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System Pathology I -- Roecker > Exam 1 Pt 4: Joints > Flashcards

Exam 1 Pt 4: Joints Flashcards

1
Q

What is a form of crystal-induced arthritis sometimes known as pseudogout? What does it involve?

A

Calcium Pyrophosphate Deposition Disease (CPDD, CPPD, chondrocalicinosis, or pseudogout)

accumulation of calcium pyrophosphate crystals in joints/soft tissues inducing inflammation

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2
Q

T/F. Calcium Pyrophosphate deposition disease is more sever than gout.

A

False. it is less severe than gout

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3
Q

Who is at risk for developing CPDD (calcium pyrophosphate deposition disease)?

A
  • advanced age (over 50)
  • family history
  • previous joint injury
  • affects 1/2 inds living longer than 85 years old
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4
Q

What joints are characteristically involved in CPDD (calcium pyrophosphate deposition disease)?

A
  • knee, shoulder, wrist, hip, elbow, ankle
  • most asympotmatic, some acute, subacute or chronic arthritis
  • monoarticular or polyarticular
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5
Q

What is HADD?

A

Hydroxyapatite deposition disease (or calcific tendinitis)

  • idiopathic, involves deposition of calcium phosphate (calcium hydroxyapatite) crystals w/in joints and soft tissues
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6
Q

What is the most common joint affected by HADD (hydoxyapatite deposition disease)?

A

shoulder!!!

- others include: elbow, wrist, hip, ankle

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7
Q

Calcification of the supraspinatus tendon is characteristic of what idiopathic disease?

A

HADD (hydroxyapatite deposition disease)

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8
Q

What are risk factors for developing HADD (hydroxyapatite deposition disease)?

A
  • advanced age (over 40)

- history of adhesive capsulitis (AKA frozed shoulder)

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9
Q

What involves ossification of the spinal ligaments, specifically the ALL? What locations does the oss. of the ALL occur?

A

DISH (Diffuse Idiopathic Skeletal Hyperostosis)

- in C and lower T (T7-T11) are MC areas

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10
Q

T/F. The zygopophyseal joints and SI joints are not involved in DISH, and ankylosis does NOT occur.

A

True.

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11
Q

What condition appears on an x-ray as “flowing oss.” or “candle wax dripping”?

A

DISH

- produces a “tortuous paravertebral mass” on anterior aspect of spine

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12
Q

How does the motion of the spine change with DISH?

A
  • reduced spinal ROM, and creates spinal “rigidity”
  • movements between VBs still exists
  • Cervical DISH may cause difficulty swallowing
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13
Q

What are the risk factors for developing DISH?

A
  • male sex
  • over age 50
  • have hyperglycemia/diabetes
  • 1/3 positive for HLA-B27
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14
Q

What are three ways an infection may occur within a joint?

A
  1. hematogenous spread
  2. spread from surrounding soft tissue infs/ osteomyelitis
  3. traumatic introduction
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15
Q

What condition is characterized by acute joint pain combined with abundant pus formation?

A

Suppurative arthritis

suppurative = causing production of pus

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16
Q

What are the most common cause of suppurative arthritis?

A

bacterial infections

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17
Q

Describe the manifestation of joints involved in suppurative arthritis. Any other signs and symptoms that one may have?

A

red, swollen, very tender to touch and vibration

systemic signs/symptoms of an inf.:

  • fever
  • malaise
  • leukocytosis
  • elevated ESR
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18
Q

What is the MC affected joint of suppurative arthritis? Is it usually mono or polyarticular?

A

(MC = knee
- usually monoarticular
also– hip, shoulder, elbow, wrist, sternoclavicular joints)

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19
Q

What is the most recognized bacterial pathogen to cause suppurative arthritis and in what population?

A

Staphylococcus aureus in children (above 2) and adults

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20
Q

What bacterial pathogen MC causes forms suppurative arthritis in these populations:

  1. Children and adults
  2. Sexually active young adult females
  3. Sickle cell disease patiens
  4. Children younger than age 2
A
  1. Staphylococcus aureus
  2. Neisseria gonorrhoeae
  3. Salmonella spp.
  4. Haemophilus influenzae
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21
Q

What is Gonococcal Arthritis? Who is MC to get it?

A

develops following untreated cases of gonnorhea; less severe joint pain, polyarticular pattern; “subacute” course

  • MC in females under age 40
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22
Q

What two conditions are our focuse when it comes to Infectious arthritis?

A
  1. Suppurative arthritis

2. Lyme Arthritis

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23
Q

What is the MC arthropod-borne disease in the US? What can it develop into?

