Pathology Flashcards
Osteomyelitis?
Cx - Infection of the bone - Bacteria in blood such as staph aureus, trauma or surgery
Sx - Inflammation, swelling, hot, loss of function in the joint bone
SPx - Humerus or femur in children and vertebral bones in adults
Ix - Blood tests, aspirates, MRI or CT of tissue
Mx - Remove dead tissue, aspirate fluid from joint, Initial IV antibiotics then prescribed - ceftriaxone and/or penicillin antibiotics
Osteomalacia?
Cx - Softening of bones by Vit D deficiency that means calcium levels are reduced
***Chrnoic kidney disease
Sx -Often none > fatigue, bone pain, muscle weakness and aches, anorexia?
SPx - Dark skin pigmentation needs longer in sun to produce same amount of vitamin D, stomach surgeries, kidney or liver disease, coeliac
Mx - Vitamin D supplements
Ix - Reduced Ca and PO, ^PTH, ^alkaline phosphate
*Leads to 2nd hyperPT
Rickets
- Osteomalacia in kids
- Effects epiphyseal growth plate that hasn’t closed leading to softening and leaking of bones
Sx - Leads to delayed growth, motor skills, pain in pelvis and spine, swollen wrists - due to excessive non mineralised osteoid at growth plate
Ix - Low Ca
Padget’s bone disease
Cx - Over active osteoblast and osteoclast
Sx - Bone deformities and pain with areas of varying bone density
Mx - Bisphosphates (knock out osteoclasts)
Ix - Normal Ca and PO, ^^alkaline phosphate, normal PTH
** most common in elderly people in: skull, lower bones, pelvis and spine showing lesions
Osteoarthritis
Cx - Wear and tear type that occurs in synovial joints
Sx - Joint pain, stiffness, weakness, worsened by activity,
** loss of joint space, osteophytes (margins of joint), subchondral sclerosis (increased bone density), subchondral cysts,
- Herberns nodes - DIP swelling
- Bouchard nodes - PIP swelling
SPx - Made worse by activity, hands, knees, hips and spine and NO systemic upset, more likely in females
Mx - topical NSAIDs 1st
- oral NSAID with PPI
- steroid injections
Rheumatoid arthritis
Cx - Auto immune - IgM antibodies attack IgG antibodies
Sx - chronic inflammation in the joint lining, tendon sheath and bursa, swelling, pain and stiffness
SPx - Tends to be symmetrical, more likely in women, often in hands, fingers, feet, ankle, systemic upset, worse in the morning, cholesterol deposits in nodules
*DIP spared
Mx - DMARDs - methotrexate
- Steroids for flares
Anti TNF
Ix - Elevated rheumatic factor, anti CCP antibodies**, CRP and ESR
- x rays of affected joints showing loss of joint space
- Joint aspirate - high WCC, yellow fluid, no crystals,
**DAS28 for activity
Gout
Cx - Deposits of uric acid (needle shaped) - negative bifrinegent crystals/monosodium urate in the synovial of joints
Sx - Swollen, hot, painful joints
SPx - More likely if you’re male, consume alcohol, high purine diet, cardiovascular disease, typically base of big toe, thumb and wrist
Mx - NSAID’s or colchicine 1st
- Allopurinol long term for reducing serum urate (NSAID or diclofenac should be given along side)
Colchicine and allopurinol at same time
Ix - Raised blood uric acid levels, aspirates, x ray off joints (>360 diagnose)
- if during flare, repeat in 2 weeks when sx resolved
Osteoporosis
- Reduced bone density leading to increased fracture risk
- Bone and muscle pain/weakness, back pain caused by collapsed vertebrae
- More likely in females, post menopausal, early menopause, long term steroids
Mx- bisphosphates - Alendronic acid and risedronate, denosumab -monoclonal antibody that regulates osteoclasts, teriparatide - synthetic PTH
Ix - DEXA scan used to determine bone density, bloods - Ca, PO, ALP, PTH normal
- T score for young individuals of same sex
- Z score for individuals of same age and sex
** Frax tool for assessing need for dexa scan
Curare paralysis
- Competitive antagonist of nicotinic cholinergic receptors causing paralysis
Botox toxins
