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Pathology Flashcards

1
Q

What auto-antibodies are associated with RA and each of the connective tissue diseases?

A 
Rheumatoid arthritis – Anti-CCP 
Lupus – Anti-dsDNA
Sclerosis - Limited - Anti centromere
                - Diffuse - Anti-Scl-70 
Dermatomyositis – Anti Jo
Sjogrens – Anti Ro La
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2
Q

Describe the difference in pathology of rheumatoid arthritis

A

Acute phases:

  • Pannus formation – inflammatory granulation tissue
  • Hyperplastic / reactive synovium

Chronic phase:

  • Fibrosis
  • deformity
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3
Q

Give examples of three metabolic conditions which have MSK consequences

A

Pagets

Osteomalacia

Crystal arthropathies

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4
Q

What processes allow the formation of uric acid crystals?

A

Uric acid is the end-product of purine synthesis

Adenine (A) and guanine (G) are purine based

=> urate is formed in DNA replication

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5
Q

What are the two main reasons for which hyperuricaemia would occur?

A

Increased production
Or
Reduced excretion

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6
Q

For what reasons would the body produce more uric acid than normal?

A

Idiopathic - unknown enzyme defect (90%)

Known enzyme defect - HGPRT deficiency
(Lysch Nyhan syndrome)

Increased cell turnover

  • Psoriasis
  • Cancer
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7
Q

What can be responsible for under excretion of uric acid?

A

Drug side effect

=> thiazide diuretics reduce urate excretion

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8
Q

In what joints do the uric acid crystals usually deposit?

A

joints at lower temperatures than core body temperature

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9
Q

What secondary degenerative changes can gout cause?

A

Deposition in soft tissues – gouty tophus

Renal disease – stones and direct deposition in tubules and interstitium

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10
Q

What features would be seen on histology of a sample with gout?

A

Amorphous eosinophilic debris and inflammation
(giant cells)

Crystals LOST during tissue processing

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11
Q

In what individuals does pseudogout usually present?

A

Usually older individuals in their large joints

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12
Q

What can cause pseudogout?

A

Usually idiopathic

known causes:
hypercalcaemia (inc. hyperparathyroidism), haemachromatosis
hypomagnesaemia
ochronsis
hypothyroidism
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13
Q

What shape do pseudogout crystals appear on microscopy?

A

Rhomboid shaped crystals

Thicker and bigger than needle shaped urate crystals

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14
Q

What is Paget’s disease of bone?

A

Abnormality of bone turn-over
=> Increased osteoclastic activity
more bone but not normally structured

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15
Q

What can predispose to Paget’s disease?

A

Genetic factors

Viruses:

  • paramyxovirus
  • measles
  • Resp. Syncytial Virus
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16
Q

What are the three stages in Paget’s disease?

A

Osteolytic
mixed
burnt out

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17
Q

What is the end result in Paget’s disease?

A

thick excess bone

abnormal reversal lines – mosaic pattern

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18
Q

What bones does Paget’s disease affect?

A

Can affect ALL bones usually axial, small bones less commonly affected

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19
Q

What can cause pain in Paget’s disease?

A

microfracture or nerve compression

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20
Q

What secondary problems can Paget’s disease cause?

A

Increased metabolism
=> heat, warm skin,
AV shunt effectively high output heart failure

Secondary malignancy – osteosarcoma

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21
Q

What is osteomalacia?

