MSK Pathology 1

Question 1

What is meant by the term vasculitis ?

Answer 1

Inflammation of the blood vessels

Question 2

How do vasculitis’s arise ?

Answer 2

Can be primary - arising on its own

or

Secondary - arising in response to infection or another condition e.g. rheumatoid arthritis

Question 3

What is the presentation of Kawasaki’s disease ?

Answer 3

• Most common in japan
• Condition follows a few weeks after a febrile disease in a infant/young child
• There is lympahdenopathy, mouth ulcers and rash.

Question 4

Kawasaki’s disease is an arteritis what do the arteries show ?

Answer 4

They show a transmural arteritis

Question 5

What are some of the complications of Kawasaki’s disease?

Answer 5

It can lead to sudden death, as it causes diffuse aneurysmal dilatation of coronary arteries which can lead to thrombosis and therefore MI and death

Question 6

What is the autoantibody present in Kawasaki’s disease?

Answer 6

Anti-endothelial

Question 7

What is giant cell arteritis ?

Answer 7

• The most common cause of vasculitis most commonly of the large and medium arteries of the head
• Patients are > 50

Question 8

What test can be done to diagnose giant cell arteritis? why if negative does it not mean that the patient doesn’t have the condition?

Answer 8

• Temporal biopsy
• Because present with skip lesions
• Responds well the steroids also so as there given before hand may clear up the bit biopsied

Question 9

What are some of the signs/symptoms of giant cell arteritis ?

Answer 9

• Headache
• Jaw claudication
• Visual distrubances

Question 10

What does ANCA stand for ?

Answer 10

anti neutrophil cytoplasmic antibodies

Question 11

There are a number of ANCA associated with a number of different vasculitides

Answer 11

appreciate this

Question 12

Who does polyarteritis nodosa (PAN) commonly affect and what are some of the associated conditions ?

Answer 12

• Commonly affects people in 30s and 40s
• Propensity for renal involvement but spares the lungs, affects many other organs
• 1/3rd have hepB positivity
• Affects small and medium vessels

Question 13

Histologically what does PAN do ?

Answer 13

Causes focal and segmental transmural necrosis of arteries

Question 14

What are some of the complications of PAN ?

Answer 14

• Early on can cause thrombosis => infarction, haemorrhage, aneurysms
• Later healing occurs and fibrosis of arteries can cause ischaemia leading to hypertension
• Relapsing course untreated can result in death

Question 15

What are the two underlying reasons that can cause gout ?

Answer 15

Caused by essentially making too much or getting rid of too little uric acid (hyperuricaemia)

This is like all metabolic problems

Question 16

Thinking back to the two underlying reasons for the formation of gout what is the most common cause of gout ?

Answer 16

Secreting too little

Question 17

What is it condition called when you are making too much uric acid resulting in gout and what is it caused by ?

Answer 17

Lesch–Nyhan syndrome (LNS) (juvenile gout), is a rare inherited disorder caused by a deficiency of the enzyme HGPRT

Question 18

What drug could cause gout ?

Answer 18

Thiazide diuretics - due to decreased uric acid secretion

Question 19

How is gout diagnosed ?

Answer 19

Diagnosed with microscopy which shows negative birefringence needle shaped crystals

Question 20

What is the characteristic presentation of gout ?

Answer 20

The main symptom of gout is a sudden attack of severe pain in one or more joints, typically your big toe.

Question 21

What is birefringence ?

Answer 21

Bending of the light twice

Question 22

Pseudogout is similar to gout but where does it usually affect ?

Answer 22

Pseudogout is a similar condition to gout, but usually affects the knee joint first.

Question 23

On microscopy what does pseudogout show ?

Answer 23

Weak positive birefringence - rhomboid shapped

Question 24

What is pagets disease and who is it common in ?

Answer 24

• Common in elderly people
• It is a disease where there is increased bone resorption (osteoclastic activity) which causes osteoblasts to rapidly lay down new bone some of which is woven (results in structural weakness)
• The thickened bone may compress nerves or the spinal cord