MSK Path Flashcards
Short Limbs
Big Head
Normal lifespan
Fertile
Achondroplasia
Common cause of dwarfism
Achondroplasia Mutation
FGFR3
On all the time –> inhibits chondrocyte proliferation
Acute back pain
kyphosis
loss of height
Vertebral crush fracture
osteoporosis
Osteoporosis
Trabecular (spongy( bone loses mass despite normal bone mineralization and labs
Type 1 osteoporosis
Post menopausal
increased bone resorption due to decreased estrogen
Type 1 osteoporosis common fxrs
Colles (distal radius)
Femoral neck
Type II osteoporosis
Senile
men and women > 70
Type II osteoporosis Prophylaxis
weight bearing exercise (increase mm. mass)
Ca and Vit. D intake
Type II osteoporosis Tx
Estrogen (SERMS)
Calcitonin
Severe:
Bisposphonates
Pulsatile PTH
Rx contraindicated in osteoporotic pts.
Glucocorticoids
Failure of bone resorption due to defective osteoclasts
Thickened/dense bones prone to fxr
pancytopenia
Osteopetrosis
Osteoclasts can’t get acidic env. to resorb bone
X-ray finding of osteopetrosis
Bone in bone
Why do you get pancytopenia with osteopetrosis?
Bone fills marrow space inhibiting hematopoeiesis
Osteopetrosis Tx
Bone marrow transplant
Osteoclasts come from stem cells–replace them
Vitamin D deficiency in kids? Adults?
Kids–rickets (bowing of long bones)
Adults–Osteomalacia
Hyperactivity of osteoblasts –> inc. serum Alk Phos
Increased osteoblastic and osteoclastic activity chalk stick fxr Normal Ca, P, PTH Increased ALP Increased Hat size and hearing loss
Paget’s Disease of bone
Hearing loss due to CN impingement
Paget’s Disease of bone pattern
Mosaic woven bone pattern –> chalk stick fxr
How does Paget’s Disease of bone cause high output heart failure?
Increased blood flow to bone due to increased AV shunts
Cancer risk increased in Paget’s disease of bone
Osteogenic Sarcoma
Bone diseases that impinge cranial nerves.
Osteopetrosis
Paget’s disease of bone
Bones thicken and narrow foramina
Bone replaced by fibroblasts, collagen, and irregular boney trabeculae
Polycystic Fibrous Dysplasia
McCune-Albright Syndrome
Polyostotic fibrous dysplasia
multiple unilateral bone lesions
Endocrine abnormalities (precocious puberty) Cafe-au-lait spots
Tumors common at knee (distal femur proximal tibia)
Giant Cell tumor
Osteosarcoma
Tumors at metaphysis of long bones
osteosarcoma
otrochondroma
Epiphyseal tumor
Giant Cell tumor
Men 30-60
Malignant Cartilaginous tumor
expansile glistening mass in medullary cavity
Chondrosarcoma
Boys < 15
Diaphysis of long bone
Onion skin appearance of bone
anaplastic small blue cell malignant tumor
Ewing’s Sarcoma
Ewing Sarcoma mutation
t(11:22) translocation
33–Ewing’s jersey
10-20 y/o male
Malignant bone tumor
sunburst pattern on x-ray
metaphysis of long bone–knee
Osteosarcoma
Codman’s Triangle
elecation of periosteum seen in osteosarcoma
Male < 25
#1 benign bone tumor
mature bone with cartilage cap
osteochondroma (exostosis)
Giant cell tumor of bone AKA
osteoclastoma
Giant cell tumor x-ray buzz
double bubble
soap bubble
Spindle shaped cells
multinucleated giant cells
20-40 y/o
Tumor at knee
Giant cell tumor
AKA osteoclastoma
Infectious Arthritis bugs
S. aureus
Streptococcus
N. gonorrhoeae
Sexually active
asymmetrical migratory arthritis
N. gonorrhoeae
Infarction of bone and marrow
pain with activity
Osteonecrosis (avascular necrosis)
Osteonecrosis causes
trauma
high dose corticosteroids
EtOH
Sickle Cell Anemia
Most common site for osteonecrosis
femoral head
HLA-B27+
Arthritis without Rheumatoid Factor
Male
Seronegative spondyloarthropathies
Skin rash joint pain Dactylitis Pencil in cup finding on xray HLA-B27+
Poriatic Arthritis
1/3 of psoriasis pts.
