MSK path 1 Flashcards
Granulomatous / destruction of internal elastic membrane; Aorta & major branches
large arteries
Giant Cell (temporal) arteritis (GCA)
Granulomatous of aorta, females <50 y/o
PULSELESS disease
Ischemic bowel disease, pulmonary, coronary, renal arteries also affected
large arteris
Takayasu
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
Polyarteritis Nodosa (PAN)
Mucucutaneous lymph node syndrome
Coronary artery involvement
Children (tx: IgG and AsA)
Kawasaki Diseasea
Limited – only respiratory
Systemic – involves renal arteries (glomerulonephritis – focal segmental)
c-ANCA
Wegeners aka
Ganulomatosus w/ polyangiitis (GPA)
Eosinophilic granulomatosus, respiratory tract
Asthma, Eosinophilia
P-ANCA
Churg-Strauss
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
Microscopic Polyangiitis
IgA deposits in small vessels
Palpable purpura – legs to buttocks/ arthritis, abdominal pain, glomerulonephritis
Henoch-Scholein purpura
HS rxn to tobacco component in heavy smokers
Can involve nerves and veins severe pain & chronic ulcerations (stop smoking before progression to frank gangrene)
Thromboangiits Obliterans (Burger’s disease)
Rotator Cuff Tendinitis - primary cause of pain
tendonitis
Extensor radialis brevis
Pain w/ supination and wrist extension
Laterial epicondylitis
Tennis elbow
Flexor carpi radialis
Pain w/ pronation & wrist flexion
Medial epiconylitis
Golfer/ pitchers elbow
Flexor tenosynovitis (flexor digitorum, superficialis)
Trigger Fingers
Inflammation of the sheaths of the extensor pollicis brevis & abductor pollicis brevis
De Quervain’s Tenosynovitis
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
Carpal Tunnel Syndrome
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
Trochanteric Bursitis
Lateral femoral cutaneous nerve (L2-L3) entrapment diffuse lateral thigh pain (sites of compression = inguinal ligament, insertion of psoas
Meralgia paresthetica
40% communicate with the knee; may rupture medial ankle ecchymosis
seen from behind the patient
Popliteal cyst (Baker’s cyst)
Superficial to kneecap swelling
Always consider sepsis
Prepatellar Bursitis
may rupture Thompson sign
Achilles Tendinitis
Women in high heeled shoes! Pain in 3rd/4rth toes due to entrapment of interdigital plantar nerves
Morton’s neuroma
Prominence of metatarsal head on either side of the foot
Bunionette
Excessive proliferation of skin & bones at distal extremities – excessive collagen desposition
Full syndrome – periostitis of long bones
Chest malignancy & lung infections
Hypertrophic Osteoarthopathy
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
N gonorrhea
Most common viral arthritis
Parvovirus (B19)
Catcher Crouch Syndrome – lumbar radiculoneuropathy
Rubella
Arthritis-urticaria syndrome
Explosive arthritic of the knee
Hepatitis B
Cryoglobulinemia vasculitis, palpable purpura over lower legs
Type II and III
Hepatitic C
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
Lyme Disease
Articular Syndrome - <24 hours, severe pain in all joints of the body
Reactive arthritis – spondyloarthritis (could be a presenting sign of HIV)
Psoriatic arthritis
HIV arthralgia
Only seen in HIV pts
Salivary gland enlargement, CD*+ lymphocytosis, sicca, parotid gland
Diffuse Infiltrative Lymphocytosis Syndrome (DILS)
Fetty Syndrome
from long-standing RA - enlarged spleen – a/w deforming nodules in joints
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
Nodular Fasciitis
Deep tissue
Bizzarre cells filled with lipid vacuoles
Usually painless, located in deep soft tissue can reach a large size before it is detected
Liposarcoma
Reactive bone formation in the muscle as a result of injury – bone women in granulation tissue
Myositis Ossificans
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
Fibromatosis
desmoid tumor
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
Fibrosarcoma
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
Malignant Fibrous Histiocytoma
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)
Rhabdomyosarcoma
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
Synovial Sarcoma
Benign localized developmental arrest in the diaphysis
Monostotic or polystotic (risk for osteosarcroma – though this would arise in a different location – metaphysis!)
Fibrous Dysplasia
(a/w café au lait skin spots, endocrinopathies
Can involve the facial bones
Benign localized developmental arrest in the diaphysis
McCune Albright syndrome
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
nonossifying fibroma
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.
Aneurysmal bone cysts
Bone-forming tumor - osteoma
Round tumors that project from sub- or endosteal surfaces of cortex
Usually solitary; multiple seen in ….
Gardner’s syndrome
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
Osteoid osteoma
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
Osteochondroma
=Exotosis
*metaphysis
arise inside medullary cavities, typically in the hand and the feet, those tubular bones.
Chondroma
*diaphysis
nonhereditary syndrome of multiple enchondromas
Ollier
multiple enchondromas form as well as soft tissue hemangiomas.
Maffucci syndrome
Multinucleated osteoclast type giant cells • Benign but uncommon • Locally aggressive • 20’s to 40’s • Cystic degeneration • Arise around knee > wrist Epiphysis
Giant Cell Tumor of Bone
Prominent bone formation extends into soft tissue
Lifted periosteum forms triangular shell of reactive bone: CODMAN TRIANGLE (arrow)
Characteristic but not pathognomonic
Osteosarcoma
Common sites include metaphysis around the knee in younger people. There is an association with retinoblastoma.
Osteosarcoma
2nd most common primary malignant bone tumor
Surgery, insensitive to chemotherapy
Chondrosarcoma
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
Ewing’s sarcoma (peripheral primitive neuroectodermal tumor)
*diaphysis
anticipation with increased repeat expansions and more severe phenotypes in younger generations.
Percussion and grip myotonia
: Increased CGT repeats of DNA on chromosome 19,
Myotonic dystrophy
muscle phosphorylase deficiency from which glycogen can not break down during exercise to produce ATP
McArdle’s Disease
Anti-Jo-1/ Anti-Synthetase Syndrome
“Jo is the f-a-mily mechanic”
Mechanics hands
Proximal and distal muscle weakness
Poor response to steroid tx
+ neurological symptoms
Basophilic w/ Gomori Trichome stain
Inclusion body myositis
CD8 cells invade muscle w/ increased MHC I expression
Polymyositis
20-50 y/o, CD4 & B cell activation RF and aCCPs, symmatric
Granulation tissue pannus joint erosion fibrosis
RA
Reduction in chondrocytes at growth plate
• Most common cause of inherited dwarfism; autosomal dominant
• Short extremities, normal trunk, large head, normal mentation
ACHONDROPLASIA
Unbalanced and excessive osteoclast and osteoblast function; increased bone turnover
• Osteolytic, mixed osteolytic-osteoblastic,
Paget dz
Failure of the bone to mineralize properly in an adult
OSTEOMALACIA
Increased bone activity + peritrabecular fibrosis + cystic brown tumors
primary hyperparathyroidism
osteitis fibrosa cystica
More lung disease than any other autoimmune
connective tissue disease
Scleroderma
the most common
pleuropulmonary manifestation of lupus
pleuritis
one of the most unpredictable
and potentially serious adverse effects
of methotrexate treatment
Pneumonitis
myositis + arthritis + lung disease (20% of all)
Can be part of anti-synthetase syndrome
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]
Sjogren’s disease of lung
