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Pathophysiology > MSK Patho (Schoenwald) > Flashcards

MSK Patho (Schoenwald) Flashcards

1
Q

What are two types of metabolic bone disease?

A

Osteoporosis

Rickets

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2
Q

What is the cause of disease in osteoporosis?

A

Reduced mass of mineralized bone due to imbalance of bone metabolism resulting in Increased bone resorption

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3
Q

What is the cause of disease in Rickets?

A

Calcium metabolism (related to a vitamin D issue)

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4
Q

Is osteomyelitis infectious?

A

Yes

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5
Q

Is osteoarthritis infectious?

A

No

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6
Q

What is Paget disease?

A

Excessive osteoblastic bone formation with abnormal structure and instability

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7
Q

Osteoclasts are responsible for bone…

A

Bone resorption

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8
Q

Osteoblasts are responsible for bone…

A

Bone formation

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9
Q

What does microscopic pathology of osteoporosis show?

A

Symmetric thinning of trabecular and cortical bone (this results in increased risk of fracture of bone)

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10
Q

In primary osteoporosis, risk increases with…

A

Age

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11
Q

What is Type I osteoporosis?

A

Postmenopausal- due to estrogen loss (more typical form)

Causes an increase in osteoclastic activity

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12
Q

What is Type II osteoporosis?

A

Senile- decreased osteoblastic activity

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13
Q

What are the most common bones fractured in osteoporosis?

A

Hip
Compression fracture of vertebrae
Distal radius (FOOSH)

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14
Q

What are the risk factors for developing osteoporosis?

A 
Aging and positive family history 
Smoking 
Alcoholism 
Decreased estrogen 
Low body mass index, low calcium diet, lack of weight bearing exercise
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15
Q

What is an endocrine-related secondary cause of osteoporosis?

A

Increased PTH, DM, Addison’s disease

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16
Q

What is a GI secondary cause of osteoporosis?

A

Malnutrition

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17
Q

What is a hematologic-related secondary cause of osteoporosis?

A

Blood cancers

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18
Q

What is a drug-related secondary cause of osteoporosis?

A

Long-term presnisone usage, heparin, some chemo agents

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19
Q

Which gender has a higher incidence of developing osteoporosis?

A

Females

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20
Q

What do patients with osteoporosis often present with?

A

Vertebral compression fractures, kyphotic

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21
Q

What is the textbook patient stereotype of someone with osteoporosis?

A

Thin, white female with a long term history of smoking, postmenopausal

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22
Q

What kind of test measures bone density?

A

DEXA scan

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23
Q

What 2 parameters does a DEXA scan report?

A

T score, Z score

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24
Q

What is a T score?

A

Reported by a DEXA scan

Bone density measurement compared to a healthy 30 year old’s bone mass (peak)

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25
Q

What is the normal values for a T score?

A

+1 to -1

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26
Q

What is a Z score?

A

The number of standard deviations above or below what is normally expected for same age, sex, weight, and ethnic or racial origin

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27
Q

What is an abnormal Z score?

A

-2 or lower

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28
Q

What does a T score of +1 to -1 indicate?

A

Healthy bone density

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29
Q

What does a T- score of -1 to -2.5 indicate?

A

Osteopenia

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30
Q

What does a T-score of -2.5 to -3.0 indicate?

A

Osteoporosis

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31
Q

What does a T score of -3.0 and lower indicate?

A

Severe osteoporosis

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32
Q

What is the difference between Rickets and Osteomalacia?

A

Same disease preocess but Rickets technically describes children and osteomalacia technically describes adults

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33
Q

What is the disease process in Rickets/osteomalacia?

A

Mineralization of osteoid is decreased while bone mass stays normal- results in bowing of legs
Vitamin D deficiency/ phosphate deficiency

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34
Q

What is Rickets?

A

Affects the growing bones of children

It is the inadequate mineralization of osteoid matrix leading to the overgrowth and distortion of epiphyseal cartilage

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35
Q

What does osteomalacia affect?

A

Newly formed bone matrix in adults

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36
Q

What is osteomyelitis?

A

Infection of the bone

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37
Q

How is osteomyelitis spread?

A

Hematogenous spread, contiguous spread

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38
Q

How is osteomyelitis more commonly spread in children?

