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NMSK-A II > Pathology > Flashcards

Pathology Flashcards

1
Q

What is the most important disease affecting the joints?

A

osteoarthritis

aka degenerative joint disease (DJD) and Rheumatoid Arthritis (RA)

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2
Q

What are important metabolic causes of arthritis?

A

1) gout

2) pseudogout

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3
Q

What are the classifications of osteoarthritis?

A

1) primary: unknown cause; “wear and tear arthritis”

2) secondary: develops under certain other conditions

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4
Q

What accelerates osteoarthritis?

A

1) mechanical instability
2) stress on joint
3) increased stress of joint surface

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5
Q

What is fibrillation?

A

formation of vertical clefts from cartilage in early stages of osteoarthritis

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6
Q

What happens to the articular cartilage in osteoarthritis?

A

1) softening
2) surface defects
3) irregular thinning

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7
Q

What is eburnation?

A

continued pressure induces sclerosis of subcohondral plate in osteoarthritis

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8
Q

What are bone cysts?

A

cysts filled with synovial fluid formed by bone degeneration under stress in osteoarthritis

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9
Q

What are osteophytes and where do they form?

A

spurs of new bone which for at the margins of the joint of subchondral bone in osteoarthritis; causes narrowing of joint space

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10
Q

What are pathologic features of osteoarthritis?

A

1) spine involvement (cervical/lumbar stiffness; bone spurs and osteophytes “lipping”)
2) hand involvement (nodular deformities: Heberden’s and Bouchard’s)
3) feet involvement (toe deformities: bunions at 1st MTP joint)

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11
Q

Is serologic data usually positive or negative in Rheumatoid arthritis?

A

positive

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12
Q

What does the initial inflammation begin as in Rheumatoid arthritis?

A

synovitis; leads to exudation of fluid and inflammatory cells into joint cavity

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13
Q

What is contained in the inflammatory infiltrates and the joint fluid in Rheuatoid arthritis?

A

inflammatory infiltrates: lymphocytes and plasma cells

joint fluid: lymphocytes, plasma cells, and neutrophils

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14
Q

What does the inflamed synovium lead to pathologicaly in Rheumatoid arthritis?

A

Pannus; exuberant synovial fronds transformed into granulation tissue

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15
Q

What do the inflammatory cells of the pannus release in Rheumatoid arthritis?

A

1) lytic enzymes

2) inflamatory mediators

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16
Q

What role do inflammatory mediators play in Rheumatoid arthritis?

A

1) destroy cartilage

2) erode underlying bone

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17
Q

What is ankylosis?

A

inflammatory mediators in RA cause joints to be immobilized and intraarticular space becomes completely obliterated as granulation tissue transforms into collagenous scar

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18
Q

What is the clinical presentation of RA?

A

1) joint pain
2) swelling
3) redness

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19
Q

What are characteristic findings of the wrist in Rheumatoid arthritis?

A

1) ulnar deviation of wrist
2) deviation of fingers in opp. direction
3) anterior slippage of proximal phalanges (“Z-Deformity”)

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20
Q

What are other names for “Z-Deformity”?

A

1) swan neck deformity
2) boutonniere deformity
3) hourglass deformity

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21
Q

What are constitutional signs and symptoms of Rheumatoid arthritis?

A

1) low-grade fever
2) loss of appetite
3) malaise
4) fatigue
5) anemia common

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22
Q

What are Rheumatoid Nodules?

A

subcutaneous nodules; seen in many anatomic sites besides joints; composed of central fibrinoid necrosis surrounded by macrophages nad lymphocytes

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23
Q

What is Pigmented Villonodular Synovitis?

A

benign tumor of synovial lining

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24
Q

What is the characteristic of pigmented villonodular synovitis?

A

exuberant proliferation of synovial lining cells with extension into subsynovial tissue

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25
Q

What is the most common site of pigmented villonodular synovitis?

A

knee

26
Q

What are gross findings of pigmented villonodular synovitis?

A

synovium develops enlarged folds and nodular excrescences

27
Q

What are microscopic findings of pigmented villonodular synovitis?

A

1) numerous mononuclear cells
2) pigmented and brown hemosiderin-laden macrophages
3) several multinucleated giant cells

28
Q

What is nodular tenosynovitis?

A

“Giant Cell Tumor of Tendon Sheath”; variant of pigmented villonodular synovitis

involves tendon sheath of hands and feet

29
Q

What is the most common soft tissue tumor of the hands?

A

Nodular Tenosynovitis

30
Q

What is treatment of nodular tenosynovitis?

A

surgery

31
Q

What is the most common site of nodular tenosynovitis?

A

flexor surface of middle or index finger

32
Q

What is Gout and where is it found?

