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NMSP Exam 2 > Bones, Joints And Soft Tissue Pt. 2 > Flashcards

Bones, Joints And Soft Tissue Pt. 2 Flashcards

1
Q

What is a common location for osteochondroma?

A

Metaphysis of long bones

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2
Q

What is the morphology of osteochondromas?

A

Bony excrescence with cartilage cap; age 10-30 yo

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3
Q

What is a common location for chondroma?

A

Small bones of hands and feet

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4
Q

What is the morphology for chondromas?

A

Circumscribed hyaline cartilage nodule in medulla; age 30-50

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5
Q

What is a common location for chondrosarcomas?

A

Pelvis and shoulder

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6
Q

What is the morphology of chondrosarcomas?

A

Extends from medulla thru cortex into ST, chondrocytes with increased cellularity and atypia; ages 40-60

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7
Q

What is a common location for osteoid osteomas?

A

Metaphysis of long bones

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8
Q

What is the morphology of osteoid osteoma?

A

Cortical interlacing microtrabeculae of woven bone; age 10-20

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9
Q

What is a common location for osteosarcomas?

A

Metaphysis of distal femur, proximal tibia

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10
Q

What is the morphology of osteosarcomas?

A

Extends from medulla to lift periosteum, malignant cells producing woven bone; ages 10-20

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11
Q

What is the common location for Ewing sarcoma?

A

Diaphysis of long bones

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12
Q

What is the morphology for Ewing sarcoma?

A

Sheets of primitive round cells; ages 10-20

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13
Q

What are the most common bone tumors?

A

Osteosarcmoa, chondrosarcoma and Ewing Sarcoma

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14
Q

What should be assumed in all osteosarcoma patients?

A

Occult metastases at the time of dx thus neoadjuvant chemotx, surgery and postop adjuvant chemotx needed

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15
Q

Where does osteosarcoma metastasize to?

A

Lungs, bones, brain, etc

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16
Q

What accounts for the majority of benign and malignant primary bone tumors?

A

Cartilaginous tumors; characterized by the formation of hyaline or myxoid cartilage

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17
Q

What is the morphology of the conventional subtype of chondrosarcoma?

A

Nodules of glistening gray white, traslucent cartilage; matrix is often gelatinous or myxoid and can ooze from cut surface; spotty calfications and central necrosis may create cystic spaces

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18
Q

What is the morphology of the dedifferentiated subtype of chondrosarcoma?

A

Low grade with a high grade component; no cartilage

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19
Q

What is the morphology of the clear cell subtype of chondrosarcoma?

A

Sheets of large malignant chondrocytes with abundant clear cytoplasm, numerous osteoclast-type giant cells and intralesional bone formation

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20
Q

What is the morphology of the mesenchymal subtype of chondrosarcoma?

A

Islands of well differentiated hyaline cartilage surrounded by sheets of primitive appearing small round cells

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21
Q

What are the characteristics of synarthroses (solid joints)?

A

Provide structural integrity and allow only minimal movement; lack a joint space

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22
Q

What are examples of fibrous synarthroses?

A

Include the cranial sutures and the bonds between roots of teeth and jawbones

23
Q

Describe synovial joints

A

Have a joint space; allows wide ROM

24
Q

What is hyaline cartilage?

A

A unique CT ideally suited to serve as an elastic shock absorber and wear-resistant surface; composed of water, type 2 collagen, proteoglycans, chondrocytes

25
What is the primary pathogenic abnormality in OA?
Mechanical injury to articular cartilage
26
What is the primary pathogenic abnormality in RA?
Autoimmunity
27
What is the role of inflammation in OA?
May be secondary; inflammatory mediators exacerbate cartilage damage
28
What is the role of inflammation in RA?
Primary: cartilage destruction caused by T cells and Abs reactive with joint antigens
29
Which joints are involved in OA?
Primarily weight bearing (knees, hips)
30
Which joints are involved in RA?
Often begins with small joints of fingers; progression leads to multiple joints involved
31
What is the pathology of OA?
Cartilage degeneration and fragmentation, bone spurs, subchondral cysts; minimal inflammation
32
What is the pathology of RA?
Inflammatory pannus invading and destroying cartilage; severe chronic inflammation; joint fusion (ankylosis)
33
Which serum Abs are present in OA?
None
34
Which serum Abs are present in RA?
Various including ACPA and RF
35
Does OA have involvement of other organs?
No but RA does (heart, lungs, etc)
36
What are diagnostic markers for RA?
Anti-citrullinated peptide Abs (ACPAs); rheumatoid factor aslo present (IgM and IgA that binds to IgG Fc receptor)
37
What extra-articular lesions are seen with RA?
May involve skin, heart, blood vessels and lungs leading to clincal manifestations that overlap with other autoimmune dz such as SLE and scleroderma; uveitis and keratoconjunctivitis can be seen
38
What is leukocytoclastic vasculitis?
Acute necrotizing vasculitis of small and large arteries that may involve pleura, pericardium, or lung and evolve into a chronic fibrosing process; produces purpura, cutaneous ulcers and nail bed infarction; seen with RA
39
What is the treatment for RA?
Corticosteroids, other immunosuppressants (MTX) and most notably TNF antagonists, which are effective in many pts (long term treatment —> susceptible to infections, TB)
40
What may be seen on imaging in a pt with RA?
Joint effusions and juxta-articular osteopenia with erosions and narrowing of the joint space and loss of articular cartilage
41
The autoimmune response in RA is initiated by what?
CD4 T helper cells
42
What are rheumatoid nodules?
Firm, nontender, round to oval small masses; microscopically they resemble necrotizing granulomas with a central zone of fibrinoid necrosis surrounded by a prominent rim of activated macrophages and numerous lymphocytes and plasma cells
43
Which pathogens can cause reactive arthritis?
GU infections with chlamydia; GI infections with Shigella, salmonella, yersinia, campylobacter, and c diff); HIV+ pts can also be affected
44
How do pathogens cause infectious arthritis?
Microorganisms seed joints via hematogenous dissemination; direct inoculation or contiguous spread ST abscess or focus of osteomyelitis; leads to rapid joint destruction and permanent deformities
45
What are examples of endogenous crystals that can result in crystal induced arthritis?
Monosodium urate (gout), Ca pyrophosphate dihydrate (pseudogout) and basic Ca phosphate
46
Which disorders result in decreased uric acid excretion?
Primary gout caused by unknown enzyme defects or secondary gout caused by chronic renal disease
47
Which disorders result in increased uric acid production?
Primary gout caused by enzyme defects (partial HGPRT deficiency) or secondary gout caused by increased nucleic acid turnover (ex. Leukemia) or congenital (lesch-nyhan sydnrome, HGPRT deficiency)
48
Which inflammatory components are involved in acute gouty arthritis?
IL-1B and LTB4
49
Soft tissue tumors are mostly sporadic but some are associated with germline mutations including..
Tumor suppresor genes: NF1, Gardner, Li-Fraumeni, Osler-Weber-Rendu; Environmental exposure: radiation, burns, toxins
50
What cytogenic abnormality is associated with Ewing sarcoma family tumors?
t(11;22)(q24;q12) and t(21;22)(q22;q12)
51
What cytogenic abnormality is associated with liposarcoma (myxoid and round cell type)?
t(12;16)(q13;p11)
52
What cyotgenetic abnormality is associated with synovial sarcoma?
t(x;18)(p11;q11)
53
What cyotgenetic abnormality is associated with rhabdomyosarcoma (alveolar type)?
t(2;13)(q35;q14) and t(1;13)(p36;q14)

NMSP Exam 2 (4 decks)

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