sausage fingers
stiff spine due to fusion of joints–bamboo spine
HLA-B27
uveitis
Aortic regurgitation
Ankylosing Spondylitis
Crohn’s and UC associated with what joint diseases?
Ankylosing Spondylitis
peripheral arthritis
Conjunctivitis Urethritis Arthritis Post GI or chlamydia infxn HLA-B27+
Reactive Arthritis (Reiter’s Syndrome)
“I can’t see, pee, climb trees”
Marker specific for Rx induced lupus
Antihistone Ab
Why is there a false + on Syphilis RPR/VDRL with SLE pts?
Antiphospholipid Abs cross react with cardiolipin used in tests
Kidney syndromes associated with SLE
- Diffuse proliferative GN (nephritic)
2. Membranous GN (nephrotic)
Markers for SLE
ANA–sensitive but not specific
dsDNA–specific, poor prognosis
Anti-Smith (anti-Sm)–very specific, not prognostic
Sx of SLE
Fever fatigue weight loss Liebman-Sacks endocarditis hiar adenopathy Raynaud's Malar rash (butterfly) arthritis Neurologic Sx photosensitivity
Liebman-Sacks Endocarditis
verrusous sterile vegetations on both side of heart valve
associated with SLE
Immune mediated widespread noncaseating granulomas elevated ACE Hypercalcemia bilateral hilar denopathy on chest xray Black female Enlarged lymph nodes
Sarcoidosis
Sarcoidosis associated with
restrictive lung disease
erythema nodosum
uveitis
hypercalcemia
Mechanism of hypercalcemia with sarcoidosis
elevated 1-alpha Hydroxylase mediated vit. D activation in epithelioid macrophages
Sarcoidosis Tx
Steroids
Microscopic findings of sarcoid (buzz words)
Schaumann bodies
Asteroid Bodies
Pain/Stiffness in shoulder and hips fever malaise weight loss femal > 50 Increased ESR, normal CK NO MM. WEAKNESS
Polymyalgia rheumatica
Polymyalgia rheumatica associated with
Giant Cell Temporal Arteritis
Tx Polymyalgia rheumatica
Low dose steroids
Woman 20-50 chronic widespread MSK pain Stiffness parasthesia poor sleep fatigue
Fibromyalgia
Progressive symmetrical proximal mm. weakness (shoulders most common)
endomysial inflammation
CD8+ mediated
Polymyositis
Progressive symmetrical proximal mm. weakness
malar rash
Grottron’s papules
heliotrope rash
CD4+ cells
Dermatomyositis
What do you need to worry about with dermatomyositis pts.
Occult malignancy
Cells involved in Polymyositis and dermatomyositis
Poly–CD8+
Derm–CD4+
D is 4th letter of alphabet
Poly/Dermatomyositis Labs
Increased CK
ANA+
anti-Jo-1 Ab’s
Poly/Dermatomyositis Tx
Steroids
1 NMJ disease
Myasthenia Gravis
Proximal mm. weakness that improves with use
Lambert Eaton
Lambert Eaton Pathophys
auto-Ab against presynaptic Ca channel –> decreased ACh released
Myasthenia Gravis pathophys
Ab against post synaptic ACh receptors
MG associated with
Thymoma
Thymic Hyperplasia
Lambert Eaton Associated with
Small Cell CA of lung
Metaplasia of Skeletal mm. to bone following trauma
UE and LE most commonly
Myositis Ossification
