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PATHPROS > MUSCULOSKELETAL PATHOLOGY - 4 > Flashcards

MUSCULOSKELETAL PATHOLOGY - 4 Flashcards

1
Q

What’s the pathogenesis of the condition described?

triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis

A

autoimmune reaction initiated by prior infection of the genitourinary system (Chlamydia) or the gastrointestinal tract (Shigella, Salmonella, Yersinia, Campylobacter)

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2
Q

What is synovial fluid examination from the involved joint likely to show?

Sudden onset of severe pain in the great toe

Localized hyperemia, warmth, Fever

Hyperuricemia

A

Monosodium urate crystals , both free and within the phagosomes of neutrophils

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3
Q

The allele assoc with 50% cases of Rheumatoid arthritis

A

HLA-DRB1

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4
Q

2 antibodies assoc with Rheumatoid arthritis

A

Rheumatoid factor

Autoantibodies against citrullinated peptides (Anti CCPs)

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5
Q

See the attached image

Gout or Pseudogout?

A

Pseudogout.

Rhomboid; Positively birefringent

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6
Q

1. See the attached radiograph. What is it characteristic of?

75 year old

deep achy pain that worsens with use

Synovial fluid - decreased vsicosity, WBC 900 cells/mm3, Neutrophils 20%

2. Enumerate the radiographic findings

A
  1. Osteoarthritis
  2. Radiographic features include:
    a. Narrowing of joint space
    b. Subchondral sclerosis
    c. Subchondral boen cyst
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7
Q

What roles do TNF and IL-1 play in the pathogenesis of RA?

A

Stimulate synovial cells to secrete MMPs(matrix metalloproteases) that destroy hyaline cartilage

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8
Q

What crystals deposit in Pseudogout?

A

Calcium pyrophosphate crystals

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9
Q

Clinical consequence of cervical spine involvement in rheumatoid arthritis

A

Subluxation of the atlantoaxial joint

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10
Q

What are the radiographic findings assoc with the condition described?

Sudden onset of severe pain in the great toe

Localized hyperemia, warmth, Fever

Hyperuricemia

A

Juxta-articular erosion with overhanging edges

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11
Q

What’s your diagnosis?

14 year old with knee pain

Lasts for 6 weeks

ANA positive

A

Juvenile idiopathic arthritis

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12
Q

Properties of the crystals assoc with this condition , when viewed with a polarizing filter

Sudden onset of severe pain in the great toe

Localized hyperemia, warmth, Fever

Hyperuricemia

A

needle shaped

negatively birefringent

(yellow when aligned with the compensator filter and blue when perpendicular to the filter)

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13
Q

List the seronegative spondyloarthropathies

A

Psoriatic arthritis

Ankylosing spondylitis

Inflammatory bowel disease associated arthritis

Reactive arthritis

(PAIR)

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14
Q

List causes of gout based on mechanism of hyperuricemia

A
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15
Q

form of noninflammatory arthritis characterized by progressive joint destruction due to a primary neurologic disorder

A

Charcot Joint (Neuropathic joint disease)

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16
Q

bony outgrowths at lateral portions of the joints, capped by fibrocartilage and hyalone cartilage

A

Osteophytes

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17
Q

Characteristic radiographic findings in Rheumatoid arthritis

A

juxta-articular osteopenia with erosions

narrowing of the joint space

18
Q

Describe the morphologic appearance of a rheumatoid nodule

A

necrotizing granulomas with a central zone of fibrinoid necrosis surrounded by a prominent rim of activated macrophages and numerous lymphocytes and plasma cells

19
Q

List the locations where rheumatoid nodules are commonly found

A

the extensor surface of the fingers, forearms, and pressure points (Achilles tendon, olecranon process) and in the lungs

20
Q

Microscopic description of calcium pyrophosphate deposition disease (CPPD/Pseudogout) deposits in soft tissues

A

amorphous basophilic oval blue-purple aggregates.

21
Q

OA/RA?

Describe what you see in the attached image.

A

RA

Swan neck deformity - hyperextension of the proximal interphalangeal (PIP) joints and hyperflexion of the distal interphalangeal (DIP) joints

22
Q

Examples of enteropathic arthritis

A

Arthritis assoc with Ulcerative colitis and Crohn disease

Arthritis assoc with Whipple disease

After certain bacterial infections of the gut - Yersinia, Salmonella, Shigella, and Campylobacter

23
Q

Describe the morphologic finding most likley to be seen in osteoarthritis

A

near-complete loss of articular cartilage. Subchondral cysts

24
Q

Microscopic features of Rheumatoid arthritis

A
  1. Synovial cell hyperplasia
  2. Prominent lymphoid follicles composed of §CD4+ helper T cells, B cells, plasma cells, dendritic cells, and macrophages
  3. Pannus
25
Q

Most common extra-articular manifestation of ankylosing spondylitis

A

Anterior uveitis

26
Q

OA/RA?

Describe what you see in the attached image.

A

RA

Boutonniere deformity with marked flexion of the PIP joint and extension of the DIP joint

27
Q

Important clinical consequence of the finding shown in the attached image

A

Kyphosis—>interferes with chest wall movement —>limitation of chest expansion—>hypoventilation

28
Q

Describe a tophus

A

large aggregations of urate crystals surrounded by an intense inflammatory reaction of foreign body giant cells

29
Q

2 dermatologic manifestations of Reactive arthritis

A

Keratoderma blennorhagicum

Circinate balanitis

30
Q

OA /RA?

See the attached photomicrograph

A

OA

The photomicrograph shows Fibrillation of the articular cartilage

31
Q

Describe the gross appearance shown in the attached image.

A

Eburnated bone (Ivory like bone) characteristic of osteoarthritis

32
Q

Radiographic findings assoc with the condition described below:

Nail pitting, onycholysis

Sausage shaped digits

Salmon colored plaques on skin with positive Auspitz sign

A

erosion of the distal end of the interphalangeal joint with bony proliferation at the proximal end of the affected joint.

(Pencil in cup deformity)

33
Q

List few causes for Charcot joints

A

Diabetes mellitus

Leprosy

Syringomyelia

Tabes dorsalis

34
Q

What is Rheumatoid factor?

A

IgM (mostly) or IgA autoantibodies that bind to the Fc portion of the patient’s own IgG.

35
Q

OA/RA?

prominent osteophytes at the distal interphalangeal joints

A

OA

(Heberden’s nodes)

36
Q

List the 4 cytokines/substances elaborated in RA

A

Interferon gamma

IL-17

TNF and IL-1

RANK L

37
Q

OA/RA?

malaise, fatigue, and generalized musculoskeletal pain

swollen, warm, painful

Particularly stiff when rising in the morning

A

Rheumatoid arthritis

38
Q

rheumatoid nodules lung + pneumoconiosis

A

Caplan Syndrome

39
Q

What is the pathogenesis of the condition described?

75 year old

deep, achy pain in the knees and hips that worsens with use

crepitus

A

degeneration of the articular cartilage and its disordered repair

(The condition described is osteoarthritis)

40
Q

Unifying features of seronegative spondyloarthropathies

A
  1. Pathologic changes in the ligamentous attachments rather than synovium
  2. Involvement of sacroiliac joints, with or without other joints
  3. Absence of rheumatoid factor
  4. Association with HLA-B27
41
Q

Desribe the composition of pannus

A

a mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblasts that grows over the articular cartilage and causes its erosion leading to bony ankyloses

42
Q

Renal complications of gout

A

uric acid nephrolithiasis

pyelonephritis

PATHPROS (36 decks)

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