A

hyperuricemia and the deposition of uric acid crystals in various tissues, primarily the joints, subcutaneous tissue, and kidneys

33
Q

What is Hyperuricemia?

A

uric acid >7 mg/dl

34
Q

Who is most commonly affected by gout?

A

males with a family history

35
Q

What is primary gout?

A

metabolic: hyperproduction of uric acid (most common primary)
renal: underexcretion of uric acid (most common overall)
[most common of all gout]

36
Q

What is secondary gout?

A

related to another disease; leukemia, chronic hemolysis, obesity, alcoholism [2/3 of all gout]

37
Q

What is the general pathology of Gout?

A

deposits of uric acid crystals in the tissues in the form of insoluble Monosodium Urate; typically develops after many years of asymptomatic hyperuricemia, usually 15-30 years.

38
Q

Where are the most common sites of deposition?

A

1) joints [acute]

2) periarticular connective tissue [acute or chronic]

39
Q

What is the overwhelming first symptom of acute gout?

A

Tarsometatarsal joint of the big toe. (known as Podagra: foot seizure)

40
Q

What is a common cause of uric acid release from the joint capsule?

A

Uric acid is probably released from the deposits in the joint capsule by minor trauma in individuals who are already susceptible. It enters the joint cavity and over-saturates the fluid

41
Q

What are the signs of acute gout?

A

all 5 signs of inflammation

42
Q

What is the best way to diagnose gout?

A

synovial fluid analysis; polarize and see “needles” of monosodium urate + location

43
Q

What happens after the uric acid enters into the joint cavity?

A

promotes crystallization inside the joint due to cold temps; crystals are chemotactic and provide an acute inflammation within the joint

44
Q

What causes the severe pain in gout?

A

neutrophils and inflammatory mediators

45
Q

What else does the crystallization of the uric acid cause in the joint?

A

activates Complement and Kallikrein, which promotes inflammation and pain, and also recruits more leukocytes into the joint; pain and acute inflammation

46
Q

How can the clinical features of gout be classified?

A

acute or chronic; acute: the joint is swollen, hyperemic and warm, and the patient cannot walk; Systemic symptoms include fever, leukocytosis, tachycardia, and general exhaustion. The attacks may last 2-3 days or longer and usually subsides spontaneously

47
Q

What is distinguishing about chronic gout?

A

less inflammation, more bone deformities

48
Q

What is tophi?

A

subcutaneous deposits of uric acid in gout; most common on the ears, the extensor sites of the arms, over the olecranon, and over the patella; not painful, encapsulated

49
Q

What are contained within tophi?

A 
1) urate crystals (birefringent)
surrounded by:
2) macrophages
3) lymphocytes
4) giant cells
50
Q

What are the renal complications of gout?

A

1) renal failure
2) uric acid stones
predispose to:
obstructive nephropathy
chronic pyelonephritis

51
Q

How do you diagnose gout?

A

1) hyperuricemia with labs
2) great toe monoarthritic joint pain
3) X-rays to see tophi

52
Q

What is Pseudogout and where do you find it?

A

Calcium Pyrophosphate Dihydrate (CPPD) deposition disease refers to the accumulation of this compound in synovial membranes

53
Q

What is chondrocalcinosis?

A

deposit in the joint cartilage, ligaments and tendons of pseudogout

54
Q

What are characteristics of pseudogout?

A 
old age (gout is middle age)
preexisting joint damage
excessive level of inorganic pyrophosphate in the synovial fluid
55
Q

Where are the most common places for crystal deposits in pseudogout?

A

(chondrocalcinosis); knees after trauma and after surgical removal of the meniscu

56
Q

What other diseases associated with Pseudogout?

A

1) hyperparathyroidism
2) hypothyroidism
3) hemochromatosis
4) Wilson’s Disease

57
Q

What are gross findings of pseudogout?

A

calcium pyrophosphate deposits appear as chalky white areas on the cartilaginous surfaces

58
Q

What are microscopic findings of pseudogout?

A

1) crystals of pseudogout are stubby, short, and rhomboid (coffin-shaped)
2) weakly birefringent under polarized light
3) Only a few mononuclear cells and macrophages surround the foci of crystals

59
Q

What are the clinical features of Pseudogout?

A

1) self-limited attacks of acute arthritis lasting from 1 day to 4 weeks
2) involve 1 or 2 joints
3) inflammation and swelling of the knees, ankles, wrists, elbows, hips and shoulders (25% patients)
* *no big toe**

60
Q

In regards to metatarsal joints, how can gout and pseudogout be differentiated?

A

MT joints spared in pseudogout

61
Q

In regards to lytic lesions, how can gout and pseudogout be differentiated?

A

lytic lesions in gout

62
Q

What are the two main ways to differentiate gout and pseudogout?

A

1) location

2) crystal type

NMSK-A II (10 decks)

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