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Path Fall > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is the difference between autoimmunity and self-tolerance?

A
  1. Autoimmunity= reactions against self by self antigens.

2. Self-tolerance= Immune system does not react against self antigens.

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2
Q

What is central tolerance

A

Antigen- induced deletion of self-reactive T and B lymphocytes during maturation in thymus and bone marrow, respectively.

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3
Q

What is peripheral tolerance?

A

Several mechanisms silence potential auto-reaction:

  1. Anergy= lack of co-stimulation.
  2. Suppression by regulatory T cells
  3. Deletion by apoptosis.
  4. Some self antigens hidden because they are isolated from blood/lymph
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4
Q

What factors lead to failure of self-tolerance?

A

Combined effects of susceptibility genes, which influence lymphocyte tolerance, and environmental factors that alter display/reactions against self-antigens.

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5
Q

Define systemic lupus erythematous (SLE)

A

autoimmune disease involving multiple organs where vast array of auto-antibodies bind to immune complexes that deposit into cells and tissues causing injury.

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6
Q

What are the genetic factors of systemic lupus erythematous (SLE)?

A
  1. Familial association
  2. HLA association
  3. Other defects in classical pathway of complement, and Fc receptor on B cells
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7
Q

What are the environmental factors of systemic lupus erythematous (SLE)?

A
  1. UV radiation
  2. X chromosome (female>male)
  3. Drugs (hydralazine, procainamide, D-penicillamine)
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8
Q

Describe the kidney problems in systemic lupus erythematous (SLE).

A

deposition of immune complex within the glomeruli (Type III hypersensitivity)

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9
Q

Describe the joint problems in systemic lupus erythematous (SLE).

A

non-erosive synovitis with little deformity.

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10
Q

Describe the skin problems in systemic lupus erythematous (SLE).

A

butterfly rash, urticaria, bullae, maculopapular lesions, ulcerations

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11
Q

Define sjogren syndrome

A

Chronic disease characterized by dry eyes, dry mouth, resulting from immunologically mediated destruction of the lacrimal and salivary glands

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12
Q

What is the common autoantibody profile of Sjogren syndrome?

A

SS-A (more sensitive)

SS-B ( more specific)

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13
Q

What diseases are most commonly associated with Sjogren syndrome?

A
  1. Rheumatoid arthritis
  2. SLE
  3. Polymyositis
  4. Scleroderma
  5. Vasculitis
  6. Mixed connective tissue disease
  7. Autoimmune thyroid disease
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14
Q

What are the common clinical features of Sjogren disease?

A
  1. More common in women between 50-60
  2. Keratoconjunctivitis
  3. Xerostomia
  4. Parotid gland enlargement
  5. Dryness of respiratory tract
  6. Tubulointerstitial nephritis
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15
Q

What are the common characteristics of scleroderma?

A
  1. Excessive fibrosis in multiple tissues.
  2. Obliterative vascular disease.
  3. Evidence of autoimmunity (mainly autoantibodies)
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16
Q

What is diffuse systemic sclerosis?

A

initial widespread skin involvement, rapid progression and early visceral involvement.

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17
Q

What is limited systemic sclerosis?

A 
mild skin involvement (often only fingers/face), visceral involvement occurs late, disease generally follows benign course.
AKA CREST syndrome: 
1. Calcinosis
2. Raynaud's
3. Esophageal dysmotility
4. Sclerodactyly 
5. Telangiectasia
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18
Q

Describe bone matrix

A

Organic compound mixture of osteoid (35%) and a mineral component (65%); bone hardness due to hydroxyapetite

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19
Q

What is the relationship between RANKL and osteoprotegerin (OPG) and bone remodeling?

A
  1. Decreased RANKL and increased OPG= no osteoclast activity (bone formation)
  2. Increased RANKL and decreased OPG= stimulated osteoclast activity (bone resorption)
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20
Q

What is the difference between osteopenia and osteoporosis?

