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2nd Year Medicine > MSK pathology > Flashcards

MSK pathology Flashcards

1
Q

Connective tissue disease? e.g.?

A

Autoimmune - inflammatory diseases characterised by presence of auto-antibodies

e.g. rheumatoid arthritis, SLE, scleroderma, dermatomyositis

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2
Q

Rheuamatoid arthritis? Marker? Histology?

A

Inflammation of joints

* Marker = rheumatoid factor, auto ab against Fc IgG

* Histo = lots of lymphocytes + plasma cells in synovial tissue

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3
Q

Phases of rheumatoid arthritis?

A

* Acute phase = inflammatory granulaion tissue (pannus) + hyperplastic synovium

* Chronic phase = fibrosis, deformity

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4
Q

SLE dx? Histo?

A

Dx: ANA+, anti double-stranded DNA, biopsy

Histo = chronic inflammation (lymphocytes + plasma cells)

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5
Q

Examples of metabolic MSK diease? (3)

A

Pagets, osteomalacia, crystal arthropathies

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6
Q

Crystal arthropathy? What process involves urate production?

A

gout, uric acid (end-product of purine synthesis)

* Urate formed in DNA replication as guanine and adenine are purine based

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7
Q

Causes of hyperuricaemia? (2)

A

* Increased production e.g. idiopathic,enzyme defect (Lynch Nyhan syndrome), cancer, psoriasis

* Reduced excretion (most common cause of gout) - drug side effect e.g. thiazide diuretics

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8
Q

Ax crystal arthropathy?

A

Crystals in joints causing inflammatory reaction

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9
Q

Pathological findings crystal arthropathy?

A

* Cytology – joint fluid shows needle-shaped crystals

* Histology – amorphous eosinophilic debris (giant cells), will not see crystals, another form of crystal arthropathy that can look similar = pyrophosphate arthropathy

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10
Q

What is another form of crystal arthropathy not involving urate crystals?

A

Calcium pyrophosphate = pseudogout or chondrocalcinosis

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11
Q

Pseudogout s/s?

A

* Usually asymptomatic (ncidental finding on x-ray)

* Can experience some joint pain

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12
Q

Cytology pseudogout?

A

Crystals are bigger, coarser and more rhomboid in shape (in contrast to urate crystals)

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13
Q

Paget’s disease of bone?

A

* Abnormality of bone turnover

* Increased osteoclastic activity

* Paradoxically – more bone but not normally structured (so often weaker, patients prone to develop fractures with minor trauma)

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14
Q

Ax Paget’s disease of bone?

A

Cause uncertain: possible genetics, viral infection (paramyxovirus, measles, RSV)

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15
Q

Pathological finding paget’s disease?

A

* Osteolytic (less dense)

* Burnt out

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16
Q

s/s Paget’s disease of bone? (4)

Secondary malignancy?

A

* Pain

* Enlargement + abnormal shape

* Increased metabolism (heat)

* AV shunt can lead to HF

Secondary malignancy = osteosarcoma

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17
Q

phases of bone fracture?

A

Initial phase - haematoma, inflammatory cells, cytokine release

1 week - callus, organised haematoma, remodelling bone

2-3 weeks - woven bone deposited perpendicular to cortical bone, cartilage deposition at fracture site

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18
Q

Effects of metastatic bone disease? (3)

A

* Most are osteolytic – loss of bone

* Prostate is osteosclerotic (more dense) – areas of opacity

* Remember myoloma/plasmacytoma - malignant proliferation of plasma cells, causes bony lesions

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19
Q

Avascular necrosis? Ax?

A

bone infarction (often asymptomatic until very end stage)

* Ax: trauma, alcohol, dysbarism, steroid injection, sickle cell, infection

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20
Q

Morphology avascular necrosis? Histology?

A

wedge-shape dinfarct (usually subcortical)

* Histo: creeping substitution (new bone growing over dead bone)

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21
Q

Osteoarthritis?

A

Degenerative bone disease

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22
Q

Features of osteoarthritis?

A

* Cartilage cracks (fibrillation) - reduced joint space

* Subchondral cysts

* Osteocytes - new bone formation at side

* Sclerosis

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23
Q
A

Ganglion cyst - space with myxoid material. Secondary inflammatory changes

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24
Q
A

Giant cell tumour

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25
Q
A

Liposarcoma

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26
Q
A

rhabdomyosarcoma

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27
Q
A

Osteoma

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28
Q
A

Osteoid osteoma

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29
Q
A

Osteosarcoma

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30
Q
A

Ewing’s sarcoma - small round blue cell tumours

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31
Q
A

Myositis ossificans

32
Q
A

…

33
Q
A

Osteoarthritis

34
Q
A

Synovial proliferation and inflammation in rheumatoid arthritis

35
Q
A

Athroscopic appearance of normal joint (top) vs rheumatoid joint

36
Q
A

…

37
Q
A

…

38
Q
A

Osteoarthritis

Right hip = normal, left hip = loss of joint space, subchondral cysts

Loss of joint space between tibia and calcanea

39
Q
A

CHRONIC TOPHACEOUS GOUT

40
Q
A

Calcium pyrophosphate deposition disease

41
Q
A

CPPD

42
Q
A

Milwaukee shoulder

43
Q
A

Synovitis (RA)

44
Q
A

extensor tenosynovitis

45
Q
A

Enthesitis as a result on spondylarthropathy

46
Q
A

Dactylitis (“sausage” digits)- spondylarthropathy

47
Q
A

…

48
Q
A

Ankylosing spondylitis

49
Q
A

Ankylosing sponylitis (SIJ fusion) - LATE SiGN (so like normal SIJ joints on x-ray is not a reassuring sign!)

50
Q
A

…

51
Q
A

MRI- bone marrow oedema, enthesitis - EARLY SIGNS of AS!!

(White corner of SIJ is marrow oedema)

52
Q
A

“pencil in cup” - psoriatic arthritis

53
Q
A

Keratodema Blenorrhagica - reactive arthritis (reiter’s syndrome)

54
Q
A

Circinate balanitis - reiter’s syndrome (reactive arthritis)

55
Q
A

Small vessel vasculitis

56
Q

Saddle nose as a result of GPA

A
57
Q
A

Cavitating nodules as a result of GPA

58
Q
A

ANCA patters (i.e. cANCA (GPA) and pANCA (MPO and EGPA))

59
Q
A

Gottons sign - dermatomyositis

60
Q
A

Heliotrope rash - dermatomyositis

61
Q
A

Shawl sign - dermatomyositis

62
Q
A

Malar rash + subacute cutaneous lupus associated with SLE

63
Q
A

Jaccoud’s arthritis - deforming arhtropathy (associated with SLE)

64
Q
A

Livido reticularis - associated with anti-phospholipid syndrome

65
Q
A

Sclerodactyly - associated with systemic sclerosis

66
Q
A

Telangectasia - associated with systemic sclerosis

67
Q
A

Cauda equina syndrome

68
Q
A

Blounts disease

69
Q
A

Legg-Calve-)Perthes disease - flattened, sclerotic

70
Q
A

Slipped upper femoral epiphysis (SUFE)

71
Q
A

CAM deformity (FAI)

72
Q
A

Left = normal

Right = torn labrum

73
Q
A

Avascular necrosis

* Left - hanging rope sign

* Middle - MRI showing oedema

* Right - secondary OA

74
Q
A

ITOH x-ray

Normal density on left, on right there is osteopenia (almost transparent)

75
Q
A

ITOH - MRI

Oedema like in AVN

2nd Year Medicine (24 decks)

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