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Clinical Pathology > Diseases of the musculoskeletal system 1 > Flashcards

Diseases of the musculoskeletal system 1 Flashcards

1
Q

What is arthritides?

A
  • Pain and stiffness of a joint
  • Inflammation of the joint
  • Not a single disease
  • Hundreds of diseases- causing pain and stiffness of the musculoskeletal system
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2
Q

What is the main difference between acute and chronic arthritis?

A
  • Acute arthritis-Pain, heat, redness and swelling

- Chronic arthritis- commonest types- Osteoarthritis & Rheumatoid arthritis

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3
Q

What is osteoarthritis?

A
  • Degenerative joint disease
  • Progressive erosion of articular cartilage
  • Results in the formation of bony spurs and cysts at the margins of joints
  • Knees and hands in women and hip in men
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4
Q

What is secondary OA?

A
  • Knee in basket ball players and elbow in baseball players

- Underlying systemic diseases such as diabetes and marked obesity

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5
Q

What is the pathogenesis of OA?

A
  • Deterioration or loss of cartilage that acts as a protective cushion in between bones
  • As the cartilage is worn away-bone forms spurs
  • Fluid filled cysts in the marrow- subchondral cysts
  • Results in pain and limitation of movements
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6
Q

Which cells are the basis of OA?

A
  • Chondrocytes produce interleukin-1 – initiates matrix breakdown
  • Prostaglandin derivatives induces the release of lytic enzymes – prevents matrix synthesis
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7
Q

What are Bouchard’s nodes?

A
  • Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints
    Seen in osteoarthritis, where they are caused by formation of calcific spurs of the articular (joint) cartilage.
  • Less commonly, they may be seen rheumatoid arthritis, where nodes are caused by antibody deposition to the synovium.
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8
Q

What are Herberden’s nodes?

A

DIP equivalent of Bouchard’s nodes.

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9
Q

What is rheumatoid arthritis (RA)?

A
  • Chronic systemic disorder-principally affecting the joints
  • Producing a non suppurative proliferative synovitis- destruction of articular cartilage and ankylosis of joints
  • Also affects skin, muscles, heart, lungs and blood vessels
  • Women 3-5 times more than men
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10
Q

What are the clinical features of RA?

A
  • Malaise, fatigue and generalised musculoskeletal pain to start of.
  • Involved joints are swollen, warm,painful and stiff in the morning or after activity.
  • Slow or rapid disease course and fluctuates over 4-5 years
  • Small joints of the hands and feet are frequently affected-ending in a deformed joint
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11
Q

What is the pathogenesis of RA?

A
  • Genetic susceptibility-65-80%- HLA- DR4 &DR1 or both
  • Primary exogenous arthritogen- EBV,other viruses, Borrelia
  • Autoimmune reaction within the synovial membranes- CD4 positive T-cells
  • Mediators of joint damage- Cytokines-
  • IL-1-6 and TNF-alpha&beta
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12
Q

What is the criteria for diagnosis for RA?

A
  1. Morning stiffness
  2. Arthritis in 3 or more joint areas
  3. Arthritis of hand joints
  4. Symmetric arthritis
  5. Rheumatoid nodules
  6. Serum Rheumatoid factor

4 of the above criteria

  • Rheumatoid factor- present in most but not all patients, less specific
  • Analysis of synovial fluid- confirms the presence of neutrophils- inflammatory picture
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13
Q

What are the typical radiographic changes in RA?

A
  • changes-narrowing of joint space

- loss of articular cartilage

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14
Q

What non-MSK systems may be involved in RA?

A
  • Skin-Rheumatoid nodules- commonest cutaneous manifestation, in areas of pressure
  • Lung, Spleen, Heart, other viscera
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15
Q

Which arthroses are sero-negative?

A
  • Ankylosing spondylitis
  • Reiter’s syndrome
  • Psoriatic arthritis
  • Enteropathic arthritis
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16
Q

What is gout?

A
  • End point of a group of disorders producing hyperuricemia
  • Uric acid is the end product of purine metabolism
  • Deficiency of the enzymes involved
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17
Q

What are the clinical features of gout?

A
  • Chronic arthritis
  • Tophi in various sites
  • Gouty nephropathy
  • Transient attacks of acute arthritis- crystallization of urates within and about joints, leading to chronic gouty arthritis and deposition of masses of urates in joints and other sites- tophi
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18
Q

What are the features pyogenic osteomyelitis?

A
  • Systemic illness-fever, malaise, chills and marked pain over the affected region
  • X-ray lytic focus of bone destruction surrounded by zone of sclerosis
  • Blood cultures are positive
  • Biopsy- if needed shows sheets of neutrophils
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19
Q

What is the aeitiology of pyogenic osteomyelitis?

A
  • Caused by bacteria
  • Hematogenous spread
  • Extension from a contiguous site
  • Direct implantation
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20
Q

What are the clinical features of infective arthritis?

A
  • Acutely painful and swollen joints with restricted movements
  • Fever, leucocytosis and elevated ESR
  • Bacterial-Staphylococcus, Streptococcus, Gonococcus, Mycobacteria,
  • Predisposing conditions-trauma, IV drug abuse, debilitating illness
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21
Q

What is osteoporosis?

A
  • Increased porosity of the skeleton
  • Reduction in bone mass
  • Localised or entire skeleton
  • Primary or secondary
  • Primary-age and postmenopausal
22
Q

What are the clinical features of osteoporosis?

A
  • Vertebral factures
  • Kyphosis
  • Scoliosis
23
Q

Describe osteoclast dysfunction in Paget’s disease.