A
  1. Osteopenia: decreased bone mass ( 1 to 2.5 standard deviations below the mean peak bone mass)
  2. Osteoporosis: osteopenia that is severe enough to significantly increase risk of fracture (2.5 or greater standard deviations below mean peak bone mass)
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21
Q

Define Paget disease of bone (osteitis deformans)

A

Condition of increased, disorderly and structurally unsound bone.
Mainly affects bones of pelvis, skull, spine, and legs.
Susceptible to fractures, increased risk of osteoarthritis and osteosarcoma.

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22
Q

What are the 3 stages of Paget disease of bone?

A
  1. Initial osteolytic stage
  2. Mixed osteoclastic/osteoblastic stage.
  3. Osteosclerotic stage
23
Q

What is the difference between a simple fracture and a compound fracture?

A

Simple: Overlying skin is intact.
Compound: Bone communicates with skin surface.

24
Q

What is a comminuted fracture?

A

The bone is fragmented into more than 2 fragments.

25
Q

What is a displaced fracture?

A

The ends of the bone at the fracture site are not aligned.

26
Q

What is a stress fracture?

A

Slowly developing fracture that follows a period of increased physical activity in which the bone is subjected to repetitive loads.

27
Q

What is a greenstick fracture?

A

Extending only partially through the bone, common in infants when bones are soft.

28
Q

What is a pathologic fracture?

A

Involving bone weakened by underlying disease process, such as a tumor.

29
Q

What is the process of fracture repair?

A
  1. Hematoma fills fracture gap and surrounds bone injury.
  2. Fibrin mesh forms.
  3. Osteoprogenitor cells activated
  4. 1 week= soft callus (procallus)
  5. 2 weeks= bony callus
  6. Remodelling of callus
30
Q

What factors disrupt normal fracture healing?

A
  1. Displaced and comminuted fractures result in deformity.
  2. Malformed callus can create false joint (pseudoarthrosis)
  3. Infection
  4. Malnutrition and skeletal dysplasia
31
Q

What is osteonecrosis?

A

Infarction (ischemic necrosis) of bone and marrow cells.

32
Q

What are predisposing factors of osteonecrosis?

A
  1. Vascular injury: trauma, vasculitis.
  2. Drugs- corticosteroids.
  3. Systemic disease- sickle cell crisis
  4. Radiation
33
Q

What is osteomyelitis?

A
  1. Inflammation of bone and marrow, virtually always secondary to infection.
34
Q

How do organisms reach bone in pyogenic osteomyelitis?

A
  1. Hematogenous spread.
  2. Extension from contiguous site.
  3. Direct implantation after compound fractures or orthopedic procedures (infections of feet in diabetes)
35
Q

Describe osteosarcoma’s category, behavior, common locations, average age, and morphology

A
  1. Category: bone forming.
  2. Behavior: Malignant.
  3. Common locations: metaphysis of distal femur, proximal tibia.
  4. Avg. Age: 10-20 yrs.
  5. Morphology: Extends from medulla to lift periosteum
36
Q

Describe osteochondroma’s category, behavior, common locations, average age, and morphology

A
  1. Category: cartilage forming.
  2. Behavior: Benign.
  3. Common locations: metaphysis of long bones.
  4. Avg age: 10-30.
  5. Morphology: Bony excresence with cartilage cap.
37
Q

Describe chondroma’s category, behavior, common locations, average age, and morphology

A
  1. Category: cartilage forming.
  2. Behavior: benign.
  3. Common locations: small bones of hands and feet.
  4. Avg age: 30-50 yrs.
  5. Morphology: circumscribed hyaline cartilage in nodule in medulla.
38
Q

Describe chondrosarcoma’s category, behavior, common locations, average age, and morphology

A
  1. Category: cartilage forming.
  2. Behavior: malignant.
  3. Common locations: pelvis, shoulder.
  4. Avg age: 40-60 yrs.
  5. Morphology: extends from medulla through cortex into soft tissue.
39
Q

Describe Ewing sarcoma’s category, behavior, common locations, average age, and morphology

A
  1. Category: unknown origin.
  2. Behavior: malignant.
  3. Common locations: diaphysis of long bones.
  4. Avg age: 10-20 yrs.
  5. Morphology: sheets of primitive small round cells.
40
Q

Describe the structure of synovial joints.

