MSK Path High Yield Flashcards
“failure of longitudinal bone growth (endochondrial ossification) leading to short limbs”
Achondroplasia
What is the mutation in achondroplasia?
a constitutive activation of fibroblast growth that inhibits chondrocyte proliferation
“trabecular (spongy) bone loses mass and interconnections despote normal bone mineralization”
Primary osteoporosis
Which 4 drugs classes cause osteoporosis?
1- antconvulsants
2- steroids
3- anticoagulants
4- Thyroid replacement therapy
Which type of osteoporosis is associated with increased osteoclast activity?
Type I post menopausal
Which type of osteoporosis is associated with decreased osteoblast activity?
Type II (senile)
“failure of normal bone resportion due to defective osteoclasts–> thickened dense bone”
osteopetrosis
What are associated findings with osteopetrosis?
Visual and
Pancytopenia and estramedullary hematopoiesis
What is the mutation in osteopetrosis?
Carbonic anhydrase II
“defective bone mineralization/ calficification of osteoid–> soft bones that bow out”
Osteomalacia/ rickets
What is the PTH level in osteomalacia/ rickets? The ALP level?
Increased!!!
ALP is increased because of the osteoblasts
“increase in both osteoblastic and osteoclastic activity leading to a mosaic bone pattern of woven and lamellar bone”
Paget disease of bone
What are the 4 stages of paget disease?
1- Lytic (osteoclasts)
2- Mixed (both)
3- Sclerotc (osteoblasts)
4- Quiescent (minimal activity)
What cancer is there an increased risk of with pagent disease of bone?
osteogenic sarcoma
What is a common cause of death in paget disease?
High Output cardiac failure
What is the most common site of osteonecrosis? What is the causative artery?
Femoral head
Medial circumflex femoral artery
What is Leff- Calve Perthes disease?
Idiopathic osteonecrosis
What are the abnormal lab values in osteoporosis?
None
What is the abnormal lab value in paget disease?
Increased ALP
What are the abnormal lab values in osteomalacia?
Decreased Ca
Decreased PO4
Increased ALP
Increased PTH
What are the abnormal lab values in Primary hyperparathyroidism?
Increased Ca
Decreased PO4
Increased PTH
Increased ALP
What are the abnormal lab values in secondary hyperparathyroidism?
Decreased Ca
Increased PO4
Increased ALP
Increased PTH
“brown tumor due to fibrous replacement of bone and subperiosteal thinning”
Osteitis fibrosa cystica
What are the 3 actions of vit D?
Intestine: Increased absortion of Ca and PO4
Kidney: increased reab of Ca and PO4
Bone: increased reab of calcium and phosphate
Location of osteoma?
facial bones
What is condition is osteoma associated with?
Gardner syndrome
“benign tumor of osteoblasts surrounded by a rim of reactive bone”
Osteoid osteoma
Bone tumor associated with nighttime pain that improves with aspirin
Osteoid osteoma
Where are osteoid osteomas typically located?
Diaphysis
Where is osteoblastoma usually located?
Vertebrae
What is the major difference between osteoblastoma and osteoid osteoma?
Pain does not resolve with aspirin in osteoblastoma
Where are osteochondromas usually found?
metaphysis (lateral projection)
“Tumor of bone with overlying cartilage cap”
Osteochondroma
“malignant proliferation of osteoblasts”
Osteosarcoma
Where are Osteosarcomas usually located?
Metaphysis
What is the X ray appearance of osteosarcoma on Xray?
Codman triange or sunburst pattern
“bone tumor composed of multinucleated giant cells and stromal cells”
giant cell tumor
Where are giant cell tumors usually located?
Epiphysis of long bones
What is the appearance of giant cell tumors on xray?
soap bubble appearance
“malignant proliferation of poorly differentiated cells derived from neuroectoderm”
Ewing sarcoma
Where are ewing sarcomas usually located?
diaphysis
Joint pain that improved with use?
Rheumatoid arthritis
Joint pain that worsens with use?
Osteoarthrtis
What type of hypersensitivity is RA?
Type III and Type IV
Which joints are spared in osteoarthritis?
MCP
What joints are spared in RA?
DIP
“inflammatory granulation tissue formation in joints seen in RA”
Pannus
What type of necrosis do rheumatoid nodules exhibit?