A

Hematogenous

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39
Q

What is the most common causative agent in the hematogenous spread of osteomyelitis?

A

Staph aureus

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40
Q

How is osteomyelitis more commonly spread in adults?

A

More common to have contiguous spread in adults

Ex- diabetic foot wound, staph is common but can be polymicrobial

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41
Q

True or False osteomyelitis can be either chronic or acute

A

True- osteomyelitis can be chronic or acute

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42
Q

What are the clinical findings in osteomyelitis?

A

Pain, warmth of area affected

Fever can be present but is often absent

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43
Q

What labs are you going to see in osteomyelitis?

A

Elevated ESR, CRP

Elevated platelet count

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44
Q

What radiographic findings are you going to see in osteomyelitis?

A

Destruction of bone

Periosteal edema

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45
Q

How is the diagnosis of osteomyelitis made?

A

Blood cultures
Biopsy of bone
(Superficial cultures are not reliable)

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46
Q

What is the treatment for osteomyelitis?

A

Long term IV antibiotics targeted to organism +/- surgical debridement

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47
Q

How does osteomyeltitis result in ischemia of bone?

A

Infection lifts periosteum of bone, which impairs blood flow, resulting in ischemia

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48
Q

What is a sequestrum?

A

A dead bone fragment (in osteomyelitis)

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49
Q

What is an involucrum?

A

New bone growth around the sequestrum (in osteomyelitis)

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50
Q

What is a Brodie’s abscess?

A

Residual abscess surrounded by bone growth

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51
Q

Generally speaking, what is arthritis?

A

Inflammation of the joint

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52
Q

What can be done to help differentiate between infectious and inflammatory arthritis?

A

Synovial fluid anaylsis

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53
Q

What is the synovial fluid analysis going to indicate in a normal joint?

A 
Clear appearance 
<200 WBCs 
<25 PMNs 
95-100% serum glucose 
No crystals
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54
Q

What is a synovial fluid analysis going to indicate in a joint with non-nflammatory arthritis?

A 
Appearance- clear 
<400 WBCs 
<25 % PMNs 
95-100% serum glucose level 
No crystals
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55
Q

What is the synovial fluid analysis going to indicate in a joint with an acute gout attack?

A 
Appearance- turbid 
2000-5000 WBCs 
>75% PMNs 
80-100% serum glucose level 
Negative birefringence needle-like crystals
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56
Q

What is the synovial fluid analysis going to indicate in a joint with pseudogout?

A 
Turbid appearance 
5000-50,000 WBCs 
>75% PMNs
80-1000% serum glucose level 
Positive birefringence rhomboid crystals
57
Q

What is the synovial fluid analysis in a joint with septic arthritis?

A 
Purulent/ turbid appearance 
>50,000 WBCs 
>75% PMNs 
<50% serum glucose level 
No crystals
58
Q

What is the synovial fluid analysis in an inflammatory process such as RA?

A 
Turbid appearance 
5,000-50,000 WBCs
50-75% PMNs 
Approx 75% serum glucose level 
No crystals
59
Q

What is the most common degenerative joint disease in people over the age of 65?

A

Osteoarthritis

60
Q

What joint disease is attributed to “wear and tear” ?

A

Osteoarthritis

61
Q

What is the mechanism of disease in osteoarthritis?

A

Progressive loss of cartilage in the joint space

62
Q

What type of joints are impacted by osteoarthritis?

A

Weight bearing joints

63
Q

What do microscopic findings show in osteoarthritis?

A

Loss of cartilaginous staining (loss of proteoglycans), loss of chondrocytes

64
Q

What causes the inflammation in osteoarthritis?

A

Fibrillation and splitting of cartilage surface- allows for synovial fluid infiltration, which leads to inflammation

65
Q

What leads to erosion of open bony surface in osteoarthritis?

A

Granulation tissue and fibrosis replace cartilage, which leads to erosion of open bony surface

66
Q

What causes a limitation of range in motion in joints with osteoarthritis?

A

Osteophyte formation- reactive new bone limits ROM of joint

67
Q

What are examples of osteophytes?

A

Heberden node- distal interphalangeal joint

Bouchard node- proximal interphalangeal joint

68
Q

What are the clinical findings in osteoarthritis?

A

Morning stiffness worsening throughout the day
Joint pain, usually unilateral
Crepitus on exam
Pain and tenderness on exam

69
Q

What radiologic findings will you see in osteoarthritis?

