moderate severity, deforming
43
Q

Osteogenesis imperfecta morphology

A
  • commonly shin deformations and scoliosis
44
Q

Deficiency of lysosomal acid hydrolase enzymes that degrade mucopolysaccharides
- progressive accumulation in cells

A
  • hurlers: type I MPS, deficiency of a-L induronidase
  • hunters: type II MPS, deficiency of iduronate-2-sulfatase;
    XL recessive
45
Q

Long bones lacking normal medullary cavity filled with persistent primary spongiosa
- Fractures pancytopenia and cranial nerve deficits

A
  • osteopetrosis “marble bone” disease
  • very heaped but very brittle bones
  • type II Carbonic anhydrase deficiency
  • May also have renal tubular acidosis
46
Q

Mosaic pattern of lamellar bone in axial skeleton/femur
Increased ALPase
Increased osteoblast/osteoclast
Predominantly whites

A
  • Paget’s disease
  • sqstm1 mutation in 50%
  • abnormal bone architecture
47
Q

Osteoclast signaling

A
  • RANK binds and MCSF is released with osteoprotegrin from stromal cell/osteoblasts
  • causes release of NFKB in monocyte osteoclast precursor
  • OPG binds and inhibits RANK
48
Q

A specific and sensitive marker for osteoblast activity

A
  • osteocalcin
49
Q

Osteogenesis imperfecta

A
  • AD (primarily)
  • type I collagen defect (COL1A)
  • type I (mild) type II (lethal) type III/IV (moderate to severe, deforming)
50
Q
  • Short stature, chest wall abnormalities, bone malformations
  • a-L induronidase
  • indurate-a-sulfatase
A
  • hunters and hurlers

- mucopolysaccharide accumulation

51
Q
  • dense, brittle bones
  • concurrent renal tubular acidosis
  • pancytopenia -> Extra medullary hematopoiesis
A
  • carbonic anhydrase II deficiency -> osteopetrosis (marble bone disease)
  • decreased osteoclast activity
52
Q

Genetic factors and developing osteoporosis

A

Estrogen receptor, vitamin D receptor and LRP 5

53
Q

Severe complications of Paget’s disease

A
  • Giant cell tumors, sarcoma (osteosarcoma/Fibrosarcoma)

- 5-10% in people with polyostoic disease

54
Q

Vitamin D deficiency in kids

Deformed bones

A

Ricketts,

In adults it’s osteomalacia

55
Q

Severe cortical bone defect: increased bone resorption
Dissecting trabeculae on X-ray
Brown tumor

A
  • hyperparathyroidism
  • can result in osteitis Fibrosis cystica if untreated
  • brown tumor not actually tumor: microinfarcts and 2nd hemorrhages
56
Q
  • Increased bone resorption
  • delayed matrix mineralization
  • growth retardation
  • osteoporosis
  • metabolic acidosis
A

Renal osteodystrophy

  • Phosphate retention due to renal failure results and secondary hyperparathyroidism (phosphate is a secondary regulator of PTH: PTH blocks resorption of phosphate in tubules normally leading to excretion, so with increased phosphate more PTH is needed to induce -> too much resorb)
  • decreased vitamin D conversion
57
Q

Wedge shaped infarcts in medullary bone

A
  • subchondral infarcts

- cortical bone not usually affected by infarcts due to the periosteal collateral circulation

58
Q

Pyogenic osteomyelitis

A
  • H. Fu: kids under 2
  • S. aureus: kids and adults
  • N. gonnoreae: adolescents and young adults
  • salmonella: HbS
    Typically hematogenous spread: ots. Tuberculosis increasing
59
Q

Osteomyelitis clinical course

A
  • a necrotic center known as a sequestrum forms inside of the involucrum
  • may form a communicating nidus to drain through the soft tissue
60
Q

Osteomyelitis localized to the jaw

A
  • sclerosing osteomyelitis of Garre
61
Q
  • HLA B27 to susceptibility
  • Destruction of sacroiliac and apophysial joints
  • ANA seronegative
A

Ankylosing spondylitis

62
Q
  • B 27 Cw6 susceptibility

- Psoriatic condition associated with axial joints and enthesis

A

Psoriatic arthritis

63
Q

Finkelstine test

A
  • adduction of wrist with thumb adducted causes pain over radial styloid process
  • DeQuervains tenosynovitis
64
Q

Yergasons sign

A

Bicipital tendinitis: Anterior shoulder pain

65
Q

Shoulder pain with full range of motion

A
  • Olecranon bursitis not involving the joint itself
66
Q

Capsulitis arthrogram

A
  • Reduced uptake of die on MRI
67
Q

Pain in shoulder with abduction of arm from 60-120°

A
  • Rotator cuff tendinitis: Most commonly weakness of the supraspinatus tendon -> Impingement of supraspinatus between humeral head and acromion process
68
Q