- Inhibit exocytosis, Ach unable to cross synaptic cleft and bind in junctional folds
Carpal tunnel syndrome
Cx - Compression on the median nerve caused by inflammation
Sx - Tingling, numbness or pain in 3.5 digits (thumb, index, middle and half of ring)
Mx - Cut flexor retinaculum to release pressure, steroid injection to relive inflammation
Rigor mortis
- Where after an AP has occurred and no ATP is synthesised, can’t break the cross bridge between actin and myosin
- Muscles become rigid 4 hrs after death around the limbs
Psoriasis
- Too many keratinocytes
Sx - itching and patchy skin, red and pink dry skin with slivery/white scales
Ix - Skin biopsy
Mx - topical steroids (creams and ointments)
Ankylosing spondylitis
*Typically in a young man with lower back pain worse in the mornings and night
* Associated with HLA B27 gene
Cx - inflammation in lower axial skeleton
- sacroiliac joints and vertebral column
Sx - lower back pain that radiates to the bum, often stiffness or pain in the mornings, can be woken at night, better on exercise , swimming helps
- restrictive lung defect
** reduced chest expansion, lateral flexion and forward flexion - schobers<5
Ix - CRP and ESR
* - HLA B27 genetic test
* - X ray of sacroiliac joints
- MRI of spine to show bone marrow oedema
Mx - NSAIDS and exercise regime first line
- steroids
- additional physio
*more common in men
Marfan’s syndrome
- A dominant inherited disorder that affects CT
- commonly affecting heart, eyes, blood vessels and skeleton
- Can affect the aorta causing dissections and aneurysm that can be life threatening
Cx - mutation in fibrillar 1 protein
Sx - tall and slender builds
- high arched palate and crowded teeth
- heart murmurs
- extreme near sightedness
- flat feet and a curved spine
- protruding or sunken breast bone
Ix - genetic testing
*Recurrent pneumothoraces common
Psoriatic arthritis
*Inflammatory arthritis associated with psoriasis
- asymmetrical
Sx - plaques of psoriasis on the skin
- pitting of the nails
- oncholysis
- dactalysis
**Eye disease, aortitis, amyloidosis
- worse in mornings, improves with use
***Affects hands and feet
Ix - PEST screening tool -those with psoriasis
X ray - periostitis, ankylosis, osteolysis, dactylitis,
Mx - NSAIDS if mild
- Methotrexate mod to severe
- Anti TNF meds
Reactive arthritis
- Where synovitis occurs as a reaction to a recent tigger - can affect multiple joints and can take 4 weeks post infection
- often single joint in lower limb (knee)
**no infection in the joint
Cx - gastroenteritis, chlamydia (STI),
Axs - bilateral conjunctivtis, anterior uveitis, circinate balanitis
**(can’t see, pee or climb and tree)
Sx - hot, swollen, painful joint
Ix - ESR, CRP, ANA, rheumatoid factor
- no infection in the joint itself
Mx (when septic arthritis is excluded)
- NSAID
- steroid injections
- recurrent cases may rewire DMARDS
lupus erythematosus
*Inflammatory autoimmune CT disease
*More common in women and Asias around middle age
*systemic so affects multiple organs
** Can be drug induced by hydrazine
Sx - non specific symptoms
- fatigue, weightloss, joint and muscle pain, fever, photosensitive malaria rash (across face), mouth ulcers, SOB, raynauds, hair loss, clots
Ix - Anti nuclear antibodies (99%)
- anti double stranded DNA antibodies (most specific to SLE)
- CRP typically normal but ESR raised
- nephritis
- C3 and C4 reduced - auto immune acute disease
- lupus anticoagulant and anti phospholipid antibodies (increase clotting risk)
Mx
- hydroxycloroquine - treatment of choice 1st
- NSAIDs and suncream
Azithroprine
Sciatica
Cx - L5-S1 disc herniation compressing spine
Sx - Pain, numbness, tingling, weakness of glutes, bad, of legs, calves, foot and toes, possible urinary incontinence
***Unilateral
Ix - MRI
- positive leg raise test
Mx - Usually heals on its own,
- NSAIDS and steroids
Cauda equina
Cx - Ruptured disc, stenosis, tumour….