A

Joint space narrowing
Subchondral sclerosis and cysts- synovial fluid leaks into defects in cartilage
Osteophytes

70
Q

What is infectious arthritis?

A

Acute or chronic infection of joint

71
Q

What is infectious arthritis caused by?

A

Direct seeding of bacteria

72
Q

What types of bacteria causes infectious arthritis?

A

Staph
Neisseria gonorrhea
Chlamydia- reactive arthritis (Reiter’s syndrome)
Strep pneumoniae

73
Q

What is Reiter’s syndrome?

A

Reactive arthritis
Caused by chlamydia
Affects joints, eyes, urethra

74
Q

What happens to the joint space in infectious arthritis?

A

Edematous and neutrophilic infiltration of the synovial space and fluid

75
Q

What happens to the joint space in infectious arthritis?

A

Edematous and neutrophilic infiltration of the synovial space and fluid

76
Q

How is the diagnosis of infectious arthritis made?

A

Clinical exam

Synovial fluid analysis and culture

77
Q

What is the treatment for infectious arthritis?

A

Antibiotic treatment directed at causative organism

78
Q

What is RA?

A

Chronic progressive, inflammatory disease

Collagen vasculature disorder

79
Q

Is the etiology of RA known or unknown??

A

Unknown

80
Q

What is the genetic prevalence in RA?

A

HLA-DR4

HLA-DR1

81
Q

What is the female to male prevalence in RA?

A

3:1 female to male

82
Q

What are the clinical features of RA?

A

Morning stiffness for longer than 1 hour
3 or more affected joints
Symmetric involvement of joints
Constitutional symptoms- fever, weight loss, fatigue
Warm, tender joints with swan neck deformity, Dupuytren’s contracture, and boutonnière deformity

83
Q

What is the Felty syndrome triad?

A

Leukopenia
Splenomegaly
RA

84
Q

What do the microscopic features in RA show?

A

Progressive, villous hypertrophy of synovalis secondary to fibrinous swelling

85
Q

In chronic RA, what replaces acute inflammatory reactions?

A

Fibrosis eroding of the cartilaginous surface of the joints

86
Q

What do the x-rays of RA show?

A

Osteopenia

Narrowing of joint space

87
Q

What joints are affected in osteoarthritis? RA?

A

Osteoarthritis- weight-bearing- hips, knees, PIP, DIP

RA- MCP, PIP, feet, wrists, ankles, elbows, knees

88
Q

How long does morning stiffness last in osteoarthritis? RA?

A

Osteoarthritis- less than 30 minutes

RA- longer than 1 hour

89
Q

What are the symptoms in osteoarthritis, RA?

A

Osteoarthritis- pain with movement, better with rest

RA- stiffness and pain worse with inactivity

90
Q

What will the physical exam show is osteoarthritis, RA?

A

Osteoarthritis- heberden and Bouchard nodes

RA- rheumatoid nodules, radial deviation of wrist, ulnar deviation of phalanges

91
Q

Ankylosing Spondylitis is sero____ spondyloarthropathy

A

Seronegative

92
Q

What percentage of people with ankylosing spondylitis have the HLA B27 gene?

A

90%

93
Q

Ankylosing spondylitis preferentially involves….

A

Vertebral column, SI joints

94
Q

What is the onset of ankylosing spondylitis?

A

2nd and 3rd decade of life (teens-20s)

95
Q

What is the clinical presentation of ankylosing spondylitis?

A

Gradual onset of back pain

Loss of mobility

96
Q

Gout is arthritis due to what depositing in the joint space?

A

Uric acid crystals

97
Q

What are 90% or primary cases of gout due to?

A

Increased production or decreased excretion

98
Q

What are some secondary causes of gout?

A

Cell turnover from leukemia

Chronic renal disease

99
Q

What are some risk factors for gout?

A

Alcohol, obesity, thiazide diuretics

100
Q

What are tophi?

A

Aggregates of urates rimmed with macrophages, lymphocytes, and giant cells- found in joints and ligaments, can cause a chronic tophaceous arthritis

101
Q

What is the pathology behind gout?

