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Clinical Pathology II > MSK Conditions > Flashcards

MSK Conditions Flashcards

1
Q

Multiple Myeloma: MC Symptom

A

-Persistent skeletal pain (70% of cases) that is usually <6 months in duration
-Pain is usually back and rib pain

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2
Q

What type of fractures are common in multiple myeloma?

A

Pathological fractures; sudden onset of pain (vertebral collapse)

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3
Q

Multiple Myeloma: Areas of Swelling (7)

A

Ribs, skull, sternum, vertebrae, clavicle, shoulders, pelvis

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4
Q

Mutiple Myeloma: Other Signs/Symptoms

A

• Renal failure/insufficiency
• Recurrent bacterial infections
• Anemia
• Bleeding (purpura or epistaxis) – only in thrombocytopenia
• Weight loss, weakness, lethargy

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5
Q

Multiple Myeloma: Lab Findings (Protein)

A

-Serum total protein (high): High globulin, NL/low albumin*
-Serum protein electrophoresis: Reversed A:G Ratio*
-Bence Jones Proteinuria*

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6
Q

Multiple Myeloma: Lab Findings (CBC/Blood findings)

A

-N/N anemia
-PBS: Rouleau
-Increased ESR
-Normal: WBC, Platelets
-Lymphocytosis

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7
Q

Multiple Myeloma: Lab Findings (Enzymes)

A

-Normal ALP*: Marrow issue (osteoclastic), not bone

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8
Q

Multiple Myeloma: Other Lab Abnormalities

A

-Abnormal KFTs**: BUN, Creatinine, Uric Acid
-Serum Calcium: Elevated in some patients

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9
Q

Mulitple Myeloma: Follow-Up

A

• Suspicion – order protein electrophoresis
• Definitive diagnosis – bone marrow biopsy

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10
Q

Multiple Myeloma: X-Ray Findings

A

• Pelvis, spine, ribs and skull are most commonly affected
• Punched-out lytic lesions
• Bone scans are not usually helpful

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11
Q

Osteolytic Metastasis: Lab Findings

A

-Increased: Urine Calcium, Serum ACP (if prostate cancer)

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12
Q

Osteolytic Metastasis: X-Ray Findings

A

• Pathological fractures
• No periosteal reaction or sclerosis
• Kidney, lung, breast and thyroid are most common
• Kidney/thyroid - cause blow out lesions

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13
Q

Osteoblastic Metastasis: Lab Findings

A

-Increases: Serum ALP, Serum ACP (if prostate cancer)
-Decreased: Urine Calcium
-Normal: Serum Calcium

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14
Q

Osteoblastic Metastasis: X-Ray Findings

A

• Sclerosis
• Normal architecture is lost
• Usually breast or prostate

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15
Q

What is usually affected in multiple myeloma

A

Pelvis, spine, ribs and skull

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16
Q

Osteolytic Metastasis: Most commonly affected

A

• Kidney, lung, breast and thyroid are most common

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17
Q

Osteoblastic Metastasis: Most commonly affected

A

Breast or prostate

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18
Q

Primary Bone Tumors: Lab Abnormalities (“HEAL”)

A

• Hypercalcemia
• Anemia
• ESR/CRP elevations
• LDH elevation

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19
Q

Osteosarcoma: Signs/Symptoms

A

*Most significantly night pain
-Pain and swelling are the most consistent symptoms: Onset if gradual, progressive
-Pain is aching and persistent

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20
Q

Osteosarcoma: Lab Findings

A

Serum ALP increases

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21
Q

Osteoarthritis: Signs/Symptoms

A

-Pain worsened by exercise: Usually resolves in <30 mins
-Decreased ROM, Crepitis, joint deformity

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22
Q

Osteoarthritis: Lab Findings

A

Usually Normal Findings: ESR could become increased

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23
Q

Osteoarthritis: X-Ray

A

• Irregular or asymmetric narrowing of the joint space

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24
Q

Rheumatoid Arthritis: Signs/Symptoms

A

-Tenderness in nearly all inflammed joints (most sensitive)
-Joint pain on passive ROM
-Stiffness lasting >30 mins (morning/prolonged activity)
-Diffuse swelling of hands and wrists

