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Musculoskeletal and Connective Tissue > Pathology > Flashcards

Pathology Flashcards

0
Q

Which bone is most commonly dislocated carpal bone? What effect does this have?

A

Lunate bone

Often dislocates anteriorly–> into carpal tunnel–> compresses Median Nerve

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1
Q

How to treat Rheumatoid Arthritis?

A

Acute: Celecoxib
Chronic: Methotrexate, Sulfasalazine

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2
Q

Mnemonic to memorize carpal bones?

A 
So Long To Pinky Here Comes The Thumb
Proximal row (Thumb to Pinky)--> Distal row (Pinky to Thumb)
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3
Q

What is the most commonly injured nerve of the lower limb?

A

Common Fibular

Vulnerable to compression injury, where it wraps around head of fibula

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4
Q

Which nerve courses around Hamate bone?

A

Hamate bone sits directly proximal to 4th and 5th digits
Has a hook that is vulnerable to trauma
Median Nerve wraps arounds around it.

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5
Q

Dislocation of Elbow

A

Posterior displacement of ulna and damage to cubital tunnel most likely–> Ulnar N. injury
Damage to Ulnar N at level of elbow–> WEAK wrist flexion, abduction and adduction of digits hypothenar muscles, flexion of 4th and 5th interphalangeal joints. Some sensory loss on digit 5 and 4.

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6
Q

What can a Humerus fracture lead to?

A

Lacerate Radial N.
Loss of fcn of muscles in wrist and digits
Sensory loss of posterior forearm and hand
Difficulty stabilizing wrist and making a fist

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7
Q

Describe the innervation of the thumb

A

Thumb receives innervation from radial, ulnar, and median nerves
Thumb Extensors: Radial N.
Thenar Muscles: Median N.
Adduction (Adductor pollicis): Ulnar N.

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8
Q

Quadrangular Space (Borders and what runs through it)

A

Formed by Teres minor, Teres major, Long head of biceps, and surgical neck of humerus
Axillary N. and Posterior Humeral Circumflex Artery run in Quandrangular Space.

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9
Q

Shoulder dislocations

A

Typically displace the head of the humerus Anteriorly and Inferiorly
Can injure Axillary N.
Impaired shoulder abduction and loss of sensation over the lateral upper arm

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10
Q

What is the source of osteoblasts following a fracture? What can go wrong?

A

Periosteum located near fracture site

Displace osteoblasts can produce hypertrophic ossification that may impair joint mobility

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11
Q

What can crutches that are too long cause?

A

May injure/compress posterior cord of Brachial Plexus (RADIAL N. especailly)
“Wrist drop”
Triceps and wrist extensors paralyzed
Tingling sensation and anesthesia of dorsal surface of arm, forearm, and hand

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12
Q

Which metastases account for most of bone cancers?

A

Prostate carcinoma
Breast carcinoma
Lung carcinoma

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13
Q

What can bone metastases lead to ?

A

Osteolysis OR osteogenesis

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14
Q

How to screen for bone cancer?

A 
Plain film (X-ray)
Serum Ca2+
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15
Q

Labs for Osteolytic lesions vs. Osteoblastic lesions

A

Osteolytic: Plain films. Hypercalcemia
Osteoblastic: Radionucleotide bone scans show increased uptake. Increased Alkaline Phosphatase. Can lead to Hypocalcemia.

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16
Q

What kind of metastases lead to osteolytic vs. osteoblastic lesions?

A

Osteolytic: Renal cancer
Osteoblastic: Breast and Prostate

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17
Q

Therapy for bone metastases

A

Bisphosphonates

Pain medications

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18
Q

Which bones are common sites for metastases? (In order)

A

Vertebrae
Proximal femur
Pelvis

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19
Q

T-Score Classifications (Bone mass)

A

<1 Osteopenia

Used to determine fracture risk

20
Q

Key Hormones in Bone remodeling

A 
Estrogens
Vit. D
PTH
Thyroid Hormone
Locally produced Growth Factors (Insulin-like Growth Factors, ILs, TGF-b, PTHrP)
21
Q

When should Bone Mineral Density be determined?

A

Postemenopausal women w/ risk factors OR
All women >65yo
Use DEXA scan (Dual-Energy X-ray Absorptiometry)

22
Q

Symptoms of Osteoporosis

A

Older pts
Sudden-onset of back pain
Vertebral compression, Loss of height, kyphosis, hip fractures, weakness, Colles fracture

23
Q

Tx for Osteoporosis

A

Bisphosphonates (Alendronate, Ibandronate, Risedronate, Zoledronic acid) Chemical analogs of pyrophosphate–> Reduce fracture risk by 40-50%
Calcitonin and Recombinant Human PTH-analog Teriparatide–> Reduce fracture risk by 65% and Non-vertebral by 45%. BUT, risk of
osteosarcoma.
Estrogen replacement (theoretically). BUT, Cardiovascular Risks.
Selective ER modulators (Tamoxifen, Raloxifene)

24
Q

Osteitis Fibrosa Cystica

A

Primary Hyperparathyroidism
Presentation: Bone pain/tenderness, bowing of bones
“Brown tumors”: Cystic spaces w/in bone, disorganized osteoid stroma, old blood
Labs: Increase Ca2+, decrease Phos., Vit. D activation.

25
Q

Fibrous Dysplasia

A

Male=Female
Range of severity (Mono-ostotic vs. Poly-ostotic)
Sporadic genetic disease- Gs-alpha-G-protein subunit
Expanding lesions of mesenchymal cells arise in medullary bone
Skeletal abnormalities
McCune-Albright Syndrom (Triad). Women 10:1

26
Q

Fibrous Dysplasia (Degrees of severity)

A

Less severe: Normally, mono-ostotic. Around 30yo. M=F

More severe: Poly-ostotic. Less than 10yo. F>M. Face, ribs, proximal femur, tibia.

