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Musculoskeletal and Skin > MSS-Week 1 > Flashcards

MSS-Week 1 Flashcards

1
Q

Types of muscle contraction

A

Isometric
Concentric (shortens)
Eccentric (lengthens) - most force

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2
Q

Bone matrix components

A

Inorganic: calcium phosphate (hydroxyapatite)
Organic: Collagen I, proteoglycans, glycoproteins

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3
Q

Osteoblasts

A

synthesize bone matrix (osteoid)

Activated by BMPs, growth factors, cytokines

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4
Q

Osteocytes

A

Mature bone cells, occupy lacunae
Normally only one per lacuna
Connect to canaliculi–gap junctions
Function to maintain bone matrix

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5
Q

Osteoclasts

A

Destroy bone matrix for remodeling (resorbtion)
multinuclear
clamp down on “ruffled border”
activated by PTH and RANK/L
inhibited by calcitonin and osteoprotegerin (blocks RANK)

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6
Q

Paget’s Disease

A

Abnormal osteoclasts cause high rate of remodeling, leads to overabundance of weak immature bone (primary/woven bone)

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7
Q

Bone structure

A

cylindrical subunits= osteons
concentric lamella surrounding a canal= Haversian canal
Lacunae in adjacent lamella are joined by tiny canaliculi
Larger canals between adjacent lamellae= Volkmann’s canals
Collagen I fibers are arranged anti-helical

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8
Q

Repair of bone fracture

A

Macrophages remove debris
Chrondroblasts secrete hyaline cartilage to form provisional callus
Osteoblasts replace provisional with bony callus
Remodeling replaces woven with mature bone

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9
Q

Cartilage matrix components

A

collagen (esp II)
Ground substance: aggrecan (proteoglycan), hyaluronate backbone-> proteoglycan aggregates
multiadhesive glycoproteins

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10
Q

Cells of cartilage

A

Chrondrocytes: cell nests occupy the space of lacunae
secrete components of matrix
Chrondroclasts: multinucleated cells that degrade calcified cartilage, derived from monocytes

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11
Q

Types of cartilage

A

Hyaline: bluish-white, glassy,, has perichondrium
Articular: no perichondrium, smooth
Elastic: yellowish, contains elastin
Fibrocartilage: white, opaque, collagen I

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12
Q

Lipoma

A 
Most common soft tissue tumor of adults
mobile, slowly enlarging, painless
most are soft, yellow, well-encapsulated
Angiolipomas can have local pain
Cure: cut it out
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13
Q

Liposarcoma

A

One of most common sarcomas of adults
deep soft tissues of proximal extremities and retroperitoneum
Well-differentiated: good prognosis
Myxoid/round cell: intermediate
Pleomorphic: aggressive, metastasize
Less likely to be benign if cells vary in size and presence of lipoblasts (multiple vesicle fat cells)

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14
Q

Pseudosarcomatous Proliferation

A 
Reactive non-neoplastic lesions
response to trauma or idiopathic
Develop suddenly, grow rapidly
Nodular Fasciitis: deep dermis or muscle
Myositis Ossificans: proximal extremities, young adults, presence of metaplastic bone
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15
Q

Fibromatosis

A

Superficial: may resolve or recur,, palmar, plantar, penile
Deep: Desmoid tumors: lies between benign fibrous tumors and low-grade fibrosarcomas,, frequently recur,, Gardner syndrome,, APC or B-catenin genes

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16
Q

Fibrosarcoma

A 
Malignant fibroblasts
mostly adults
deep tissues of thigh, knee, retroperitoneum
aggressive
Neg for all markers except vimentin
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17
Q

Leiomyoma

A

Smooth muscle tumors
Uterine most common neoplasm in women
usually small solitary easily cured lesions

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18
Q

Leiomyosarcoma

A

Smooth muscle sarcoma
superficial: good prognosis
Retroperitoneum: usually large, bad, metastatic

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19
Q

Rhabdomyosarcoma

A

Most common soft-tissue sarcoma of childhood
Usually head, neck, GU (where normally no skeletal muscle)
Embryonal: 50%, <10yo
Alveolar: more severe, 10-25yo, usually deep soft tissue of extremities
Pleomorphic: worst

