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MSK lectures > Musculo-Skeletal Pathology Non-Neoplastic 02/10/18 > Flashcards

Musculo-Skeletal Pathology Non-Neoplastic 02/10/18 Flashcards

1
Q

What are the 4 non-neoplastic causes of MSK disease?

A

Connective tissue diseases
Metabolic diseases
Fractures
Degenerative Disease

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2
Q

What are the basics of the 4 Hypersensitivity reactions?

A

1 - Immediate IgE
2 - Antibody mediated
3 - Immune complex mediated
4 - Delayed/Cell mediated

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3
Q

Are connective tissue diseases autoimmune?

A

yes

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4
Q

The presence of what characterises a connective tissue disease?

A

Autoantibodies

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5
Q

What percentage of the population have a connective tissue disease?

A

1-2%

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6
Q

Give 2 conditions and their autoantibodies

A

Rhematoid arthritis - rheumatoid factor
Lupus - often structural parts of DNA
Scleroderma - Anti-centromere
Dermatomyositis - Anti Jo

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7
Q

What is Rheumatoid arthritis?

A

Inflammation of the joints

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8
Q

What autoantibodies are present in reumatoid arthritis?

A

Rheumatoid factor

Autoantibody agains Fc IgG

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9
Q

Can rheumatoid arthritis be systemic?

A

Yes

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10
Q

What is formed in the acute phase of RA?

A

Pannus

Inflammatory granulation tissue at the edges and over the articular surfaces of joints

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11
Q

What happens to the cartilage in RA?

A

It is destroyed

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12
Q

What occurs in the chronic phase of RA?

A

Fibrosis

Deformity

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13
Q

What kind of condition is SLE?

A

Prototypic systemic auto-immune condition

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14
Q

What are the autoantibodies directed at in SLE?

A

DNA

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15
Q

ANA is +ve in what percentage of lupus patients?

A

95%

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16
Q

What are some other antibodies found in SLE?

A 
Anti double stranded DNA
\+ve anti-sm 
RNP
SS-A
SS-B
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17
Q

What cells are present in chronic inflammation?

A

Lymphocytes and plasma cells

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18
Q

What are the acute histological signs in inflammatory conditions?

A

Oedema
Fibrin
Reactive features in synovial cells

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19
Q

What are 3 metabolic diseases?

A

Pagets
Osteomalacia
Crystal arthropathies

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20
Q

What is an example of a crystal arthropathy?

A

Gout

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21
Q

What is the end product of purine synthesis?

A

Uric acid

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22
Q

What 2 DNA bases are purine based?

A

Adenine and Guanine

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23
Q

When is urate formed?

A

DNA replication

24
Q

What are the two reasons for Hyperuricaemia?

A

Increased production of Uric acid

Reduced excretion

25
Q

Why does increased production of uric acid occur?

A

Usually idiopathic
HGPRT deficiency
Increased cell turnover - Psoriasis, Leukamia

26
Q

What is a reason for reduced excretion of uric acid?

A

Drugs - Thiazide diuretics

27
Q

What are the clinical manifestations of hyperuricaemia?

A 
Precipitation of crystals
Usually in joints
Elicit acute inflammatory reaction
Gouty tophus
Renal disease
28
Q

What are the pathological findings of hyperuricaemia?

A

Long thin needle shaped crystals

Amorphous eosinophillic debris and inflammation

29
Q

What can Calcium pyrophosphate deposition cause?

A

Common crystal arthropathy

Psuedogout or chondrocalcinosis

30
Q

What are the symptoms of pseudogout?

A

Usually none

May have joint pain

31
Q

What is seen on investigations for psuedogout?

A

Large Rhombus shaped crystals

32
Q

What is paget’s disease?

A

Abnormality of bone turnover

Increased osteoclastic activity but not normally structured

33
Q

What causes Pagets disease?

A

Not sure
Genetic?
Viral infection

34
Q

What are the three stages of Paget’s disease?

A

Osteolytic
Mixed
Burnt Out

35
Q

Are the reversal lines normal in pagets?

A

No they are mosaic like

36
Q

When can pagets cause pain?

A

Microfracture or nerve compression

37
Q

What does pagets do to bones?

A 
Enlargement and abnormal shape 
Leontiasis
Ossea
Platybasia
Sabre tibia
38
Q

What is the malignancy that pagets can cause?

A

Osteosarcoma

39
Q

What metabolic affects can pagets have?

A

Heat
Warm skin
AV shunt
Cardiac failure

40
Q

What is osteomalacia?

A

Abnormal Vitamin D metabolism

41
Q

What is osteomalacia related to?

A

Sun exposure

42
Q

What does osteomalacia cause?

A 
Rickets
Bowed legs
Square heads
Pigeon chest
Rickety rosary
43
Q

What is a pathological fracture?

A

Where the fracture is outkeeping with the level of trauma

E.g. Osteoporitic fractures, Tumours

44
Q

What are the initial phases of trauma?

A

Haematoma
Influx of inflammatory cells
Cytokine release
After a week - callus, organised haematoma, early remodelling at bone ends

45
Q

What occurs during weeks 2-3 of bone repair?

A

Maximum girth of callus
Woven bone deposited perpendicular to cortical bone
Cartilage deposition at fracture site which undergoes endoochondral ossification
Bridging with bony callus

46
Q

What causes bony lesions?

A

Malignant proliferation of plasma cells

47
Q

What is the difference between osteosclerotic and osteolytic lesions?

A

Sclerotic - appear as areas of opacity (prostate)

Lytic - Bone is resorbed and appear as radiolucent

48
Q

What is Avascular necrosis?

A

Bone infarction

49
Q

What causes avascular necrosis?

A

Alcohol
Trauma
Steroids

50
Q

What shape is the infarct in avascular necrosis?

A

Wedge shaped

Subcortical

51
Q

What is an example of a degenerative disease?

A

Osteoarthritis

52
Q

What are the stages involved in joint changes?

A 
Early - small cracks in cartilage
Fibrillation
Cartilage is worn away 
Bone on Bone
Surface becomes polished - eburnation
Cortical bone thickens greatly to cope with load
Leakage of synovial fluid forming small cysts
Rapid bone remodelling
Mistakes are made and osteophytes form
53
Q

What is eburnation?

A

Subchondral sclerosis

54
Q

What is a subchondral cyst?

A

Synovial fluid accumulation

55
Q

What is an osteophyte?

A

Disorganised bone remodelling

MSK lectures (50 decks)

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