27
Q

McCune-Albright Syndrome

A

Fibrous Dysplasia
Cafe-au-lait spots
Precocious puberty (Endocrine excess- Thyroid hormone, ovarian hormone) Pregnancy/ hormone therapy exacerbates.
F>M

28
Q

Goodpasture Syndrome

A 
Pulmonary hemorrhage
Glomerulonephritis
Type II Hypersensitivity
anti-Glomerular Basement Membrane (anti-GBM)--> Type IV collagen
HLA-DR2
M>F
29
Q

Goodpasture Syndrome (Tx)

A

Corticosteroids
Cyclophosphamide
Plasmapharesis (to remove anti-GBM)
Dialysis (possibly)

30
Q

Goodpasture Syndrome (prognosis)

A

Medical emergency

Most pts will have ESRD, 30% requiring dialysis

31
Q

Giant-Cell Arteritis

A

Large vessel vasculitis
Granulomatous inflammation of Internal Elastic Lamina
Temporal Artery most commonly affected
Temporal HA/tenderness, Jaw claudication, visual changes
50% pts have Polymyalgia Rheumatica
Older pts (>50yrs)

32
Q

Polymyalgia Rheumatica

A

Neck and proximal upper and lower extremity myalgias
Abrupt onset
Morning stiffness (can last Hrs!)
Symmetrical involvement
Tx: Quick and complete response to low-dose Corticosteroid

33
Q

Giant-Cell Arteritis (diagnosis, Tx, complications)

A

Diagnosis: ESR>50, Temporal artery biopsy (segmental involvement)
Tx: High-dose Prednisone, slowly taper dose. Prophylaxis for steroid-induced osteoporosis.
Complications: blindness

34
Q

Polyarteritis Nodosa

A

Inflammation of small and medium vessels
Skin, peripheral, nerves, kidneys, joints, GI, testicles
Histology: transmural necrotizing inflammation of vessel wall–> ischemia
40-60yrs, Males

35
Q

Polyarteritis Nodosa (diagnosis, tx, prognosis)

A

Diagnosis: Biopsy is diagnostic. High ESR, decreased Complement, HBVsAg. ANCA is ABSENT!!!
Tx: High-dose corticosteroids, cyclophosphamide
Prognosis: Depends on CNS involvement. Corticosteroids drastically improve prognosis.

36
Q

Buerger Disease

A

“Thromboangiitis Obliterans”
Small and medium vessels
Distal extremity ischemia, claudication, pain at rest. Ulcers/gangrene of digits. Raynaud’s.
Segmental inflammation, absence of atheromas
Heavy tobacco smoking
20-45yrs, Males

37
Q

Buerger Disease (diagnosis, tx, prognosis)

A

Diagnosis: No specific lab. Diagnosis of exclusion
Tx: Complete discontinuation of smoking. Ca2+channel blockers for Raynad’s
Prognosis: Quitting smoking has best prognosis

38
Q

Takayasu Arteritis

A

“Pulseless disease”
Granulomatous inflamm. of large vessels
Long-segment stenoses or arterial occlusions
Aortic aneurysm, stenosis, thrombosis
Unequal pulses, unequal BPs ( >30mmHg), bruits

39
Q

Takayasu Arteritis (Tx, prognosis)

A

Tx: High-dose systemic steroid therapy, Methotrexate
Prognosis: Chronic, relapsing-remitting

40
Q

Wegner Granulomatosis (GPA)

A

Small vessel necrotizing vasculitis
Upper and lower resp., Glomerulonephritis
Presentation: Alveolar hemorrhage, pneumonitis, sinusitis, epistaxis, mucosal ulcerations, oral ulcers

41
Q

Wegner Granulomatosis (diagnosis, tx)

A

Diagnosis: c-ANCA, anti-Proteinase 3
Tx: High-dose systemic steroids, immunosuppressives, TMP-SMX for infection prevention, IV Igs, Plasmapharesis

42
Q

Churg-Struass Vasculitis

A

Small and Medium vasculitis
Asthma-like symptoms, Palpable purpura, subcutaneous nodules, new-onset allergies, Allergic rhinitis
Eosinophilia!

43
Q

Churg-Strauss Vasculitis (diagnosis, Tx, prognosis)

A

Diagnosis: p-ANCA, eosinophilia
Tx: High-dose steroids, immunosuppressives
Prognosis: Poor (even w/ steroids)

44
Q

Kawasaki Disease

A

Febrile vasculitis of Childhood

9-12months, , swollen/fissured lips

45
Q

Kawasaki Disease (Tx, Prognosis)

A

Tx: IV Igs, High-dose Aspirin (anti-inflammatory), anti-coagulation
Prognosis: Acute- self-limiting. Cardiac complications.

46
Q

Henoch-Schonlein Purpura

A

Small vessel vasculitis
MOST common child vasculitis
Younger children, Hx of upper resp. infection
Palpable purpura, colicky abdominal pain, arthritis, hematuria
Multi-system involvement!
IgA, C3, immune complex deposition

47
Q

Henoch-Schonlein Purpura (diagnosis, Tx)

A

Diagnosis: Labs WNL. Abnormal renal/urinalysis if renal involvement
Tx: Symptomatic. NSAIDs. Sometimes corticosteroids.

48
Q

Microscopic Polyangiitis

A

+ p-ANCA
Alveolar hemorrhage, Glomerulonephritis
NO upper resp. involvement
NO granulomas!

Musculoskeletal and Connective Tissue (4 decks)

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