A

Abnormal vitamin D metabolism
Sun exposure related

Causes:

  • Rickets in young pts
  • Bowed legs, square heads, pigeon chest, rickety rosary
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22
Q

Describe the simple pathogenesis of a fracture

A

Trauma
Bone breaks – pain from periosteum
Haemorrhage
Remember – rubor, calor, tumour and dolor

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23
Q

At what stage after a bone is fractured, does the callus reach its maximum girth

24
Q

What can cause a pathological fracture

A

Osteoporosis is very common
Tumours
Benign - usually children and primary
Malignant – adults and metastatic

25
What cancers commonly metastasize to bone?
``` Breast Bronchus Lung Prostate Thyroid Renal ```
26
What conditions can cause bony lesions?
myeloma/plasmacytoma Malignant proliferation of plasma cells. Causes bony lesions
27
What is avascular necrosis?
Bone infarction
28
What can cause avascular necrosis?
``` trauma (scaphoid) alcohol dysbarism Steroid injection sickle cell disease, infection ```
29
How do subchondral cysts form?
synovial fluid through bone forming small cysts
30
Why do osteophytes form in degenerative diseases such as osteoarthritis?
remodelling of bone to cope with stress Remodelling = disorganised and produces abnormal outgrowths - osteophytes
31
Give examples of benign tumours of bone
Ganglion Cyst Giant cell tumour Fibromatosis Fibrous dysplasia
32
Where does a ganglion cyst usually present?
peripheral lump near a joint capsule or tendon sheath **Common around the wrist**
33
Why is a ganglion cyst not a true cyst?
It has no epithelial lining
34
How do ganglion cysts appear histologically?
- space with myxoid material | - Secondary inflammatory changes
35
Give some examples of common superficial fibromatoses
Dupuytren’s Knuckle pads Plantar Penile – Peyronie’s
36
How do deep fibromatoses differ from superficial fibromatoses?
- Mesenteric or pelvic - Desmoid tumours - Association with Gardner’s Syndrome
37
Where can giant cell tumours present?
Pigmented villonodular synovitis – present in large joints Giant cell tumour of tendon sheath – present in small joints e.g. digits
38
Giant cell tumours in large joints are more easily excised than those in smaller joints. TRUE/FALSE?
FALSE small nodules are easily excised (with occasional recurrence) PVNS – more destructive and diffuse in a joint space. Difficult to excise and can often recur.
39
How do angiolipomas usually present?
multiple and peripheral painful subcutaneous lesion
40
A leiomyoma is a tumour of what?
Smooth muscle => Can arise from large vessel walls (e.g. muscular veins)
41
What rare benign tumour can occur from skeletal muscle?
Rhabdomyomas
42
What is the name given to a benign tumour of cartilage?
Enchondroma
43
Where do simple osteomas usually present?
In the cranial bones | => lumps often seen on forehead of patient
44
What name is given to the condition where a patient present with multiple osteomas?
Gardner’s syndrome
45
What age group are most commonly affected by Osteosarcoma?
paediatric age-group | **occurs in Long bones**
46
How is an osteosarcoma defined?
malignant tumour that produces osteoid is an osteosarcoma until proven otherwise
47
Who is most likely to be affected by Ewing's sarcoma?
children and adolscents
48
Where do Ewing's sarcomas commonly affect?
Any soft tissue or bony location | => often long bones in adolescents
49
Ewing's sarcomas are destructive, rapidly growing and highly malignant. TRUE/FALSE?
TRUE
50
What cells are thought to mutate and give rise to Ewing's sarcomas?
primitive mesenchymal or neuroectodermal cell
51
How do Ewing's sarcomas appear in clinic?
Small round blue cell tumours
52
What type of cancer do you always want to exclude?
Carcinoma group: - Sarcomatoid carcinoma - carcinosarcoma - metaplastic carcinoma
53
What is a Pseudosarcoma?
Tissues undergoing repair often appear very atypical and the diagnosis can be very difficult
54
What reactive lesion appears histologically as a chaotic appearance with haemorrhage, pseudocystic spaces and large atypical cells?
Nodular Fasciitis
55
What is Myositis ossificans?
A reactive lesion which affects large muscles: - quadriceps - gluteus - brachialis (occasionally)
56
Chondrosarcomas affect what parts of the body?
``` Axial skeleton (pelvis) Head and Neck ``` **NOT common in peripheries**
57
Where do rheumatoid nodules usually present, and what are they?
Elbow Necrobiotic granulomatous inflammation

Musculoskeletal (27 decks)

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