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msk > pathology > Flashcards

pathology Flashcards

1
Q

name types of arthritis

A 
osteoarthritis
rheumatoid arthritis
seronegative spondyloarthropathies
infective arthritis
crystal induced arthritis
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2
Q

what are different types of seronegative spondyloarthropathies

A

Ankylosing spondylitis
Reactive arthritis, Enteritis associated arthritis
Psoriatic arthritis

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3
Q

what joints does arthritis focus on

A

synovial joints

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4
Q

primary cause of osteoarthritis

A

insidious
no cause
age related

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5
Q

secondary causes of osteoarthritis

A

predisposing condition

excess weight bearing, deformity injury, systemic conditions

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6
Q

features of osteoarthritis

A

aches and pains

usually hips, knees, lower lumbar and cervical vertebrae, PIP and DIP joints on fingers

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7
Q

pathogenesis of osteoarthritis

A

degeneration of the cartilage and disordered repair
injury to chondrocytes and matrix
stimulate inflammatory changes in synovium and subchondral bone
repetitive injury and chronic inflammation

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8
Q

presentation of rheumatoid arthritis

A

malasie, fever
msk pain
joint involvement - swollen, pain, warm
small joints before large joints

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9
Q

progression of rheumatoid arthritis

A

Joint swelling, Decreased range of movement, Joint fusion (ankylosis)
Associated involvement of tendons and ligaments
Joint deformity
Unstable, (very) limited ROM
Synovial herniation – cysts eg Baker’s cyst
Joint effusions, peri-articular bone loss, loss of articular cartilage

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10
Q

what does IFNg activate in rheumatoid arthritis

A

macrophages and synovial cells

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11
Q

what does IL-17 recruit in rheumatoid arthritis

A

neutrophils and monocytes

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12
Q

what does TNF and IL-1 stimulate production of in rheumatoid arthritis

A

proteases from synovium

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13
Q

RANKL in rheumatoid arthritis

A

expressed on activated T cells and stimulates bone resorption

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14
Q

what autoantibody in rheumatoid arthritis

A

IgM or IgA

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15
Q

what are the acute phases of rheumatoid arthritis

A

pannus formation

hyperactive/reactive synovium

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16
Q

what is potential extra-articular manifestations in rheumatoid arthritis

A

rheumatoid nodules
small vessel vasculitis
pyoderma gangrenosum

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17
Q

features of ankylosing spondylitis

A

destructive arthritis
sacro-iliac and intervertebral joints
bony ankylosis

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18
Q

two forms of crystal arthropathy

A

gout - urate metabolism

pseudo-gout - calcium pyroposphate

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19
Q

synthesis of hyperurucaemia

A

from purine catabolism

reflects abnormal purine metabolism

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20
Q

excretion of hyperurucaemia

A

renal filtration
resorbed in proximal tubule
limited excretion from distal tubule

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21
Q

what happens in osteoporosis

A

decreased bone mass

risk of fracture

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22
Q

what bone mass indicates osteopenia

A

1-2.5 SD

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23
Q

what bone mass indicates osteoporosis

A

> 2.5 SD

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24
Q

causes of secondary osteoporosis

A

endocrine disorders
GI disorders
drugs
miscellaneous - immobilisation

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25
Q

main causes of osteoporosis

A
  • age related
  • reduced physical activity
  • genetic factors
  • calcium
  • hormonal effects
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26
Q

how does old age cause osteoporosis

A

reduced proliferation and biosynthetic capacity of osteoblasts
response to growth factors attenuated

27
Q

what hormonal effects can cause osteoporosis

A
  • post-menopausal
  • low oestrogen causes high bone turnover
  • monocytes release inflammatory mediators
28
Q

cause of osteomalacia

A

vit D deficiency

29
Q

what can vit D deficiency lead to

A

hypocalcaemia and PTH elevated

30
Q

what happens in osteomalacia

A

impaired mineralisation of bone matrix

  • bone remodelling
  • thick osteoid seams
  • bone is weakened
31
Q

what is avascular necrosis

A
  • necrosis of bone and marrow

- the result of loss of effective vascular supply

32
Q

predisposing factors for AVN

A
  • alcohol
  • corticosteroids, bisphosphonates
  • connective tissue disorders
  • decompression
  • sickle cell disease
  • infection, pregnancy, pancreatitis, radiation
33
Q

