Pathology Flashcards
Which joints does osteoarthritis commonly affect?
Weight-bearing joints
Name some of the systemic features that can occur with rheumatoid arthritis
Subcutaneous nodules
Anaemia
Splenomegaly
Amyloidosis
Define osteoporosis
Reduction in total bone mass causing weakening of the bones
Osteoporosis can be a complication of…
Cushing’s syndrome
Steroid therapy
What is the pathology behind osteomalacia and rickets?
Inadequate mineralisation of the organic bone matrix due to a deficiency in the active metabolites of vitamin D
What can cause vitamin D deficiency?
Lack of dietary vitamin D
Lack of sunlight
Intestinal malabsorption
Renal and liver disease
Define Paget’s disease of bone
Common disease of unknown aetiology causes a localised increase in bone turnover
Which bones are most commonly affected in Paget’s?
Pelvis and spine
What will be elevated in plasma of a patient with Paget’s Disease of Bone?
Alkaline Phosphatase
What are the most prominent symptoms of osteoarthritis?
Pain and limitation of movement
What is Herpes Zoster?
Shingles
Viral infection
Almost always affects the skin of a single dermatome
Dormant version of chicken pox that gets reactivated when the host is immunosuppressed
Describe sciatica
Pain going down the leg from the lower back
Typically symptoms only on one side of the body
Weakness or numbness may occur
Typical cause = spinal disc herniation
In most people it goes away by itself
Describe spina bifida
Failure of apoptosis
There isn’t continuity of the epithelium, neural tube and mesoderm
Spinal cord may be exposed
Can cause deformity and hypoplasia of the legs
Describe hip dysplasia
Abnormal growth of the hip
Relatively common
Can be dislocated at birth or sometime later
Problem can be: acetabulum, head of femur or capsule
Describe a slipped upper femoral epiphysis
Fracture through the growth plate
Rest of femur rides up and forward in relation to epiphysis
Ages 10-16 years most affected
How would the limb appear after a posterior dislocation of the hip?
Limb looks shortened and medially rotated
What muscles cause the medial rotation of the femur after a posterior dislocation?
Gluteus medius
Gluteus minimus
Which type of muscles cause the shortened limb appearance after a posterior dislocation of the hip?
Extensors
Adductors
Are trochanteric fractures intra or extra capsular?
Extra capsular
How does the limb appear after a hip fracture?
Shortened limb
Externally rotated
Abducted
Which muscles cause external rotation after a hip fracture?
Iliopsoas
Which muscles cause abduction after a hip fracture?
Gluteus medius
Gluteus minimus
Name the stages of rheumatoid arthritis
Synovitis
Pannus
Fibrous ankylosis
Bony ankylosis
What is piriformis syndrome?
Hypertrophy and spasms of piriformis
Pain down the back of the leg
Can present with similar pain as slipped disc (sciatic nerve)
Usually presents in young athletes
Name 2 types of fracture of the distal radius
Colles’ fracture
Smith’s fracture
Describe Colles’ fracture
Fracture of distal radius
Tends to be older people
Posterior displacement of distal fragments of radius
Falling on an outstretched hand
Describe Smith’s fracture
Fracture of the distal radius
Anterior displacement of the distal fragments
Falling on a flexed wrist/direct trauma to forearm
How can we fracture the scaphoid?
Falling on an outstretched hand
What is another name for popliteal cysts?
Bakers cysts
What is a popliteal cyst a sign of?
Chronic knee effusion
What does Popeye sign indicate?
Rupture of the long head of the biceps tendon
What is Froment’s sign?
Test for ulnar nerve palsy
Tests the action of adductor pollicis
Place a piece of paper between thumb and index finger and try to pull it out whilst seeing if the patient can prevent you without flexing their thumb
After a fracture, what happens to the different parts of the clavicle?
Lateral end = displaced inferiorly by weight of arm and medially by pectoralis major
Medial end = pulled superiorly by muscles
Unopposed medial arm rotation can produce which deformity?
Waiter’s tip
What is the standard treatment for muscle injuries?
RICE
Rest, ice, compression and elevation
When would we want to check the blood supply to the legs and feet?
If they have peripheral vascular disease
If they have just had an operation
What are varicose veins?
Very obviously dilated veins
If we remove them, we need to be aware of the nerve supply around them
Over what age do we consider it old age?
Over 65 years
Define some of the consequences of ageing
Loss of muscle strength and endurance
Loss of bone strength
Increased fall and fracture risk
Reduction in ability to go about daily life
Bone mineral loss is accelerated by ….
Low reproduction hormones
Poor calcium/vitamin D
Inactivity
Endocrine or GI pathologies
What is a T score?
The bone density of a patient
0 = normal
More negative = lower bone mass
Describe Type 1 osteoporosis
Post-menopausal women
Loss of oestrogen accelerates bone loss
Describe Type 2 osteoporosis
Senile
Age related
Usually to do with hyperparathyroidism or calcium deficiency
What are bisphosphonates?
Anti-resorptive agents for bone
Affects osteoclasts - inhibits
Describe osteoarthritis
Disorder of synovial joints characterised by areas of damage to articular cartilage
Formation of osteophytes
Pain, stiffness, deformity, joint swelling (Distal IP)
Decreased joint space
Define dislocation
Complete loss of continuity of the articulating surfaces of a joint
What is meralgia parasthetica?
Nerve compression syndrome
Common in pregnancy and in obese people
No muscle weakness associated - sensory nerves only
Rare in children
Which system do we use to classify nerve injuries?
Seddon classification
Describe a class I peripheral nerve injury
Neurapraxia
Temporary block to conduction
Everything is intact - no degeneration
Complete recovery made
Describe a class II peripheral nerve injury
Axonotmesis Compression/moderate traction Loss of continuity of myelin sheath Some Wallerian degeneration Partial/full recovery
Describe a class III peripheral nerve injury
Neurotmesis Partial or complete division of the structure Disruption of axon and sheath Wallerian degeneration No recovery without surgery