A

Urate crystals (needle shaped) precipitated in the synovium, crystals are chemotactic for neutrophils/ activate complement, acute arthritis occurs as a result of neutrophilic infiltrate with uric acid crystals in the joint

102
Q

Where do 50% of first attacks of gout occur?

A

At the first metatarsophalangeal joint (big toe, very painful)

103
Q

Pseudogout occurs in patients with…

A

Degenerative joint disease

104
Q

Pseudogout mimics….

A

Osteoarthritis symptoms

105
Q

What kind of crystals are found in Pseudogout?

A

Calcium pyrophosphate crystals- rhomboid

106
Q

Paget disease is also known as…

A

Osteitis deformans

107
Q

What is Paget disease?

A

Excessive osteoblastic bone formation with abnormal structure and impaired stability

108
Q

Paget disease has an increase in incidence after the age of…

A

40

109
Q

What is the stereotypical patient with Paget Disease?

A

Caucasian, men more than women, older than 40

110
Q

The early phases of Paget disease are asymptomatic/ symptomatic

A

Asymptomatic

111
Q

What are the clinical features of Paget disease?

A

Enlargement of head bones, headache, deafness, visual disturbances and deformation/tenderness of long bones

112
Q

What are the radiologic findings in Paget disease?

A

Pathologic fracture= chalk stick fracture (cross fracture of long bones)
Thick course cortex of bone

113
Q

What are the lab findings in Paget disease?

A

Elevated serum alkaline phosphatase

114
Q

What are 3 malignant primary tumors of bone?

A

Osteosarcoma
Ewing sarcoma
Chondrosarcoma

115
Q

What is the most common tumor arising within the bone?

A

Multiple myeloma

116
Q

Which are more common…benign or malignant tumors in the bone?

A

Benign tumors are 100X more common than malignant

117
Q

What is the most common malignant bone tumor?

A

Osteosarcoma

118
Q

Which bone cancer occurs mostly in children and adolescents?

A

Osteosarcoma

119
Q

What are the common sites of an osteosarcoma?

A

Metaphysical areas adjacent to knee and shoulder

120
Q

What do X-rays show in osteosarcoma?

A

Localized lytic or osteoblastic lesions with fuzzy borders and prominent subperiosteal reactive bone formation (Codman triangle)

121
Q

What do the microscopic findings in an osteosarcoma reveal?

A

Osteoblastic lesion with lacy osteoid deposition

122
Q

Where do osteosarcomas commonly metastasize to?

A

The lung

123
Q

What is the second most common tumor of children?

A

Ewing sarcoma

124
Q

What does an Ewing sarcoma often present as?

A

Fever and pain mimicking an inflammatory process- often misdiagnosed as osteomyelitis

125
Q

How is the diagnosis of an Ewing sarcoma confirmed?

A

Biopsy

126
Q

What bones are most commonly affected by Ewing sarcomas?

A

Long bones- humerus, tibia and femur

127
Q

Where do Ewing sarcomas commonly metastasize to?

A

Lungs, brain, and skull

128
Q

A chondrosarcoma arises from…

A

Cartilage

129
Q

What age is affected by chondrosarcoma?

A

40-60s, peak of incidence in 60s

130
Q

What bones do chondrosarcomas usually affect?

A

Central portions of skeleton- shoulder, pelvis, proximal femur and ribs

131
Q

What does radiology show in a chondrosarcoma?

A

Bulky osteodestructive lesion with characteristic pattern of calcification (popcorn)

132
Q

Where do chondrosarcomas commonly metastasize to?

A

Lungs

133
Q

How are malignant soft tissue tumors spread?

A

Hematogenous spread, classified by tissue derivation

134
Q

What type of malignant soft tissue tumor is the most common?

A

Malignant fibrous histiocytoma- deep fascia, skeletal muscle, and retroperitoneal space

135
Q

Where do liposarcomas occur?

A

Deep subcutaneous tissue of thighs, abdomen, and retroperitoneum

136
Q

What age group experiences the most liposarcomas?

A

Greater than age 50

137
Q

Who is most susceptible to Rhabdomyosarcoma and what type of tissue does it involve?

A

Children and adolescents, skeletal muscle

138
Q

What type of tissue is affected by Leiomyosarcomas?

A

Smooth muscle, uterus, and GI

139
Q

What type of tissue is affected by Neurofibrosarcomas?

A

Peripheral nerves

Pathophysiology (5 decks)

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