what does parathyroid hormone do

A
  • activates osteoclasts
  • increased resorption of calcium by renal tubules
  • increased urinary phosphate excretion
  • increased synthesis of active forms of vit D
34
Q

what can hyperparathyroidism cause

A
  • continued osteoclasis
  • osteoporosis
  • brown tumours
  • osteitis fibrosa cystica
35
Q

what is a brown tumour

A

mass of reactive tissue in osteoporotic bone prone to tumour

36
Q

what is Paget’s disease of bone

A

abnormality of bone turn-over

-osteitis deformans

37
Q

what are the three stages of Paget’s disease

A
  • osteolytic
  • mixed
  • osteosclerotic
38
Q

what happens in osteolytic stage

A

resorption pits with large osteoclasts

39
Q

what happens in the mixed stage

A

osteoclasis and osteoblastic activity

40
Q

what is the net result of paget’s disease

A

thick excess bone with abnormal reversal lines

41
Q

characteristic of soft tissue lesions

A
  • present as lump or swelling
  • pain and discomfort
  • wide range of lesions
42
Q

what is a ganglion cyst

A
  • lump near joint or tendon sheath
  • common at wrist
  • degenerative change with connective tissue
  • no epithelial lining
  • secondary inflammatory changes
43
Q

what is nodular fasciitis

A

-fast growing lump in soft tissue
-self limiting
disorder
-cellular proliferation of fibroblastic and myofibroblastic cells
-young adults

44
Q

what is myositis ossificans

A
  • history of trauma
  • insertions of large muscles of arms and legs
  • cellular proliferation but with evidence of bone formation and zonation
45
Q

what is superficial fibromatoses

A
  • non cancerous tumour
  • common
  • Dupuytren’s
  • 60 yrs
  • idiopathic
46
Q

what is Dupuytren’s

A
  • thickening of the skin on your hand (palms)
  • firm grey-white tissue
  • nodules and fascicles
  • bland fibroblasts
  • dense collagen
47
Q

what is deep fibromatosis

A
  • desmoid tumour
  • large infiltrative masses
  • do not metastasise
48
Q

what is tenosynovitis

A
  • giant cell tumour of tendon sheath
  • digits and wrist
  • reactive proliferations
  • pigmented villonodular synovitis
49
Q

name benign tumours

A 
Lipoma
Haemangioma
Leiomyoma
Rhabdomyoma
Chondroma
Osteoma
Neurofibroma / Schwannoma
50
Q

name malignant tumours

A 
Liposarcoma
Angiosarcoma
Leiomyosarcoma
Rhabdomyosarcoma
Chondrosarcoma
Osteosarcoma
Neurofibrosarcoma / MPNST
51
Q

what are tumours derived from fat called

A

benign - lipomas

malignant - liposarcoma

52
Q

what are tumours derived from smooth muscle called?

A

leiomyomas

53
Q

what are tumours derived from skeletal muscle called

A

rhabdomyomas

54
Q

examples of benign tumours that arise from cartilage

A
  • enchondroma
  • osteochondroma
  • chondromyxoid fibroma
55
Q

what is a chondrosarcoma

A

a malignant tumour that produces cartilage

  • bulky tumour
  • nodules of grey/white cartilaginous tissue with gelatinous matrix
  • locally invasive in bone and into muscle and fat
56
Q

what are the three types of chondrosarcoma

A
  • dedifferentiated chondrosarcoma
  • clear cell chondrosarcoma
  • mesenchymal chondrosarcoma
57
Q

where are simple osteomas found

A

cranial bones

58
Q

what is Gardner’s syndrome

A

multiple simple osteomas

59
Q

where are osteosarcomas found

A

long bones

-usually in children

60
Q

what is any malignant tumour that produced osteoid called? (unless proven otherwise)

A

osteosarcoma

61
Q

characteristics of Ewing’s sarcoma

A
  • children and adolescents
  • any soft tissue or bony location
  • destructive, rapidly growing and highly malignant
62
Q

name some causes of a pathological fracture

A
  • osteoporosis

- tumours

63
Q

what does osteolytic mean

A

bone is resorbed and appear as radiolucent

msk (45 decks)

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