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25
Q

Rheumatoid Arthritis typically affects:

A

Small hand joints, feet, wrists, elbows, ankles is typical

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26
Q

Rheumatoid Arthritis: Systemic Symptoms

(“SO FLAMED”)

A

• fatigue
• malaise
• depression
• anorexia
• lymphadenopathy
• splenomegaly
• ocular disease
• entrapment neuropathies

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27
Q

________ are seen in 30-40% of RA patients

A

Subcutaneous nodules

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28
Q

What disease is typically found during lab findings w/ RA?

A

Anemia of chronic disease (80%)

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29
Q

Rheumatoid Arthritis: Lab Findings

A

• ESR is elevated in 90% of cases; CRP commonly elevated
• Rheumatoid factor positive: Not specific for rheumatoid arthritis (some conditions cause false +)
• Anti-Cyclic Citrullinated Peptide (Anti-CCP) Antibodies
• ANA

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30
Q

Rheumatoid Arthritis: Early X-Ray Findings

A

• Early: Soft tissue swelling; Increased/decreased joint space; Subarticular osteoporosis; Marginal erosions/cysts

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31
Q

How to differentiate between Osteoarthritis and RA?

A

-Time: Osteoarthritis (>30 mins)/RA (>30mins)
-Pain: Osteoarthritis (worsened w/ exercise)/RA (Worse in the morning and w/ passive ROM)
-Lab Findings: Osteoarthritis (NL)/RA (Elevated ESR, RF, Anti-CCP, ANA & ACD is common-80%)

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32
Q

Where does Psoriatic Arthritis Most Commonly Occur?

A

-Psoriasis of the nails (90%) or skin (5%)
• SI Joint & Spine
• The DIPs of the fingers and toes are especially affected.

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33
Q

Psoriatic Arthritis: Signs/Symptoms

A

• Joint swelling, tenderness, warmth, restricted movement
• Fever, malaise
• Morning stiffness, pain
• Sausage digit
• No subcutaneous nodules

34
Q

Psoriatic Arthritis: Lab Findings

A

• Increased serum uric acid in 30% of cases
• HLA-B27 antigen present in patients with spondylitis-type psoriatic arthropathy
• ESR elevated in acute phase
• May have the anemia of chronic disease

35
Q

Gouty Arthritis: Structures MC Involved

A

• The metatarsophalangeal joint of the great toe is frequently involved
-Subcutaneous nodules: Ears & extensor surfaces

36
Q

Gouty Arthritis: Signs/Symptoms

A

• Acute mono-or polyarticular pain: Described as throbbing, crushing or excruciating
• Inflammatory response: Shiny, tense, hot, dusky red skin, exquisite tenderness
• Subcutaneous or intraosseous nodules (20%) (tophi): Commonly impacts ears & Extensor surfaces

37
Q

Gouty Arthritis: Precipitating Factors

A

Precipitating factors:
• Primary pathology->hyperuricemia
• Dietary choices: High purine foods, Fructose & Alcohol
• Insulin resistance
• Hydration
• Certain medications

38
Q

Does Psoriatic Arthritis contain subcutaneous nodules?

A

No

39
Q

Gouty Arthritis: Lab Findings

A

• Increased serum uric acid levels: Not diagnostic, cardinal biochemical abnormality;
• Leukocytosis with left shift – acute attack
• Increased ESR: Acute attack

40
Q

What factors can lower uric acid levels?

A

Aspirin, vitamin C may lower uric acid to below reference values

41
Q

What factors can lower uric acid levels?