A

Lyme Disease; can develop into Lyme Arthritis when it is untreated

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24
Q

What bacterial spirochete causes lyme disease and how is it transmitted to humans?

A

Borrelia burgdorferi; transmitted via lxodes deer tick

spirochetal infs– spread throughout body and involve mult. organ systems

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25
Q

Lyme arthritis develpos in about _____ patients with untreated Lyme Disease within ____ of initial infection.

A

75%; within months

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26
Q

What are the three distinct phases of lyme diseae?

A
  1. Early Localized Phase
  2. Early Disseminated Phase
  3. Late Disseminated Phase (chronic phase)

(disseminated = to spread throughout organ or body)

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27
Q

What is characteristic on the skin in the Early localized phase of lyme disease?

A

“bullseye rash”; aka erythema chronicum migrans

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28
Q

What is stage 2, early disseminated phase of lyme disease dominated by?

A

secondary skin lesions that cover larger areas of the body, like thorax
May have:
- CN dysfxn
- meningitis
- migratory joint pain of large extremity joints
- migratory muscle pain
- carditis

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29
Q

What does the chronic phase of lyme disease manifest like?

A
  • constant polyarthritis and permanent joint distruction
  • knees, shoulders, elbows, ankles
  • also have meningities, CN dysfxn, myalgia, carditis
  • life threatening CNS inflam.
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30
Q

What is the Tx for lyme disease and how effective is it? What if it doesn’t work, then what do we call the disease?

A

antibiotics–cure rates ~90%

Posttreatment Lyme Disease syndrome

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31
Q

T/F. Primary joint tumors are common and MC malignant.

What do they originate from?

A

False–they are RARE and MC benign!!

Originate from tissues constituting a joint:

  • synovial tissue
  • fat
  • cartilage
  • fibrous tissue
  • vascular tissue
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32
Q

What are usually more common than primary joint tumors?

A

tumor-like lesions

  • lesions w/in or near joint that resemble tumors, but ARE NOT true neoplasms
  • most commonly develop from trauma of degeneration
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33
Q

What is a collection of degenerative CT that is MC near joint capsule or sheath of wrist or hand?

A

ganglion cyst (not true cyst b/c no epithelial lining)

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34
Q

Where are ganglion cysts MC? Do they communicate with the joint? What are they filled with?

A

dorsal or ventral surface of wrist; do not communicate w/ joint; filled with myxoid cartilage

35
Q

What develops following herniation of synovial fluid w/in synovial joint into periarticular soft tissues?

A

synovial cysts

36
Q

Where are the two characteristic locations of synovial cysts?

A
  • popliteal fossa

- near lumbar zygapophyseal joints

37
Q

What is a synovial cyst formed in the popliteal space called? What are known risk factors for this condition?

A

Baker cyst

RA and OA

38
Q

What synovial cysts that form w/in spinal canal called? What does it commonly cause?

A

Spinal synovial cyst; commonly causes spinal stenosis (narrowing of spinal canal)

39
Q

What age of individuals MC develop spinal synovial cysts and why? Where is the MC location?

A

older adults; due to degeneration of zygapophysis joints

MC is posterior to L4 and L5 vert.

40
Q

Are soft tissue tumors more likely to be benign or malignant?

A

benign

41
Q

What percentage of soft tissue sarcomas affect pediatrics?

A

15%

42
Q

Malignant soft tissue tumors represent a ____ percentage of all cancer diagsoses, but constitute about ___ percent of all cancer-related deaths.

A

small (<1%); 2% all cancer-related deaths, telling use they are aggressive

43
Q

Where are the MC locations of soft tissue tumors?

A

thigh or retroperitoneal area (abdomen)

44
Q

Are soft tissue tumors MC sporadic or hereditary?

A

sporadic

45
Q

What is the MC soft tissue tumor in adults?

A

lipoma

46
Q

What are lipomas? Risk for malignancy? Encapsulated or not?

A
  • benign adipocyte tumor composed of mature adipocytes and are NOT a risk for malignancy
  • soft to touch and painless
  • encapsulated –therefore more mobile
47
Q

Where to lipomas characteristically develop?

A

proximal extremities or torso (trunk)

48
Q

What is the most common sarcoma of mid-to-later adulthood (age 50-70)?

A

liposarcoma

49
Q

What are liposarcomas? Where do they MC develop?

A

malignant tumor of adipocytes, MC develop in retroperitoneum (therefore not easily detected = poor prognosis)

50
Q

What is a benign tumor of fibroblasts located w/in superfical fascia?