Sx - Faecal and urinary incontinence
- reduced power in limbs
- reduced sensation to pain and temperature
***Bilateral symptoms
- Urinary incontinence a late symptom and irreversible sign
Ix - MRI
Mx - surgical decompression
Pseudogout
- Older adult with hot, swollen, painful knee
- Haemachomatosis a RF
Cx - depositis of calcium pyrophosphate crystals
Sx - typically milder presentation than gout and septic arthritis
Ix - exclude septic arthritis
- Aspirate joint fluid showing: no bacterial growth, calcium pyrophosphate crystals, rhomboid shaped crystals, positive infringement of polarised light
- chonedrocalcinosis (thin white line in middle of joint due to calcium deposition) (LOSS)
Mx - aspirate to exclude septic arthritis
- NSAIDS, steroids
Adhesive capsulitis
*Also known as frozen shoulder
Sx - problems with active and passive movements
- last 6months -2years
- worse on external rotation
Mx - NSAID, physio, roads
Compartment syndrome
- Complication that may occur following surgery or ischaemia reperfusion
- Raised pressure in a compartment compromises tissue perfusion, leading to necrosis
- Most common in supracondylar humerus and tibial shaft fractures
Sx - pain on active and passive extension of fingers
- parasthesia
- pallor
- pulse may still be felt
- Paralysis of muscles
Consistent medication use points to compartment syndrome
Ix - pressure in compartment above 40mmHg is diagnostic
Mx - fasiotomy
Cubital tunnel syndrome
*Ulna nerve is compressed inside the cubital tunnel
Cx - person bends elbow, lifting, reaching and pulling motions
- arthritis, previous fractures
Sx - funny bone pain, numbness in ring or little finger, weak grip, drops things, claw hand
Mx - NSAIDs and steroids
Giant cell arteritis/ temporal arteritis
Vasculitis of medium and large arteries - typically temporal arteries
* Associated with poly myalgia rheumatica
- Higher risk if white females over 50
Sx - Severe unilateral headache around temporal area, scalp tenderness, jaw claudication, blurred or double vision, painless sight loss
- Other common systemic features
Ix - giant cells found on temporal artery biopsy, ESR raised, CRP raised
- reduced Hb, thrombocytosis,
Mx - first line high dose pred
- if evolving vision loss - IV methylpred
Fibromyalgia
- Widespread pain in Body most common around 30-50
- 5x more common in women
Cx - Unknown
Sx - widespread pain at multiple sites or all over
- cognitive impairment
- lethargy
- sleep disturbance and headaches
Mx - aerobic exercise
Antidepressants - duloxetine…
polymyalgia rheumatica
- Usually affects Asian women more often
- Associated with giant cell arteritis
- Older adults affected
Cx -
Sx - pain and stiffness in neck, arms, shoulders and pelvic girdle but can be everywhere, affects sleep, worse in the morning, worse when moving, weight loss and fever - rapid onset
no weakness
Ix - ESR raised CRP raised, CK normal,
Mx - Prednisolone 15mg - should respond quick
- Anti TNF when failure to respond
Sjögren’s syndrome
- Autoimmune condition affecting exocrine glands causing dryness and itching
- Much more common in females
Cx - autoimmune
Sx - dry eyes and mouth, vaginal dryness, joint pain, raynauds,
Ix - RF positive, ANA,
**anti Ro, anti La
* SCHIRMERS TEST