Fibrinoid necrosis
What HLA type is associated with RA?
HLA DR4
What are the 2 autoantibodies associated withRA?
Anti- IgG antibody
Anti- cyclic citrullinated peptide antibody
“reactive bony formation seen in osteoarthritis”
Osteophyte
“reactive bony formation seen in osteoarthritis”
Osteophyte
Autoantibodies seen in sjogrens?
Anti SS-A and SS-B (ANA antibodies)
What are 2 possible complications of Sjogrens?
Dental carries
MALT (parotid enlargement)
Which genetic conditions cause an over production of uric acid?
Lesch- Nyhan syndrome
von Gierke disease
PRPP excess
What color are urate crystals under parallel light? Perpendicular light?
Parallel–> yellow
Perpendicular–> blue
“white chalky aggregates of uric acid crystals with fibrosis and giant cells seen in gout”
tophus
:“pain and effusion in a joint caused by deposition of calcium pyrophosphate crystals within the joint space”
Pseudogout
Shape of pseudogout crystals?
rhomboid crystals
What are 3 possible causes of pseudogout?
1- hemochromatosis
2- hyperparathyroidism
3- osteoarthitis
What color are pseudogout crystals in parallel light?
Blue
Most common cause of infectious arthritis in older children and adults?
S. aureus
What is the most common cause of infectious arthritis in young adults?
Neisseria gonorrhea
Migratory infections arthritis
What HLA type are Psoriatic arthritis, ankylosing spondyliti, IBD and Reactive arthritis associated wth?
HLA- B27
“chronic inflammatory disease of spine and sacroiliac joints”
Ankylosing spondylitis
What are 2 common findings of ankylosing spondylitis?
bamboo spine (vertebral fusion)
aortic regurgitation
“conjunctivitis + urethritis + arthritis”
Reactive arthritis
What are 4 organisms associated with reactive arthritis?
Shigella
Salmonella
Yersinia
Campylobacter
Chlamydia
What 2 renal presentations are seen in lupus?
Membranous glomerulonephritis—> nephrotic
DPGN–> Nephritic
What autoantibody is MOST SPECIFIC for lupus?
anti- dsDNA/ anti- smith
What are anti-smith antibodies against?
snRNPs
What is antihistone antibodies associated with?
drug induced lupus
What is needed for a diagnosis of antiphospholipid syndrome?
Hx of thrombosis
Lupus anticoagulant/ anticoardiolipin/ ant beta2 glycoprotein sntibodies
Anticardiolipin antibodies can cause a false positive in what test?
VDLR
:immune mediated, widespread noncaseating granulomas with elevated ACE levels”
Sarcoidosis
What is the ratio of CD4/ CD8 in sarcoidosis?
Increased!
Is sarcoidosis a restrictive or obstructive lung disease/
restrictive
What causes hypercalcemia in sarcoidosis?
Increased 1alpha hydroxylase mediated vit D activation in macrophagges
“pain andstiffness in soulders and hips with fever, malaise and weightloss”
Polymyalgia rheumatica
What disease is polymyalgia rheumatica associated with?
temporal (giant cell) arteritis
“chronic widespread musculoskeletal pain associated with stiffness, paresthesias, poor sleep and fatigue”
fibromyalgia
What are the antibodies associated with polymyosiitis and dermatomyositis?
ANti-Jo-1
Anti SRP
Anti Mi-2
“progressive PROXIMAL muscle weakness, characterized by endomysial inflammation with CD8+ cells”
Polymyositis
“progressive PROXIMAL muscle weakness with associated malar rash, grotton papules on elbows and knees, “shawl and face” rash”
Dermatomyositis
What is the cell type associated with polymyositis?
CD8+
What cel type is associated with dermatomyositis?
CD4+
Autoantibodies to presynaptic Ca channel leading to decreaed ACh release?
Lambert- Easton Syndrome
What condition is myasthenia gravis associated with?
Thymoma
“metaplasia of skeletal muscle into bone following muscular trauma”
Myositis ossificans
“autoimmunity, noninflammatory vasculopathy, collagen deposition with fibrosis”
Scleroderma
Tightening of the skin without wrinkles
What autoantibody is associated with diffuse scleroderma?
anti- Scl-70 (anti- DNA topoisomerase I antibody)
What is seen in limited scleroderma?
CREST
Calcinosis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telandiectasia
