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Patho > MSK patho pt 2 > Flashcards

MSK patho pt 2 Flashcards

1
Q

Which population does Polymyalgia Rheumatica affect?

A

female, rarely diagnosed prior to 50
90% diagnosed in patients older than 66

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2
Q

In Polymyalgia Rheumatica, pain and stiffness in the morning is common in which areas?

A

cervical, shoulders, and pelvic areas
onset can be abrupt

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3
Q

What is dx based on in Polymyalgia Rheumatica?

A

1 month of symptoms and elevated ESR
>80% of patients have markedly elevated ESR (often>100 mm/hour)

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4
Q

What is Polymyalgia Rheumatica associated with?

A

giant cell arteritis, possibly temporal arteritis

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5
Q

What is temporal Arteritis?

A

type of giant cell arteritis which is relatively a common form of vasculitis
Women>, Mean age at onset is 70.
Diagnosis is temporal artery biopsy

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6
Q

What can Temporal Arteritis result in if left untreated?

A

vision loss

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7
Q

Osteoporosis is a skeletal disorder that is a result of what ?

A

Loss of bone mass
Deterioration of cancellous bone architecture

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8
Q

What is the outcome of the skeletal structure in Osteoporosis?

A

Thinning of bone cortex and loss of trabeculae from cancellous bone
Leads to increased fracture risk

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9
Q

What is a common fracture seen in Osteoporosis?

A

vertebral compression fracture or hip fracture

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10
Q

Osteoporosis is a result of net loss of _________ relative to _________

A

bone formation, bone resorption

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11
Q

In Osteoporosis, what does the bone remodeling process do?

A

repairs damage to the skeleton and involvement in serum calcium maintenance.

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12
Q

Where Osteoporosis commonly located?

A

in areas with abundant cancellous bone, such as femoral neck and spine.

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13
Q

Loss of bone mass is greatest in early menopause in osteoporosis, what is the process that leads to this?

A

Decreased estrogen > increase in cytokine activity > stimulation of production of osteoclast precursors.

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14
Q

What are the two types of Osteoporosis?

A

Type 1: Caused by estrogen deficiency
Type 2 (“senile osteoporosis”): calcium deficiency

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15
Q

Acute osteomyelitis is a __________ infection. There is an open wound seeding through __________ spread, or ________ infection extension.

A

Bacterial, hematogenous spread, or skin

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16
Q

What are the clinical findings in Acute Osteomyelitis?

A

bone/joint pain, swelling, erythema

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17
Q

In Acute Osteomyelitis there is occlusion of the local blood vessels which leads to

A

bone necrosis and local spread of infection.

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18
Q

In Acute Osteomyelitis, Infection may expand through the bone cortex and spread under the periosteum which can lead to

A

abscesses that may drain through the skin.

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19
Q

What can develop in vertebral osteomyelitis?

A

paravertebral or epidural abscess can develop.

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20
Q

Define Systemic Lupus Erythromatosus (SLE), its causes and the two types.

A

Multisystem, chronic inflammatory disease

Cause unknown; autoimmune presence as immune systems of SLE patients generate autoantibodies against many tissue components

Two types: discoid (cutaneous involvement only) and systemic

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21
Q

Which population is SLE common in? and what is the age distribution?

A

Age: young adults with onset 15-64 years
children compromise 10-15% of cases
women
Ethnic predisposition
Native American
African American
Hispanic
Chinese
Filipino

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22
Q

What is the pathologic process of SLE?

A

activation of multiclonal B-cells > exaggerated production of antibodies and immune complex formation

Immune complexes are deposited in vascular and tissue surfaces, causing inflammation and injury

Antinuclear antibodies (ANA) found in almost all SLE patients but is NOT specific

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23
Q

What is the pathophys of SLE?

A

Tissue damage by antibody and immune complex deposition
Autoantibodies form to cell nucleus components

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24
Q

What are the common symptoms of SLE?

A

Fatigue
Fever
Malaise
Weight loss

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25
Q

Why is SLE considered a “great immitator”

A

since it mimics many other diseases, thereby confusing the diagnosis
Disease course “waxes and wanes”

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26
Q

What are the s/s of SLE?

A

arthralgias and arthritis; joint deformities; skin manifestations (butterfly rash, hair loss, sun sensitivity)

27
Q

For the dx of lupus, for the ARC criteria, generally need 4 of the 11 criteria for dx which are?

A

Malar Rash
Discoid rash
Photosensitivity
Oral Ulcers
Polyarthritis involving more than 2 joints
Pleuritis or Pericarditis
Antinuclear Antibody titer positive (1:40 or higher)
Titer over 1:320 is very suggestive
Renal disease
Neurologic disorder (e.g. Seizures, Psychosis)
Anemia, Neutropenia or Thrombocytopenia
Anti-dsDNA, Anti-Sm positive, Syphilis False Positive

28
Q

What does the lab data concentrates on for SLE?