- lymphocytic infiltration on histology - lymphoid malignancy risk
Mx - artificial replacement of saliva and tears
- pilocarpine for dry mouth
-
Septic arthritis
- Haematgenous spread most common
Cx * staph aureus
* unless sickle cell anaemia =salmonella
* Adults sexually active =neisseria gonorrhoea (gram negative diplococci)
- direct penetration or surface infection, surgery
* Can spread from a distal infection point via blood
Sx - Acutely pain, hot, swollen joint (most common at knee)
- problems with function, fever, hot joint
Ix - Synovial fluid sampling
- x ray, blood cultures
Mx - IV antibiotics - flucloxacilin or clydamycin if penicillin allergy
- needle aspiration for decompression
Raynauds
Cx - Vasospasm of smaller arteries that supply fingers
Cx - disease of arteries, CT disease, disease of arteries, smoking
Sx - cold fingers or toes, skin turn white the blue, numb tingly feeling or pain upon warming or stress relief cold or emotional stress
Ix - ANA, ESR
Mx - CCB - nifedipine - rapid onset
- vasodilators
Paracetamol overdose
Sx - abdominal pain, nausea, yellowing of skin and eyes, headache, confusion or drowsiness
Mx - IV N-acetylcysteine
- activated charcoal if <4hrs
Vit K if INR/PT increased
- check levels 4-15hrs after (don’t give treatment too early - treatment line)
Tricyclic antidepressant overdose
Sx - Dilated pupils and tachycardia, seizures, arrhythmia (QRS>100ms)
Mx - activated charcoal<1hr
- benzodiazepines for seizures
- IV Na bicarb
Aspirin overdose
Sx - tachypneoic and tachycardia
- pulmonary oedema
- sweating, tinnitus**, bleeding, drowsiness,
Mx - Na bicarb for acid (aspirin is an acid)
- activated charcoal
- correct electrolytes
Beta blockers overdose
Sx - bradycardia, confusion, hypotension
Mx - IV atropine, IV glucagon, pacing if not responsive
Opioid overdose
Sx - Pin point pupils, reduced rest, reduced GCS, rest acidosis
Mx - IV naloxone
Digoxin overdose
Sx - yellow halls, hypotension, drowsiness, nausea, anorexia
Mx - IV digibind
- treat hypokalaemia
Benzodiazepines overdose
Sx - drowsiness, dilated pupils, reduced resp rate
Mx - flumazemil
Iron overdose
Sx - GI and liver problems
Mx - gastric lavage
- IV Deferoxamine
- Haemarthrosis
*Bleeding into the joint space (most commonly knee)
Cx - Aneursym, trauma, haemophilia, arthritis, vit K deficiency, ligament tears
Sx - pain, swelling and inflammation, trouble moving, bruising, hot joint
Ix - X ray, arthrocentesis,
Mx - pain and swelling
Antiphospholipid syndrome
- 30% have SLE
Sx - recurrent thromboses
Ix - anti cardiolipin, anti beta 2 glycoprotein, lupus anti coag, thrombocytopenia, prolonged APTT
Mx - aspirin primary event
- lifelong warfarin
Osteogenesis imperfecta
*Brittles bone disease
Cx - Autosomal dominant, abnormality in type 1 collagen
Sx - multiple bone fractures, blue sclera, deafness due to otosclerosis, dental imperfections
Ix - Ca, Po, ALP, PTH all normal
Still’s disease
Sx - joint pain, rash (salmon pink or macropapular), pyrexia, lymphadenopathy,
Ix - raised ferritin and leukocytes
- Diagnosis of exclusion - RF and ANA negative
Mx - NSAIDs
- steroids can be added for sx
Discoid lupus
- Auto immune chronic skin condition, more common in women between 20-50
- Dark skin patients
- Increase risk of SLE