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20
Q

Synovial Sarcoma

A

Young adults, more males
Deep soft tissue of extremities, esp knees
t(X;18)
treated aggressively, common metastatic to lung, bone, lymph

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21
Q

Types of Collagen

A

1: Fibril forming
2: FACIT
3: Collagen IV- Basement membrane
4: Collagen VI- Beaded filaments
5: Hexagonal network (cartilage)
6: Anchoring fibril
7: Transmembrane domain
8: Multiplexin- spacing between fibrils

22
Q

Collagen Synthesis

A

3 procollagen chains-> hydroxylation and glycosylation-> disulfide bonds-> triple helix->secretion to extracellular-> N and C proteases cleave ends-> Tropocollagen-> assemble into collagen fibrils-> lysyl oxidase forms covalent crosslinks-> FACIT collagens and proteoglycans added

23
Q

Collagen interactions

A

Laminins: binds anchoring fibril, basement membrane, integrins
Proteoglycans/Aggrecan
Fibronectin

24
Q

Ehlers-Danlos

A

Mutations in some part of collagen synthesis

hyperextensible skin, mobile joints, fragile tissue, bruise easily

25
Q

Osteogenesis Imperfecta

A

Mutations in Tyle I collagens
thin, bowed bones, fragile
abnormal bleeding, blue sclera

26
Q

Alport Disease

A

Collagen IV mutation (basement membrane)

Renal damage, hematuria, hearing/ocular deficits

27
Q

Scurvy

A

Deficiency of Vit C
easy bruising and bleeding, corkscrew hair
Decreased hydroxylation of collagen by lysyl and prolyl hydroxylases

28
Q

Gout

A

Uric acid crystal buildup in joints->inflammation (IL1-B pathway/inflammasome
Hyperuricemia, usually via underexcretion (kidneys)
linked somewhat to BMI too
increased risk post-menopause
can be caused/worsened by metabolic syndrome, renal disease, drugs, EtOH, diet, etc
MCU crystal birefringence

29
Q

CPPD Deposition Disease

A

Calcium pyrophosphate dihydrate crystal deposition
similar to gout, related to overproduction of PPi
may be found with CPPD and urate crystals mixed

30
Q

Pseudogout

A

Attacks of acute arthritis, usually in larger joints
Dx: rhomboidal shaped, birefringent crystals
May see chondrocalcinosis on XRay

31
Q

Rheumatoid Arthritis

A 
T-cell autoimmune, with B-cell contribution
genetic predisposition (HLA-DR)
Hormonal contribution (F>M)
Proliferation of synovium (synovitis), with characteristics of benign tumor
Invasion of joint with neutrophils, other immune cells
Rheumatoid factor= IgM anti-Fc of IgG antibody
CCP= anti-cyclic citrullinated peptide= correlates with disease activity
AM stiffness, swollen joints (usually small), rheumatoid nodules
Associated with periodontitis (PAD)
Also have Sjogren's (dry eyes/mouth), higher CV risk (vasculitis, atherosclerosis), pulm and GI (nodules) and neuro effects
32
Q

Osteoarthritis

A 
Degenerative joint disease
Chrondrocytes in articular cartilage respond to biologic stresses in a way that breaks down matrix (imbalance)
hands, hips (men), knees, spine usually
Heberden nodes= DIP,, Bouchard's= PIP
Small fractures-> joint mice, rice bodies
fracture gaps fill w synovial fluid-> subchondral cysts
Mushroom shaped bony outgrowths= osteophytes at margin of articular surface
Inflammation of synovium membrane,, thickened joint capsule
Joint deformity (NOT fusion like RA) can occur
33
Q

Bone tumors

A

Relatively rare, potentially curable
nonspecific symptoms, pain and mass, pathologic fracture
Child: osteosarcoma, Ewing’s sarcoma
young adult: Giant cell tumor
Old: Chrondrosarcoma
Epiphysis: giant cell tumor, chrondroblastoma
Metaphysis: osteosarcoma, osteochrondroma, chondromyxoid fibroma, osteoid osteoma
Diaphysis: Ewing’s sarcoma, Enchrondroma, Chrondrosarcoma, fibrous cortical defect
Sclerotic margin= good, benign
Solid/ivory-like= osteosarcomas
Rings and arcs= chondrosarcomas

