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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
Q

What is the primary pathogenic abnormality in OA?

A

Mechanical injury to articular cartilage

26
Q

What is the primary pathogenic abnormality in RA?

A

Autoimmunity

27
Q

What is the role of inflammation in OA?

A

May be secondary; inflammatory mediators exacerbate cartilage damage

28
Q

What is the role of inflammation in RA?

A

Primary: cartilage destruction caused by T cells and Abs reactive with joint antigens

29
Q

Which joints are involved in OA?

A

Primarily weight bearing (knees, hips)

30
Q

Which joints are involved in RA?

A

Often begins with small joints of fingers; progression leads to multiple joints involved

31
Q

What is the pathology of OA?

A

Cartilage degeneration and fragmentation, bone spurs, subchondral cysts; minimal inflammation

32
Q

What is the pathology of RA?

A

Inflammatory pannus invading and destroying cartilage; severe chronic inflammation; joint fusion (ankylosis)

33
Q

Which serum Abs are present in OA?

A

None

34
Q

Which serum Abs are present in RA?

A

Various including ACPA and RF

35
Q

Does OA have involvement of other organs?

A

No but RA does (heart, lungs, etc)

36
Q

What are diagnostic markers for RA?

A

Anti-citrullinated peptide Abs (ACPAs); rheumatoid factor aslo present (IgM and IgA that binds to IgG Fc receptor)

37
Q

What extra-articular lesions are seen with RA?

A

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
Q

What is leukocytoclastic vasculitis?

A

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
Q

What is the treatment for RA?

A

Corticosteroids, other immunosuppressants (MTX) and most notably TNF antagonists, which are effective in many pts (long term treatment —> susceptible to infections, TB)

40
Q

What may be seen on imaging in a pt with RA?

A

Joint effusions and juxta-articular osteopenia with erosions and narrowing of the joint space and loss of articular cartilage

41
Q

The autoimmune response in RA is initiated by what?

A

CD4 T helper cells

42
Q

What are rheumatoid nodules?

A

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
Q

Which pathogens can cause reactive arthritis?

A

GU infections with chlamydia; GI infections with Shigella, salmonella, yersinia, campylobacter, and c diff); HIV+ pts can also be affected

44
Q

How do pathogens cause infectious arthritis?

A

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
Q

What are examples of endogenous crystals that can result in crystal induced arthritis?

A

Monosodium urate (gout), Ca pyrophosphate dihydrate (pseudogout) and basic Ca phosphate

46
Q

Which disorders result in decreased uric acid excretion?

A

Primary gout caused by unknown enzyme defects or secondary gout caused by chronic renal disease

47
Q

Which disorders result in increased uric acid production?

A

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
Q

Which inflammatory components are involved in acute gouty arthritis?

A

IL-1B and LTB4

49
Q

Soft tissue tumors are mostly sporadic but some are associated with germline mutations including..

A

Tumor suppresor genes: NF1, Gardner, Li-Fraumeni, Osler-Weber-Rendu; Environmental exposure: radiation, burns, toxins

50
Q

What cytogenic abnormality is associated with Ewing sarcoma family tumors?

A

t(11;22)(q24;q12) and t(21;22)(q22;q12)

51
Q

What cytogenic abnormality is associated with liposarcoma (myxoid and round cell type)?

A

t(12;16)(q13;p11)

52
Q

What cyotgenetic abnormality is associated with synovial sarcoma?

A

t(x;18)(p11;q11)

53
Q

What cyotgenetic abnormality is associated with rhabdomyosarcoma (alveolar type)?

A

t(2;13)(q35;q14) and t(1;13)(p36;q14)

NMSP Exam 2 (4 decks)

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