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MSK pathology > MSK path 1 > Flashcards

MSK path 1 Flashcards

1
Q

Granulomatous / destruction of internal elastic membrane; Aorta & major branches
large arteries

A 
Giant Cell (temporal) arteritis 
(GCA)
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2
Q

Granulomatous of aorta, females <50 y/o
PULSELESS disease
Ischemic bowel disease, pulmonary, coronary, renal arteries also affected
large arteris

A

Takayasu

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3
Q

Fibrinoid necrosis
NO GLOMERULONEPHRITS  BUT it does affect the kidneys (renal involvement  severe HTN (RBCs in urine , NOT CASTS)
NO ANCA (RATHER, IMMUNE COMPLEXES!  30% a/w Hepatitis B
NO PULMONARY INVOLVEMENT
Many stages evident in biopsy
Wrist and Foot drop due to ulnar & common fib involvement

A 
Polyarteritis Nodosa
(PAN)
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4
Q

Mucucutaneous lymph node syndrome
Coronary artery involvement
Children (tx: IgG and AsA)

A

Kawasaki Diseasea

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5
Q

Limited – only respiratory
Systemic – involves renal arteries (glomerulonephritis – focal segmental)
c-ANCA

A

Wegeners aka

Ganulomatosus w/ polyangiitis (GPA)

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6
Q

Eosinophilic granulomatosus, respiratory tract
Asthma, Eosinophilia
P-ANCA

A

Churg-Strauss

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7
Q

Fibrinoid necrosis but w/ NO GRANULOMAS
Hypersensitivity vasculitis
p-ANCA more than -ANCA , can have immune complexes (mistake on Pandout)
glomerulonephritis (75%) + pulmonary hemorrhage
also has neuropathy: wrist/ foot drop
All lesions about the same stage

A

Microscopic Polyangiitis

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8
Q

IgA deposits in small vessels

Palpable purpura – legs to buttocks/ arthritis, abdominal pain, glomerulonephritis

A

Henoch-Scholein purpura

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9
Q

HS rxn to tobacco component in heavy smokers

Can involve nerves and veins  severe pain & chronic ulcerations (stop smoking before progression to frank gangrene)

A

Thromboangiits Obliterans (Burger’s disease)

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10
Q

Rotator Cuff Tendinitis - primary cause of pain

A

tendonitis

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11
Q

Extensor radialis brevis

Pain w/ supination and wrist extension

A

Laterial epicondylitis

Tennis elbow

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12
Q

Flexor carpi radialis

Pain w/ pronation & wrist flexion

A

Medial epiconylitis

Golfer/ pitchers elbow

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13
Q

Flexor tenosynovitis (flexor digitorum, superficialis)

A

Trigger Fingers

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14
Q

Inflammation of the sheaths of the extensor pollicis brevis & abductor pollicis brevis

A

De Quervain’s Tenosynovitis

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15
Q

Burning or tingling in hand usually at night
Median nerve compression in carpal tunnel
*median nerve may also be compressed at the pronator teres)
Thenar atrophy, Tinel’s sign, Phalen test

A

Carpal Tunnel Syndrome

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16
Q 
Does communicate with the joint 
Point tenderness over greater trochanter, worsened w/ external rotation and abduction
Worsen when lying on same side 
Difference in leg length can cause this
Lateral thigh pain above the knee
A

Trochanteric Bursitis

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17
Q

Lateral femoral cutaneous nerve (L2-L3) entrapment  diffuse lateral thigh pain (sites of compression = inguinal ligament, insertion of psoas

A

Meralgia paresthetica

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18
Q

40% communicate with the knee; may rupture  medial ankle ecchymosis
seen from behind the patient

A

Popliteal cyst (Baker’s cyst)

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19
Q

Superficial to kneecap swelling

Always consider sepsis

A

Prepatellar Bursitis

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20
Q

may rupture  Thompson sign

A

Achilles Tendinitis

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21
Q

Women in high heeled shoes! Pain in 3rd/4rth toes due to entrapment of interdigital plantar nerves

A

Morton’s neuroma

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22
Q

Prominence of metatarsal head on either side of the foot

A

Bunionette

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23
Q

Excessive proliferation of skin & bones at distal extremities – excessive collagen desposition
Full syndrome – periostitis of long bones
Chest malignancy & lung infections