A

Nodular fasciitis

51
Q

Where do most cases of nodular fasciitis develop? How do they manifest? MC in what age?

A

volar (palm-side) of arm, foot, chest, or back

rapidly-enlarging mass that is FIRM

adults

52
Q

What involves dystrophic calcification of injured soft tissues following trauma? What age group is MC affected?

A

Myositis ossificans

adolescent or young adult athletes

53
Q

What are other ways to describe myositis ossificans?

A

traumatically-induced metaplasia or heterotopic ossification

54
Q

What does myositis ossificans cause and where is it most likely to occur?

A

hard and painless mass; most likely proximal extremities about 4-7 wks after initial injury

55
Q

What represents a group of benign tumors of fibroblasts are invasive and cause painful destruction of tissues?

A

Fibromatoses

56
Q

What kind of Fibromatoses are there?

A

Superficial

Deep (desmoid tumors)

57
Q

What benign proliferations are common among males and cause firm nodule surrounded by dense collagen?

A

Superficial fibromatoses

58
Q

What are two examples of Superficial Fibromatoses?

A

Pyronine disease

Dupuytren contracture

59
Q

What is Pyronine disease?

A

formation of a superficial fibromatosis on dorsolateral penis

60
Q

What is Dupuytren contracture?

A

formation of a superficial fibromatosis on the palmar fascia (hand) and typically develops on ulnar side of hand

61
Q

What are Deep fibromatoses? Who are they more likely to occur in?

A

develop w/in anterior abdominal wall or limb girdles
- invasive, aggressive, and freq. RECUR after excision

MC in adult females

62
Q

What is a malignant soft tissue tumor of fibroblasts? Where is it most likely to develop?

A

Fibrosarcoma

thigh or retroperitoneal space

63
Q

How does a Fibrosarcoma manifest?

A

invasive, but slow-growing mass (thigh of retroperitoneal space)

64
Q

What age group is most likely affected by Fibrosarcomas?

A

adults (age 35-55)

65
Q

What characteristcally has a herringbone histological appearance?

A

fibrosarcoma

- herringbone arrangement of neoplastic fibroblasts

66
Q

What is the recurrence rate of fibrosarcomas after excision?

A

about 1/2 come back

67
Q

By the time Fibrosarcomas re Dx, where have they mets to?

A

about 25% have already mets to lungs

68
Q

T/F. Virtually all tumors of skeletal muscle tissues are benign.

A

False–virtually all are malignant (like Rhabdomyosarcoma)

69
Q

What is Rhabdomyosarcoma?

A

a malignant tumor of rhabdomyoblasts–which are precursor cells to skeletal muscle tissue

70
Q

Where do Rhabdomyosarcomas MC develop?

A

areas on MINIMAL skeletal muscle tissue

  • head or neck
  • genitourinary region
  • extremities
  • trunk
71
Q

What is the MC soft tissue sarcoma among pediatrics?

A

Rhabdomyosarcoma

72
Q

What is the rate or cure of children Dx with Rhabdomyosarcoma?

A

about 2/3 are cured

adults poorer prognosis

73
Q

What is leiomyoma? Where does it characteristically develop?

A

a benign tumor of smooth muscle cells; MC develop in uterus

- also in esophagus, or SI

74
Q

Leiomyoma found in the uterus are referred to as what? MC among who?

A

“fibroids”; firm to touch, about 1-2 cm

MC among reproductive age females

75
Q

What characteristically manifests with “cigar-shaped” nuclei?

A

Leiomyosarcoma

76
Q

What are Leiomyosarcomas?

A

a malignant tumor of smooth muscle cells

  • “cigar-shaped” nuclei
  • common
77
Q

How common are leiomyosarcomas?

A

represent 20% of all soft tissue sarcomas

78
Q

Where are leiomyosarcomas most likely to be found?

A

thigh or abdomen (retroperitoneum); firm masses

  • uterus–> common form of uterine CA
79
Q

Leiomyosarcomas found in the uterus are most likely to affect what women?

A

older (menopausal) females

80
Q

T/F. Synovial Sarcomas develop from tissues of the joint.

A

False (they used to believe that)

81
Q

What soft tissue malignant tumor of “uncertain origin” develop as a PAINLESS mass in young adults 920-40) and are very aggressive?

A

Synovial sarcoma

82
Q

What is the MC location for synovial sarcomas?

A

soft tissues surrounding the knee

  • usually surround large joints (only 10% found w/in joint)
83
Q

What is the prognosis for synovial sarcomas?

A

very poor prognosis

- less than 30% achieve long-term survival (10 years after Dx)

System Pathology I -- Roecker (14 decks)

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