A

Allows for wide range of motion, enclosed by synovial membranes.
Synovial fluid is plasma filtrate that acts as lubricant.
Hyaline cartilage on articulating bones in joint.

41
Q

Describe composition of hyaline cartilage.

A

Elastic shock absorber and wear-resistant surface.
Composed of water (70%), type II collagen, proteoglycans, and chondrocytes.
Lacks blood supply, lymphatic drainage, innervation.

42
Q

Describe osteoarthritis.

A

Degeneration of cartilage resulting from structural and functional failure of synovial joint. Mostly aging/idiopathic related.
Morphological features: bony spur, no ankylosis, subchondral cyst, subchondral sclerosis, osteophyte, thinned and fibrillated cartilage.

43
Q

Describe rheumatoid arthritis.

A

Chronic autoimmune disorder that attacks joints producing a nonsuppurative proliferative and inflammatory synovitis.
Morphologic features: inflammation, pannus, eroding cartilage, fibrous ankylosis, bony ankylosis.

44
Q

What are features of seronegative spondyloarthropathies?

A
  1. Absence of rheumatoid factor.
  2. Pathologic changes in the ligamentous attachments rather than synovium.
  3. Involvement of sacroiliac joints, with or without other joints.
  4. Association with HLA-B27.
  5. Bony proliferation leading to ankylosis (fusion of joints)
45
Q

What are features of ankylosing spondylitis?

A
  1. Prototypical spondyloarthritis.
  2. Destruction of articular cartilage and bony ankylosis, especially SI joints.
  3. Symptomatic in 2nd and 3rd decade of life as low back pain and spinal immobility.
  4. Involvement of peripheral joints: hips, knees, shoulders.
  5. 90% are HLA-B27 positive.
46
Q

What are features of reactive arthritis?

A
  1. Triad: arthritis, urethritis, conjunctivitis (can’t see, can’t pee, can’t climb a tree).
  2. Non-gonococcal.
  3. Men in 20s and 30s.
  4. More than 80% are HLA-B27.
  5. Ankles, knees, feet affected most often in asymmetric pattern.
  6. Probably caused by autoimmune reaction initiated by previous infection in GU or GI.
47
Q

What is pathogenesis of gout?

A

Arthritis caused by urate crystals within or around joints, excessive uric acid in tissues and body fluid.

48
Q

What is pseudogout?

A
  1. Calcium pyrophosphate crystal deposition disease (CPPD).
  2. Sporadic, idiopathic.
  3. Crystals develop in articular cartilage, menisci, intervertebral discs.
  4. Milder inflammation than gout.
49
Q

What is a lipoma?

A

Benign fat tumor.
Most common soft tissue tumor in adults.
Usually arises in the subcutis of the proximal extremities and trunk, most frequently during middle adulthood.

50
Q

What is a ganglion cyst?

A

Small (1-1.5 cm) cyst, firm, fluctuant, pea-sized translucent nodule located near a joint capsule or tendon sheath from cystic or myxoid degeneration of connective tissue.
Most common at wrist joint.
Composed of synovial fluid, but no communication with joint space.

51
Q

What is a synovial cyst?

A

Herniation of synovium through a joint capsule or massive enlargement of a bursa– the synovial lining may be hyperplastic and contain inlammatory cells and fibrin. (e.g. Baker cyst)

52
Q

Define rhabdomyosarcoma.

A

Aggressive, malignant, mesenchymal tumors with skeletal muscle differentiation.

53
Q

What are the 3 main subtypes of rhabdomyosarcomas?

A
  1. Alveolar (20%): network of fibrous septae that divide into clusters or aggregates. look like alveoli.
  2. Embyonal (60%): Soft grey infiltrative mass. Variant form- sarcoma botryoides.
  3. Pleomorphic (20%): numerous large eosinophilic tumor cells, myogenin present.

Path Fall (8 decks)

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