Px - lesion on scalp, face and ears
- Photosensitive
- Axs with scarring causing alopecia
-
Ix - skin biopsy
Mx - Topical steroid cream
- Sun protection
Systemic sclerosis
- Auto immune CT disease involving inflammation and fibrosis of CT and organs
Cx - unknown
Limited cutaneous/crest syndrome - Calcinosis, raynauds phenomenon, oesophageal dismotility, sclerodactaly, Telangiectasis
+scleroderma
Ix - ANA and Anti centromere
Diffuse cutaneous - Includes CREST^ plus: CV, resp and kidney problems
Ix - ANA, anti Scl-70
Mx - DMARDs and biologics in diffuse
Polymyositis
- Autoimmune condition causing muscle inflammation and proximal muscle weakness
Sx - Gradual onset, symmetrical, proximal muscle weakness
- difficulties standing, overhead pressing, walking up stairs
- muscle pain can sometimes be present
Ix - CK elevated, Anti Jo 1,
- urgent malignancy screen
Mx - steroids first line
Dermatomyositis
^ Polymyositis plus skin changes
Sx - Gottron papules (back of hands) and heliotrope rash on eye lids, periorbital oedema, photosensitive rash on torso
Ix - CK elevated, Anti Jo 1
- urgent malignancy screen
Mx - Steroids
Small vessel vasculitis
- Henoch-Schonlein Purpura
- Microscopic Polyangiitis (ANCA)
- Granulomatosis with Polyangiitis (ANCA)
- Eosinophilic Granulomatosis with Polyangiitis (ANCA)
Medium vessels vasculitis
- Polyarteritis Nodosa
- Kawasaki Disease
Large cell vasculitis
- Giant Cell arteritis
- Takayasu’s Arteritis
Henoch-Schonlein Purpura
- IgA nephritis - affects kids u10 - IgA deposits In vessels
Px - lower leg and buttocks purpuric rash
- joint pain, abdo pain, renal involvement
Mx - conservative
- analgesia, rest and good hydration
Microscopic Polyangiitis (ANCA)
- Small vessels vasculitis
Px - Renal failure due to glomerulonephritis
- Hameoptysis
Ix - P-ANCA positive - MPO
- can be C- ANCA - PR3
Mx - steroids
Granulomatosis with Polyangitis
- Small vessel vasculitis
Px - affects resp tract
- nose bleeds, hearing loss, sinusitis
- wheeze, haemoptysis
* SADDLE SHPAED NOSE - nasal bridge collapse
- rapidly progressing glomerulonephritis
Ix - C-ANCA positive
Mx - Steroids
Eosinophilic Granulomatosis with Polyangitis
- Small vessel vasculitis
- Primarily affects lungs and the skin
Px - Severe asthma
- sinusitis, allergic rhinitis
- can affect kidneys
Ix - eosinophilia, P-ANCA positive
Mx - steroids**Chaurg strauss
Behcets disease
- Inflammatory condition of vessels causing recurrent oral and genital ulcers
- can affect multiple organs
Px - oral ulcers 3x per year - painful, red halo, sharp borders
- genital ulcers the same
- Ant uveitis
- heal in 2-4 weeks and may leave scars
- erythema nodusum
Ix - Pathergy test - needle to skin **
- HLA B51 gene
Mx - Topical and oral steroids
- …
Ehlers-danlos syndrome
- Group of genetic conditions involving collagen defects
Px - hyper mobility In joints and abnormalities in CT
Ix - Beighton score for hypermobilty
Perthe’s Disease
- Childhood condition where too little blood gets to the femoral head and bone begins to die
RF - age 4-10 and male
Cx - unknown
Sx - Limping, pain, stiffness, worse with activity, limited range of motion
Ix - X ray - may not show changes initially
- shows increased joint space and loss of smooth shape of femoral head
Mx - Surgery
