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Pathology > L23 - Bone and joint > Flashcards

L23 - Bone and joint Flashcards

1
Q

Subtypes of inflammatory bone and joint disease

A
  1. Degenerative
  2. Auto-immune
  3. Crystal deposition
  4. Infection
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2
Q

What are some pathogenesis of osteoarthritis?

A
  1. Increased unit load on joints
  2. Degradation of articular cartilage
  3. Biochemical abnormalities
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3
Q

Radiological features of OA

A
  1. Narrowing of the joint spaces
  2. Sclerosis
  3. Subchondral cyst
  4. Peripheral growths of bone and cartilage
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4
Q

Protective structure of the spine that help to withstand axial load

A
  1. Nucleus pulpolus
  2. Disc annulus
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5
Q

What is the orientation of collagen fibres in disc annulus?

A

Oblique

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6
Q

Complication of disc bulging or herniation

A
  1. Posterior bulge: spinal cord impingement –> myelopathy
  2. Lateral bulge: nerve roots impingement –> radiculopathy
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7
Q

What is rheumatoid arthritis?

A

Systemic, chronic inflammatory autoimmune disease, affecting many tissue, specifically the joints

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8
Q

What gene is rheumatoid arthritis is commnoly associated to?

A

HLA-DR4 gene

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9
Q

2 antibodies produced in RA, used for diagnostic purposes

A
  1. Rheumatoid factor
  2. Anti-citrullinated protein antibody
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10
Q

What are the key pathologic features of RA?

A
  1. Synovial inflammation –> swelling
  2. Formation of the pannus –> granulation tissue that develops into fibrosis, resulting in ankylosis
  3. Destruction of adjacent bone
  4. Formation of rheumatoid nodules
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11
Q

What characterised rheumatoid nodule from other granulomas?

A

Central zone of fibrinoid necrosis

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12
Q

What is gout characterized by?

A
  1. Crystal deposition
  2. Increased levels of uric acid
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13
Q

What is the difference between primary and secondary gout in terms of the cause?

A

Primary: Idiopathic, may be due to obesity, alcohol and fatty diet

Secondary: increased level of uric acid, may be due to medication, renal failure, familial juvenile nephropathy

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14
Q

What can you observe in the examination of synovial fluid of people with gout under polarized microscopy?

A

Strongly birefringent needle shaped crystal

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15
Q

What can you observe in the examination of synovial fluid of people with pseudogout under polarized microscopy?

A

Rhomboid shaped crystal that are weakly berefringent

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16
Q

What is the main causative agent in osteomyelitis?

A

Staph Aureus

17
Q

How do infective agents enter the bone in osteomyelitis?

A
  1. Direct implantation
  2. Bloodborne spread
  3. Extension from contiguous site
18
Q

Classification of OM

A
  1. Suppurative (acute on chronic)
  2. Non-suppurative (chronic)
19
Q

How does the disease progress in suppurative OM?

A
  1. Introduction of bacteria through 3 ways
  2. Bacterial proliferation and spread (haversian system –> periosteum –> synovial cavity and fluid)
  3. Elevation of periosteum –> impaired blood supply and increase bone necrosis
  4. Rupture of the periosteum
20
Q

What is involcrum and sequestrum?

A

Involcrum: new reactive woven bone formed beneath the elevated periosteum

Sequestrum: bone necrosis

21
Q

What are the complications of tuberculous osteomyelitis

A
  1. Compression fractures
  2. Severe deformities
  3. Neurological deficits
22
Q

What is osteoporosis?

A

Osteoporosis is an acquired condition characterized be reduced bone mass, leading to bone fragility and susceptibility to fractures

23
Q

What is the difference between osteoporosis and osteomalacia and rickets?

A

Osteoporosis is the reduced mass of bone due to the reduction of bony traberculae. The bone calcification is normal

Osteomalacia is the condition where there is insufficient calcification in bone

Rickets is the same as osteomalacia but in children’s growth plate –> excessive cartilage formation

24
Q

What is osteitis fibrosa cystica?

A

Excessive osteoclastic activity due to increased amount or activity of PTH, which is then replaced by fibrous tissue

25
Q

What is paget’s disease [Osteitis Deformans]?

A

Disorderly bone formation due to a mixture of excessive and uncoordinated bone resoption and deposition, resulting in an abundant bone of poor quality

26
Q

What can be seen microscopically in patients with paget’s disease?

A

Mosaic pattern of lamellar bone, resembling jigsaw puzzle

27
Q

What are the complications of paget’s disease?

A
  1. Bone overgrowth, may result in severe OA because there is increased bone mass for other bone to heave
  2. Chalkstick fractures bue to brittle bone
  3. Nerve compression
  4. Hypervascularity of pagetic bone
  5. Development of sarcoma
28
Q

What is the most critical information pertaining bone tumour?

A

It’s location:

  1. Epiphysis –> giant cell tumour
  2. Metaphysis –> osteosarcoma
  3. Diaphysis
29
Q

What is the radiographical presentation of OS?

A

Large, destructive mass with permeative margins –> sunburst pattern

30
Q

What is the unique microscopic feature of OS?

A

Lace-like pattern of osteoid produced by eusinophilic matrix entrapping the anaplastic tumour cell

31
Q

What are the gross, microscopic and radiographic features of fibrous dysplasia?

A

Gross: tan-white tissue and gritty
Microscopic: Woven bone with moderately cellular fibroblastic proliferation

32
Q
A

Pathology (13 decks)

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