A

ANA, ESR, pancytopenias

29
Q

What is scleroderma?

A

systemic sclerosis, an uncommon connective tissue disorder of unknown etiology
Women > men
50% of patients die within 5 years of onset

30
Q

What are the two classifications of sceleroderma?

A
  1. localized (skin, muscles only)
    2.versus systemic (organ involvement)
    Localized rarely progresses to systemic
31
Q

What is the hallmark of scleroderma?

A

overproduction of collagen, leading to skin and organ changes

32
Q

What is the presentation of a pt with sceleroderma?

A

Fibrosis of skin and surrounding structures, with blood vessel involvement
Skin becomes shiny and hard; face becomes tight, resembling a mask
Raynaud’s phenomenon very common
Swelling, pain, stiffness, contractures in joints

33
Q

When a patient has scleroderma, CREST syndrome can also be seen. What is this?

A

C calcinosis
R Raynaud’s
E esophageal dysmotility
S sclerodactyly
T telangiectasia

34
Q

What are the most common systems affected in scleroderma?

A

pulmonary, cardiac, GI, kidney, vascular

35
Q

Strain

A

tearing of muscle or tendon

36
Q

Sprain

A

tearing of a ligament

37
Q

Closed fracture

A

does not fracture through skin.

38
Q

Open fracture

A

soft tissue injury open to fracture (treat from beginning as infected wound).

39
Q

Spiral fracture

A

produced by twisting or rotational force. Often caused by indirect force (child abuse).

40
Q

Greenstick fracture

A

occurs when bone is bent and fails on the side subjected to compression. Kids have more bone elasticity.

41
Q

Torus fracture aka (Buckle Fracture)

A

caused by compression force on the long axis of the bone in children. (Buckle Fracture) “dent” in bone

42
Q

What is the most common symptom of temporal arteritis?

A

Severe headache

43
Q

What occurs if acute osteomyelitis is partially treated?

A

low-grade chronic osteomyelitis can develop

44
Q

What are extra-articular manifestations for SLE?

A
  1. Renal: causes lupus nephritis as anti-DNA antiantibodies selectively target kidney; most patients will have symptomatology
  2. CV: pericarditis, valvular disease, MI
  3. Pulmonary: pleural effusions, pleurisy
  4. CNS: cognitive impairment, stroke and/or hemorrhage secondary to vasculitis
  5. Hematologic: see can see pancytopenia
45
Q

Comminuted fracture

A

produced by direct trauma, resulting in fracture into more than 2 pieces of bone.

46
Q

Avulsion fracture

A

produced by forcible resisted contraction of a muscle that pulls off fragment of bone at muscle insertion.

47
Q

Stress fracture (March fracture)

A

caused by repetitive overuse that leads to microfractures in the bone.

48
Q

Pathologic fracture

A

occurs at the site of bone weakened by tumor or osteoporosis

49
Q

Pediatric bones have ________ which adds some complexity to their fracture evaluation. This area of growth is ___________

A

growth plates, cartilaginous

50
Q

What can damage of the growth plate lead to? Some growth plates can be palpated on exam in skinny pts e.g. radius, fibula.

A

growth arrest

51
Q

Diaphysis

A

the long part of a long bone

52
Q

Metaphysis

A

the long-bone side adjacent to growth plate

53
Q

Physis

A

the growth plate

54
Q

Epiphysis

A

adjacent to the physis (often toward jointline)

55
Q

Salter-Harris Fracture Classification System

A

Used to classify growth plate fractures
This is essential information for ER/Ortho
All Salter-Harris fractures involve the physis (by definition)

56
Q

Salter-Harris I Fractures just involves the __________. If the fracture is ______ the XR will look normal.

A

physis, non-displaced

57
Q

In a Salter-Harris I Fracture, some ______ of the physis may be seen

A

widening

58
Q

______________ is a very common injury in kids. It is located _________ radius and fibula

A

Salter-Harris I Fractures
distal

59
Q

Kids will often have a non-displaced Salter-Harris I ankle Fracture in the setting where an adult would have a _______

A

sprain

60
Q

Toddlers commonly get a _______ or _______ fracture that cannot be easily seen on initial plain radiographs.

A

tibial, calcaneal

61
Q

What is a common mechanism of a toddler’s fracture?

A

Child going down slide on parent’s lap

62
Q

In toddler’s, treat focal bony tenderness as a _________

A

fracture

63
Q

What will XRs reveal in a toddlers fracture?

A

a fracture line or periosteal reaction of bone (possibly indicating healing of fracture).

Patho (16 decks)

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