A

Hypertrophic Osteoarthopathy

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24
Q

Younger patients, outer membrane IA inactivates compliment
Tenosynovitis of wrists, ankles, fingers, toes – migratory arthralgia
Often follows menstruation
Better to culture GU or pharynx where bug originally came from
Staph aureus #1
GAS #2
Salmonella in Sickle cell pts

A

N gonorrhea

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25
Q

Most common viral arthritis

A

Parvovirus (B19)

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26
Q

Catcher Crouch Syndrome – lumbar radiculoneuropathy

A

Rubella

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27
Q

Arthritis-urticaria syndrome

Explosive arthritic of the knee

A

Hepatitis B

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28
Q

Cryoglobulinemia vasculitis, palpable purpura over lower legs
Type II and III

A

Hepatitic C

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29
Q

Large effusions, little pain – occurs months/ years after the tick bite!
Over-diagnosed in south – more likely STARI
Most often the knee or TMJ
Larger joints

A

Lyme Disease

30
Q

Articular Syndrome - <24 hours, severe pain in all joints of the body
Reactive arthritis – spondyloarthritis (could be a presenting sign of HIV)
Psoriatic arthritis

A

HIV arthralgia

31
Q

Only seen in HIV pts

Salivary gland enlargement, CD*+ lymphocytosis, sicca, parotid gland

A

Diffuse Infiltrative Lymphocytosis Syndrome (DILS)

32
Q

Fetty Syndrome

A

from long-standing RA - enlarged spleen – a/w deforming nodules in joints

33
Q

Non-neoplastic reactive proliferation (fibroblastic – can develop several weeks after trauma)
Mesenchymal reaction to injury
May appear anywhere – most common on the flexor forearms
Or the trunk

A

Nodular Fasciitis

34
Q

Deep tissue
Bizzarre cells filled with lipid vacuoles
Usually painless, located in deep soft tissue  can reach a large size before it is detected

A

Liposarcoma

35
Q

Reactive bone formation in the muscle as a result of injury – bone women in granulation tissue

A

Myositis Ossificans

36
Q

Children- infrabdominal
Young adult – abdominal wall (during/after pregnancy) = desmoid (a/w Gardner syndrome & familial adenomatous polyposis
Adult – extra-abdominal
Bland spindle proliferation – no mitotic figures, no necrosis

A

Fibromatosis

desmoid tumor

37
Q

Soft tissue – painless mass
It often arises in the soft tissues of the thigh and the posterior knee. It is generally a large, painless mass deep to fascia and has an ill-defined margin.
Bone – painful – arises in metaphysis of femur or tibia

A

Fibrosarcoma

38
Q

typical spindle cells arranged in a “storiform” (woven mat) pattern are seen; to the right are the typical bizarre giant cells. By 1977, MFH was considered the most common soft tissue sarcoma of adult life. Despite the frequency of diagnosis, MFH has remained an enigma. No true cell of origin has ever been identified.

May occur following radiation tx of another sarcoma

A

Malignant Fibrous Histiocytoma

39
Q

White fish flesh appearance
Almost two-thirds of RMS cases develop in children under the age of 10

Mark w/ antibody to vimentin (intermediate cytoplasmic filament)

A

Rhabdomyosarcoma

40
Q

10% of adult sarcromas – found in a joint or deep soft tissue
Arises from mesenchymal cells, not the synovium
Most have t(X;18) translocation
Biphasic pattern of spindle cells and epithelial cells – within soft tissue

A

Synovial Sarcoma

41
Q

Benign localized developmental arrest in the diaphysis

Monostotic or polystotic (risk for osteosarcroma – though this would arise in a different location – metaphysis!)

A

Fibrous Dysplasia

42
Q

(a/w café au lait skin spots, endocrinopathies
Can involve the facial bones

Benign localized developmental arrest in the diaphysis

A

McCune Albright syndrome

43
Q

Fibrous Cortical Defect > 5-6 cm:
Few or no symptoms except pain
Usually found incidentally on radiography
Fractures can occur through the thinned cortex
Eccentric
Sharply delimited
-scooped out
-Storiform/ woven pattern/ fibroblast cell origin

A

nonossifying fibroma

44
Q

very bloody, cystic lesions. They appear like a “sponge filled with blood.” These too, may contribute to pathologic fracture and can be an operative challenge if not expected because of excessive bleeding.

A

Aneurysmal bone cysts

45
Q

Bone-forming tumor - osteoma
Round tumors that project from sub- or endosteal surfaces of cortex
Usually solitary; multiple seen in ….