A
  • Paget’s disease
  • Initial osteolytic stage
  • Predominant osteoblastic activity
  • Burnt out osteosclerotic stage
  • Net effect –gain in bone mass
  • Newly formed bone is disordered and architecturally unsound
24
Q

What tumours may be present in Paget’s disease?

A
  • Tumours –Benign &Malignant
  • Giant cell tumour- benign tumour
  • Malignant-Osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma
25
Q

What are the most common symptoms in Paget’s disease?

A
  • Pain most common symptom

- Chalk stick type fractures-common

26
Q

What is the aetiology of Paget’s disease?

A

Paramyxovirus infection

27
Q

What is the histological hallmark of Paget’s disease?

A

Mosaic pattern

28
Q

Is Paget’s disease more common in males or females?

A

Male

29
Q

What is osteomalacia?

A
  • Defects in matrix mineralization
    Related to lack of Vit D
  • Decreased bone density- too little bone-osteopenia
  • Skeletal deformities are not seen
30
Q

What is renal osteodystrophy?

A

Skeletal changes of chronic renal disease

  • Increased osteoclastic bone resorption
  • Delayed matrix mineralization
  • Osteosclerosis
  • Growth retardation
  • Osteoporosis
31
Q

What are soft tissue tumours?

A
  • Soft tissue-nonepithelial extraskeletal structures exclusive of supportive tissue of organs and lymphoid/hematopoietic tissue
  • Fibrous tissue, adipose tissue, skeletal muscle, blood and lymphatic vasculature, peripheral nervous system.
32
Q

What is the embryological origin of soft tissue tumours?

A

Mesodern

33
Q

What are the features of sarcomas?

A
  • Malignant
  • Account for 1% of malignancies
  • Congenital tumours rarely behave malignantly even with aggressive features.
  • Lymph node involvement uncommon
  • Blood spread to liver, lung etc.
34
Q

Which syndromes are associated with

A
  • Neurofibromatosis Type1- Neurofibroma
  • Gardner syndrome-Fibromatosis
  • Carney syndrome-Myxoma,melanotic schwannoma
  • Turner syndrome- cystic hygroma
35
Q

What diagnostic techniques are used for soft-tissue tumours?

A
  • Ultrasound guided core biopsy
  • Wide excision
  • Cytogenetics- culture of fresh tissue and karyotypic analysis
  • Molecular genetics- FISH and PCR and RT-PCR
36
Q

What is the classification of bone tumours?

A

Benign bone tumours

  • Osteomas
  • Osteoblastomas

Benign cartilage tumours
- Chondromas

Mixed
- Osteochondromas

37
Q

What is the most common malignant tumour?

A

Osteosarcoma

38
Q

Osteosarcomas are most common in what age group?

A

Young age group

39
Q

What is the most common site for osteosarcoma?

A

Around the knee (60%)

40
Q

Name malignant bone tumours other than osteosarcoma?

A
  • Chondrosarcomas
  • Ewing’s sarcoma
  • Giant cell Tumours
41
Q

Which primary tumours commonly metastasise to bone?

A
  • Thyroid
  • Prostate
  • Kidney
  • Breast
  • GI tract
42
Q

What are the features of SLE?

A

Cutaneous
- Butterfly rash is typical affecting the bridge of nose and the cheeks

Cardiac
- cardiomegaly, endocarditis

CNS
- important cause for morbidity and mortality- convulsions, hemiplegia

Renal
- 45% of patients, Nephrotic syndrome and glomerulonephritis

43
Q

What is systemic sclerosis?

A
  • Pathogenesis- complex and poorly understood
  • Vessel damage, inflammatory response and cytokines
  • Diffuse- widespread cutaneous lesions
  • Renal, Cardiorespiratory and Gastrointestinal tract
  • Osteoarticular involvement- artharlgia and arthritis

Poor prognosis

44
Q

What is the localised variant of systemic sclerosis?

A
  • Limited cutaneous involvement+ oeasophageal involvement and SI malabsorption
  • CREST syndrome-Calcinosis, Raynaud’s phenomenon, oesophageal dysfunction, sclerodactyly,telangiectasia
45
Q

What is polymyalgia rheumatica?

A

Stiffness, weakness, aching and pain in the muscles of neck, limb girdles and upper limbs.

Assoc with giant cell arteritis- affects occipital or facial arteries- pyrexia, headache and severe scalp pain

Pathogenesis- immunological mechanism suggested

46
Q

What is myopathy?

A

Muscle disease unrelated to any disorder of innervation or neuromuscular junction

47
Q

What is myositis?

A

Muscle fibres and overlying skin are inflamed and damaged resulting in muscle weakness

48
Q

What is rhabdomyolysis?

A
  • Destruction of skeletal muscle
  • Release of muscle fibre content into blood
  • Myoglobin is released into the blood stream
  • Filtered through the kidney and enters urine- myoglobinuria- brown urine
49
Q

What are the possible causes of rhabdomyolysis?

A
  • Trauma, crush injuries
  • Drugs- cocaine, amphetamine
  • Extreme temperature
  • Severe exertion-marathon running
  • Lengthy surgery
  • Severe dehydration
  • Important complication- acute renal failure
50
Q

What are the symptoms of malignant hyperthermia?

A
  • Bleeding
  • Dark brown urine
  • Muscle rigidity
  • Quick rise in body temperature to 105 degree F or higher
  • Discovered during anaesthesia
  • May have family history

Clinical Pathology (65 decks)

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