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MSK > Pathology 1 > Flashcards

Pathology 1 Flashcards

1
Q

list 4 types of non-neoplastic conditions

A

connective tissue
metabolic disease
fractures
degenerative disease

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2
Q

autoimmune disorders can cause connective tissue disease, true or false?

A

true
inflammatory disease
often present with MSK symptoms and signs but have potential for systemic symptoms

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3
Q

how can autoimmune disorders be diagnosed?

A

auto-antibodies
however in some conditions there are very strong, specific associations with auto-antibodies and disease while others not so much

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4
Q

give 4 autoimmune markers?

A

rheumatoid arthritis - rheumatoid factor
lupus - structural parts of DNA
Scleroderma - anti-centromere, antielomere
dermatomyositis - anti Jo

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5
Q

what is rheumatoid arthritis?

A

inflammation of joints with autoimmune basis
- rheumatoid factor
- auto antibodies against Fc IgG
can be systemic (can occur in absence of joint disease but with manifestations in other places like soft tissue etc)

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6
Q

histology of rheumatoid arthritis?

A

plasma cells

lots of inflammatory cells

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7
Q

what happens in the acute phase of rheumatoid arthritis?

A

pannus formation at edges of articular surfaces and then spreads over - inflammatory granulation tissue
hyperplastic/reactive synovium

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8
Q

what happens in chronic phase?

A

fibrosis
deformity
cartilage is destroyed by inflammatory processes causing loss of joint space

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9
Q

what is SLE?

A

systemic autoimmune condition

autoantibodies directed at parts of DNA

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10
Q

name 2 diagnostic markers of SLE

A

ANA (95%)

anti double stranded DNA (40-60%)

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11
Q

what is often required for diagnosis of inflammatory arthritides?

A

clinic-pathological correlation - clinical features and biopsy

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12
Q

name 3 metabolic diseases

A

pagets
osteomalacia
crystal arthropathies

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13
Q

what is crystal arthropathy?

A

gout - urate crystals in joint space

pseudogout - calcium pyrophosphate crystals in joint space

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14
Q

how does crystal arthropathy occur?

A

uric acid is end product of purine synthesis (adenine and guanine)
so urate is formed in DNA replication etc
either increased production or reduced excretion of urate

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15
Q

what can cause increased production of urate?

A

usually idiopathic
enzyme defect (HGPRT) = lysch Nyhan syndrome (rare)
Increased cell turnover - psoriasis, cancer following chemotherapy (causes tumour lysis)

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16
Q

what is the most common cause of gout?

A

under-excretion

can be a drug side effect (thiazides)

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17
Q

how do urate crystals end up in joints?

A

precipitation of crystals (due to reduced solubility, not necessarily to do with amount)
unclear how they end up in joint

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18
Q

how does urate cause pain?

A

crystals elicit acute inflammatory reaction which can mimic arthritis or infection in joint
can cause secondary degenerative changes

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19
Q

what other 2 sites can urate crystals deposit in?

A

soft tissues - gouty tophus

Kidneys - renal disease (stones)

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20
Q

what are the pathological findings in gout?

A

cytology - cross polarised light used to see needle shaped crystals in joint fluid
histology - amorphous eosinophilic debris and inflammation (giant cells - almost like granuloma reaction), crystals lost during tissue processing

21
Q

which is 100% diagnostic of gout?

A

cytology

histology findings could also be pseudogout

22
Q

what is calcium pyrophosphate?

A

crystal arthropahy - pseudogout/pyrophosphate arthropathy

usually affects large joints in older people

23
Q

how does psuedogout present?

A

usually aymptomatic but can cause pain

crystals are more rhomboid in shape (thicker and bigger than needles in gout)

24
Q

what is pagets disease of bone?

A

abnormality of bone turnover
increased osteoclastic activity
more bone but not normally structured - often weaker so can commonly fracture

25
Q

what can cause pagets disease?

A 
uncertain
some genetic elements (RANKL)
viral infections
- measles
- RSV
- paramyxovirus
26
Q

what are the 3 stages of pagets disease?

A

osteolytic
mixed
burnt out
end result is thick excess bone with abnormal reversal lines - mosaic pattern

27
Q

what are the 5 symptoms of pagets?

A

can affect all bones
pain - microfracture or nerve compression
enlargement and abnormal shape
increased metabolism - heat, AV shunt (can cause heart failure)
secondary malignancy - osteosarcoma

28
Q

osteomalacia?

A

abnormal vit D metabolism

can cause rickets

29
Q

what are the initial phases of fracture?

A

haematoma - fibrin mesh
influx of inflammatory cells
cytokine release - osteoprogenitor cells
after week 1 - callus forms - organised haematoma, early recruitment and remodelling at the ends of the bone

30
Q

2-3 weeks after fracture?

A

maximum girth of callus
woven bone deposited perpendicular to cortical bone
cartilage deposition at fracture site which undergoes ossification
bridging with a bony callus

31
Q

remodelling?

A

woven bone in callus is constantly remodelled - less stress on area, better remodelling to normal shape

32
Q

why might a fracture be sent to pathology?

A

abnormal bone before break

break doesn’t match level of trauma

33
Q

what can cause a fracture other than trauma?

A

osteoporosis
malignancy
tumours
………..

34
Q

what can cause a fracture other than trauma?

A

osteoporosis
malignancy
tumours

35
Q

what are myeloma/plasmacytoma?

A

malignant proliferation of plasma cells

can cause bony lesions

36
Q

osteolytic vs osteosclerotic?

A 
osteolytic = tumour breaks down/thins bone
osteosclerotic = tumour causes increase in bone density and hardening of bone
37
Q

what can cause avascular necrosis?

A 
trauma
alcohol (large cause)
dysbarism
steroid injection
sickle cell disease
infection
38
Q

what does avascular necrosis look like?

A

wedge shaped infarct
often sub cortical
histology - creeping substitution - new bone growing over dead bone (indicative of healing phase)

39
Q

degenrerative joint disease?

A

mechanical injury to joints - osteoarthritis

can be secondary to other joint disease

40
Q

what secondary disease can avascular necrosis cause?

A

osteoarthritis

41
Q

what causes degenerative disease?

A

mechanical injury to joints - osteoarthritis

can be secondary due to other joint disease

42
Q

what changes occur in joints in degenerative disease?

A

fibrillation (roughening)
cartilage is worn away until surface becomes polished bone on bone - eburnation/erosion
synovial fluid leaks through bone forming subchondral cysts
remodelling of bone to cope with stress produces outgrowths - osteophytes

43
Q

acute features of inflammatory arthritides?

A

oedema
fibrin
reactive features in synovial cells

44
Q

what causes pseudogout?

A

usually idiopathic

can be due to hypercalcaemia, haemachromatosis, hypomagnesia, ochronis, hypothyroidism

45
Q

loss of joint space on X ray?

A

cartilage loss

46
Q

subchondral sclerosis on X ray?

A

eburnation

47
Q

sunchondral cysts on X ray?

A

synovial fluid accumulation

48
Q

osteophytes on X ray?

A

disorganised bone remodelling

MSK (66 decks)

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