A

Gardner’s syndrome

46
Q

Half involve the tibia and fibula.
Usually they are cortical rather than medullary lesions. A prime characteristic of osteoid osteomas is that they are painful.
They produce prostaglandin E2 and interestingly have a characteristic pattern of pain. They are more commonly painful at night and they are relieved by aspirin. Intake of alcohol causes a massive increase in pain

A

Osteoid osteoma

47
Q

benign cartilage capped tumors attached to the underlying skeletal system by a stalk
displacement of growth plate in endochondral bones There is a condition of multiple hereditary exostosis which is autosomal dominant and may give rise to chondrosarcomas

A

Osteochondroma
=Exotosis

*metaphysis

48
Q

arise inside medullary cavities, typically in the hand and the feet, those tubular bones.

A

Chondroma

*diaphysis

49
Q

nonhereditary syndrome of multiple enchondromas

A

Ollier

50
Q

multiple enchondromas form as well as soft tissue hemangiomas.

A

Maffucci syndrome

51
Q 
Multinucleated osteoclast type giant cells
• Benign but uncommon
• Locally aggressive
• 20’s to 40’s
• Cystic degeneration
• Arise around knee > wrist
Epiphysis
A

Giant Cell Tumor of Bone

52
Q

Prominent bone formation extends into soft tissue
Lifted periosteum forms triangular shell of reactive bone: CODMAN TRIANGLE (arrow)
Characteristic but not pathognomonic

A

Osteosarcoma

53
Q

Common sites include metaphysis around the knee in younger people. There is an association with retinoblastoma.

A

Osteosarcoma

54
Q

2nd most common primary malignant bone tumor

Surgery, insensitive to chemotherapy

A

Chondrosarcoma

55
Q

round blue cell tumor so known because of its characteristic, very high nuclear cytoplasmic ration, mostly nucleus
85% of these have genetic signatures which relate them to peripheral neuroectodermal tumors
They arise in the medulla of the bone, primarily in diaphysis of long bones

A

Ewing’s sarcoma (peripheral primitive neuroectodermal tumor)

*diaphysis

56
Q

anticipation with increased repeat expansions and more severe phenotypes in younger generations.
Percussion and grip myotonia
: Increased CGT repeats of DNA on chromosome 19,

A

Myotonic dystrophy

57
Q

muscle phosphorylase deficiency from which glycogen can not break down during exercise to produce ATP

A

McArdle’s Disease

58
Q

Anti-Jo-1/ Anti-Synthetase Syndrome

A

“Jo is the f-a-mily mechanic”

Mechanics hands

59
Q

Proximal and distal muscle weakness
Poor response to steroid tx
+ neurological symptoms
Basophilic w/ Gomori Trichome stain

A

Inclusion body myositis

60
Q

CD8 cells invade muscle w/ increased MHC I expression

A

Polymyositis

61
Q

20-50 y/o, CD4 & B cell activation  RF and aCCPs, symmatric
Granulation tissue  pannus  joint erosion  fibrosis

A

RA

62
Q

Reduction in chondrocytes at growth plate
• Most common cause of inherited dwarfism; autosomal dominant
• Short extremities, normal trunk, large head, normal mentation

A

ACHONDROPLASIA

63
Q

Unbalanced and excessive osteoclast and osteoblast function; increased bone turnover
• Osteolytic, mixed osteolytic-osteoblastic,

A

Paget dz

64
Q

Failure of the bone to mineralize properly in an adult

A

OSTEOMALACIA

65
Q

Increased bone activity + peritrabecular fibrosis + cystic brown tumors
primary hyperparathyroidism

A

osteitis fibrosa cystica

66
Q

More lung disease than any other autoimmune

connective tissue disease

A

Scleroderma

67
Q

the most common

pleuropulmonary manifestation of lupus

A

pleuritis

68
Q

one of the most unpredictable
and potentially serious adverse effects
of methotrexate treatment

A

Pneumonitis

69
Q

myositis + arthritis + lung disease (20% of all)

A

Can be part of anti-synthetase syndrome

70
Q

NSIP
1. It has lymphoid follicles
(germinal centers) [shown in panel A]
2. It is bronchiolocentric
[shown in both panel A and panel B]
3. It has more lymphocytes
[shown in both panel A and panel B]
4. It has macrophages and multinucleated
giant cells [shown in panel B]

A

Sjogren’s disease of lung

MSK pathology (3 decks)

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