34
Q

Osteoid Osteoma

A

benign bone-forming tumor
long bones
<2cm
night pain, responds to aspirin

35
Q

Osteoblastoma

A

benign bone-forming tumor
vertebrae or metaphysis
>2cm
painful, non-responsive to aspirin

36
Q

Osteosarcoma

A 
Malignant tumor produces osteoid or bone, infiltrates into soft-tissue
most common sarcoma of bone
bimodal ages= 10-20yo or 55-80
metaphysis of long bones
hematogenous spread to lungs
Mutated RB gene, or p53, MDM2, or Paget dz
Has codman's triangle
Tx: neo-adjuvant chemo + surgery
37
Q

Osteochondroma

A

Common benign tumor of bone
metaphysis of long bones
Autosomal dom mutation in EXT-1
Buds off a little growth from growth plate

38
Q

Enchondroma

A 
Benign hyaline cartilage lesion
intramedullary chondroma
usually asymptomatic
small bones of hands and feet
Tx: none unless changes
39
Q

Multiple Chondromatosis

A

Mutations in IDH1 or IDH2
Ollier’s disease: multiple enchondromata
Maffucci’s syndrome: multiple enchondromata+angiomata, severe skeletal malformation

40
Q

Chondrosarcoma

A

Malignant tumor which produces ONLY cartilage
second most common bone sarcoma
usually older adults
central skeleton, pelvis and ribs
medullary location, cortical erosion
popcorn-like appearance, more cellular than enchondroma

41
Q

Non-ossifying Fibroma

A

Most common space-occupying lesion of bone (1 in 4)
metaphysis
lytic, starry night appearance

42
Q

Fibrous Dysplasia

A

Developmental arrest of bone
circumscribed, ground-glass appearance,, randomly oriented woven bone trabeculae
Monostotic: common, adolescents, ribs, mandible, femur
Polyostotic: infancy, crippling deformities, craniofacial
McCune-Albright syndrome: polyostotic FD with endocrinopathies and cafe-au-lait spots

43
Q

Ewing Sarcoma / PNET

A

Second most common malignant bone tumor of childhood/adolescents
painful, enlarging mass
Diaphysis of long bones
Destructive moth-eaten, permeative medullary lesion,, onion-skin periosteal rxn
Sheets of small round blue cells,, CD99, glycogen
hemorrhage and necrosis
EWS, t(11;22)

44
Q

Giant cell tumor of bone

A

young adults, epiphysis, knee

benign, locally aggressive

45
Q

Metastatic bone tumors

A

20x more common than primary bone tumors
usually axial skeleton, lytic
80% from breat, lung, thyroid, prostate, kidney (BLT-KP)

46
Q

Osteomyelitis

A

Bone infection
Hematogenous: from bacteremia (more common in kids)
Direct implantation: injury, P. aeruginosa
Contiguous: direct from wound or ulcer
Infxn of prosthetic device
Staph aureus is common, also gram negs
Sequestrum= pieces of dead bone
Involucrum= new external bone formation
Brodie’s abcesses= localized abcesses
Cultures of open ulcers are notoriously unreliable
Tx: long course (6-weeks IV)+ antibiotics
Rifampin is good for biofilms

47
Q

Osteoporosis

A

Most common bone disease
Ca and Vit D are important
So are PTH and estrogens
Excessive degradation by osteoclasts relative to osteoblasts
Dx: DEXA scan (t-score= young healthy,, z-score= age matched controls)
Also FRAX= fracture risk assessment tool
Osteoporosis= 2.5 or more SD below peak bone mass
Osteopenia= 1-2.5 SD below
WHO criteria only apply to caucasian postmenopausal women

48
Q

Vitamin D Deficiency

A

dietary , lack of sunlight, or metabolic enzyme probs
children: Rickets
Mild: osteoporosis
severe: osteomalcia

49
Q

Female athlete triad

A

Disordered eating, amenorrhea, osteoporosis

50
Q

When to perform BMD for osteoporosis

A

women >65yo, men >70yo
younger 50-69yo if clinical risk factors for fracture
adults with condition or medications associated with low bone mass or bone loss
repeat every 2 years post fracture

Musculoskeletal and Skin (4 decks)

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