A

Aspirin, vitamin C may lower uric acid to below reference values

42
Q

Chondrocalcinosis: Signs & Symptoms

A

• Acute pain & swelling of 1+ joints: Knee involved in 1/2 of all attacks (ankle, wrist & shoulder also common)
• Inflammation, joint effusion, decreased ROM
• Unexplained attacks of arthritis: acute or subacute
• Fever possible

43
Q

Chondrocalcinosis (CPPD): Most common areas affected

A

Knee: Most common, Pubic symphysis pubis 2nd most common; Similar to DJD

44
Q

Chondrocalcinosis: Lab Findings

A

Synovial fluid analysis
• Crystals are weakly positively birefringent
• Leukocytosis with predominantly neutrophils (80-90%)
• Elevated ESR

45
Q

Chondrocalcinosis: X-Ray Findings

A

• Articular cartilage calcification
• Periarticular calcification
• Pyrophosphate arthropathy

46
Q

Septic Arthritits is predominantly:

A

Monoarticular (90%)

47
Q

Septic Arthritis: Infants

A

Irritability, fretfulness, fever, fails to move limbs spontaneously, tenderness or pain with passive movement

48
Q

Septic Arthritis: Older Children & Adults

A

Acute joint pain, stiffness: Mc = knee (Followed by shoulder, wrist, hip, fingers, elbow)

49
Q

Septic Arthtritis will have a ______ during the course of an infection?

A

Fever (90%)

50
Q

Septic Arthritis: Other Symptoms

A

• Joint effusion, tenderness
• Joint warmth/redness – present in <50%
• Loss of joint motion
• Tenosynovitis
• Chills, malaise

51
Q

Septic Arthritis: Lab Findings

A

• Leukocytosis with neutrophilia
• Increased ESR/CRP

52
Q

Septic Arthritis: Synovial Fluid Analysis

A

• Cloudy
• >50,000/ul WBC/hpf
• >90% Neutrophils
• Synovial fluid: blood glucose less than 0.5
• Absence of crystals

53
Q

Septic Arthritis: X-Ray Findings

A

• Soft tissue swelling
• Joint displacement

54
Q

Ankylosing Spondylitis: Signs & Symptoms

A

• Episodes of insidious onset of aching low back pain: MC
• Subgluteal or LBP and/or stiffness
• Duration >3 months
• Morning stiffness (relieved by activity)
• Often nocturnal recurrent back pain: Get up to “walk off” back pain
• Pleuritic chest pain is often an early feature

55
Q

Ankylosing Spondylitis: Lab Findings

A

• Anemia of chronic disease in 30% of cases
• Increased ESR
• Increased CSF protein
• Increased incidence of HLA-B27 antigen

56
Q

Reactive Arthritis: Urogenital Tract S/Sx

A

• Urethritis 7-14 days after exposure
• Prostatitis, cervicitis (usually asymptomatic) possible

57
Q

Reactive Arthritis: Eye Signs & Symptoms

A

• Conjunctivitis is the most common eye lesion
• 30-50% of patients
• usually bilateral
• mild and non-infectious appearing
• lasts only a few days
• develops over the next few weeks, usually mild

58
Q

Reactive Arthritis: Other Symptoms

A

• Joint pain and swelling – knees, ankles, feet
• Enthesitis – Achilles tendon and plantar fascia
• Sacroiliitis: Inflammation of the SI joint
• Skin lesions similar to psoriasis possible
• Enteritis possible
• Fever, fatigue possible

59
Q

Reactive Arthritis: Lab Findings

A

• Increased ESR/CRP
• Leukocytosis and mild normo/normo anemia possible
• 60-80% have +HLA-B27

60
Q

Peripheral Arthritis: Areas Affected

A

• Affects the large joints of the arms and legs (knees, ankles, elbows, wrists)
• Often migratory and asymmetrical

61
Q

Axial Arthritis: Areas Affected

A

• SI joints and spinal involvement
• Chronic lower back pain and stiffness, particularly in the morning or after periods of inactivity

62
Q

Enteropathic Arthritis: Labs

A

• ESR/CRP elevations possible (corresponds w/ flare of IBD)
• May have anemia of chronic disease
• HLA-B27 – positive in some patients, more likely in those with spinal involvement

63
Q

Lyme Disease: Progression

A

-Stage 1: Skin rash, flu-like symptoms
-Stage 2: 1+ organ systems involved; Neurogenic or Cardiac
-Stage 3: Arthritis (large joints), chronic neurologic symp.