Typically healthy young person with inability to abduct the arm at all

A
  • Supraspinatus tendon tear
69
Q

Morphological changes in osteoarthritis

A
  • thickened joint capsule, synovial hypertrophy
  • sclerosed subchondral bone
  • cyst formation
70
Q

Bouchards and heberdens nodes

A
  • B before H in osteoarthritis
  • B=proxymal
  • H= distal
71
Q

Gullwing deformity on X-ray

A
  • Indicative of osteoarthritis
72
Q

RA vs OA in hand

A
  • OA spares MCP joints, RA does not

- RA is disfiguring, not just inflammatory

73
Q

Boutonnière and swan neck deformities

A
  • Both due to contracture of muscle groups in the hands in rheumatoid arthritis
74
Q

Extra-articular features of rheumatoid arthritis

A
  • pleuritis
  • pulmonary nodules
  • interstitial lung disease
  • Caplans syndrome
    ~ lung nodules
    ~ pneumoconiosis
    ~ RA
75
Q

RA, splenomegaly, granulocytopenia

A

Feltys syndrome

76
Q

Scleromalacia perforans

A
  • complication from RA

- thinning of sclera result in extrusion of intra occular contents

77
Q

Caplans syndrome

A

~ lung nodules
~ pneumoconiosis
~ RA

78
Q

Jaccouds vs. SLE arthropathy

A

Both are symmetrical and nonerosive but SLE is nondeforming unlike jaccouds

79
Q

SLE trt

A
  • avoidance of the sun
  • hydroxychloroquine
  • steroids
  • cyclophosphamide/mycophenolate mofetil
80
Q

SSA Ro/La

A

ANA sp to sjorgens syndrome

81
Q

Calcinosis, Raynaud’s phenomenon p, esophageal dysmotility, sclerodactyly, telangiectasia

A
  • crest syndrome assoc with scleroderma (limited cutaneous)
82
Q

Can’t see, can’t pee, can’t tree

A
  • conjunctivitis, urethritis, arthritis
  • triad of reactive arthritis
  • typically oligoarthritis
83
Q

Treatment for reactive arthritis

A

Abx if infection is still present
NSAIDs
Corticosteroids
DMARDs: sulfalazine, methotrexate, anti-TNFa

84
Q

Keratoderma blenorrhagica

A
  • identical to pustular psoriasis

- variable prognosis

85
Q

Enteropathic arthropathy trt

A
  • NSAIDs are a problem
  • sulfasalazine
  • TNFa inhibitors
86
Q

Hyperuricemia levels

A
  • M: 7.1mg/dl

- F: 6.0 Mg/dl

87
Q

Precipitants of gout and gouty arthritis

A
  • drugs: Diuretics, heparin, cyclosporine
  • trauma
  • EtOH
88
Q

Disease states associated with CPPD crystals

A
  • Hypothyroidism, Hyperparathyroidism,hypophosphatasia, hemochromatosis, hypomagnesemia
89
Q

Vasculitis affecting large and medium blood vessels

A
  • giant cell arteritis
  • takayasu’s arteritis
  • angiitis of CNS
90
Q

Vasculitis affecting predominantly medium and small blood vessels

A
  • polyarteritis nodosa
  • microscopic angiitis
  • Wegeners syndrome
  • Churg-straus syndrome
91
Q

Vasculitis affecting predominantly small blood vessels

A
  • Henoch-schonlein purpura
  • HSN vasculitis
  • mixed cryoglobinemia
92
Q
  • medium/small vessels

- Identified by recent history of severe asthma, eosinophilia, sinusitis, pulmonary infiltrates, G.I. ischemia

A

Churg straus vasculitis

93
Q
  • Small/medium vessels
  • ischemia involving
    ~ renal, GI mesentery, peripheral nerves, CNS
  • livedo reticularis (doily rash)
A

Polyarthritis nodosa

94
Q

Angiogram demonstrating aneurysmal dilation tapering a blood vessel

A

Diagnostic for polyarteritis nodosa

95
Q
  • Headache, scalp tenderness, fever, weight loss, night sweats, visual disturbance, blindness
  • Vasculitis involving cranial arteries and large branches aorta
A
  • Giant cell arteritis (temporal arteritis)

- trt with high dose steroids

96
Q

Wegeners syndrome

A
  • Radiographically identical to metastatic carcinoma of the lung
  • get a biopsy
  • saddle nose deformity
97
Q

Henoch schonlein purpura

A
  • classic triad:
    ~ lower extremity rash
    ~ abdominal pain
    ~ hematuria

MSI (9 decks)

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