64
Q

Lyme Disease Lab Findings

A

-ELISA—>Western Blot (Confirmation)
-IgM and IgG against Borrelia Burgdorferi
-Elevated ESR
-CRP: Monitors treatment
-Leukocytosis possible

65
Q

Osteoporosis: Signs/Symptoms

A

• may be asymptomatic
• aching pain in the bones, especially the back
• Acute pain, localized, aggravated by weight bearing

66
Q

Those with osteoporosis have increased likelihood of:

A

Atraumatic & Crush Fractures

67
Q

What areas are commonly affected by osteoporosis:

A

• Vertebra, upper femur, distal radius, proximal humerus, pubic ramus, ribs

68
Q

Osteoporosis: Lab Findings

A

-Usually all normal

• CBC, multi-panel chemistry tests usually normal
• Normal serum calcium, phosphorus, ALP, protein ELP, ESR, urinary calcium

• Following fracture – ALP may be transiently elevated

69
Q

Paget’s Disease: Signs & Symptoms

A

• Most often the disorder is asymptomatic
• Picked up on routine blood work
• Increasing skull size: Hat too small & bitemporal skull enlargement with frontal bossing
• Headaches
• Decreasing auditory acuity

70
Q

Paget’s Disease: Pain symptoms

A

• Bone pain: Mild to severe, Deep/aching, May be accentuated at night, Constant, unrelated to activity
• Spine pain: LBP common & Can have radiculopathy
• Acute bone pain suggests:Pathologic fracture & malignant degeneration

71
Q

What enzyme is typically increased in Paget’s disease?

A

• **Serum alkaline phosphatase usually increased
• Elevations will fluctuate throughout stages of life and disease course

72
Q

How is serum calcium affected in Paget’s Disease?

A

• **Serum calcium normal, rarely increased

73
Q

Paget’s Disease: Other Lab Findings

A

• Serum phosphorus normal

74
Q

Osteomalacia & Rickets

A

• Bowing of long bones – softened bones
• Vertical shortening of the vertebrae – d/t softened bone
• Flattening of the pelvic bones – contracts the pelvic outlet

75
Q

Osteomalacia & Rickets: Signs/Symptoms

A

• Bone pain (dull), tenderness, muscle weakness
• Weight loss, anorexia, tetany
• Other symptoms: Malnutrition or chronic renal disease

76
Q

What is usually affected in osteomalacia & rickets?

A

Affecting the ribs and upper thighs; muscle weakness is usually proximal

77
Q

What type of fractures are common in osteomalacia & Rickets?

A

• Pseudofractures – incomplete ribbon-like demineralizations appear in the cortex

78
Q

Osteomalacia & Rickets: Lab Findings

A

• Serum calcium may be normal/decreased (never high)
• Hypophosphatemia (low phosphates)
• ALP is increased
• Decreased serum Vitamin D and its metabolites
• Increased serum PTH
• Urinary calcium is low in all forms of the disease except those associated with acidosis

79
Q

Which MSK disorders will have HLA-B27 antigens?

A

-Psoriatic arthritis: spondylitic-type arthropathy
-Enteropathic Arthritis
-Ankylosing Spondylitis
-Reactive Arthritis

“PEAR”

80
Q

Septic Arthritis: How long before changes are seen on X-Rays?

A

• 10 days in the extremities
• 21 days in the spine

81
Q

Most sensitive test of Paget’s Disease

A

• Urine pyridinoline crosslinks

82
Q

Rheumatoid Arthritis: Late X-Ray Findings

A

• Late: Deformities with subluxations; Bony destruction; Bony fusion; Complete destruction of joint space

Clinical Pathology II (10 decks)

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