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Pathology: Musculoskeletal Disorders Flashcards

1
Q

Function of Skeletal Functions

A

Body framework
House bone marrow/blood forming organs
Calcium and phosphorus homeostasis

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2
Q

Bone Formation and Modeling

A

Osteoblasts - primary bone forming cells
Osteocalsts - giant cells from macrophages, remodel bone
Nutritional and Hormonal factors - vitamin D, PTH, cytokines, growth hormone

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3
Q

Congenital Bone Diseases

A

Achondroplasia

Osteogenesis Imperfecta

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4
Q

Metabolic/Nutritional Diseases

A

Osteoporosis
Rickets/Osteomalacia
Hyperparathyroidism
Renal Osteodystrophy

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5
Q

Infectious/Inflammatory

A

Osteomyelitis

Paget’s Disease

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6
Q

Tumor

A

Bone Tumor

Cartilage Tumor

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7
Q

Acondroplasia

A
  • Impaired cartilage muaturation
  • Autosomal dominant, 80% of new mutations
  • Disorganized chondrocytes
  • Clinical: dwarfism, shortening of proximal extremities, bowing legs, lordotic posture
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8
Q

Osteogenesis Imperfecta “Brittle Bone Disease”

A
  • Defective synthesis of type 1 collagen
  • Autosomal dominant or recessive
  • Clinical features: born fragility, multiple fractures, blue sclerae, abnormal dentition, deafness
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9
Q

Osteoporosis

A
  • Decrease in bone mass
  • Thinning, wide spacing of trabeculae of medullary bone
  • X ray changes late in disease
  • Fractures 20x common in women
  • Increase susceptibility to fractures - vertebral compression, hip and pelvic fractures
  • Risk factors: lack of estrogen, decreased peak bone mass, diet, physical activity, vitamin D receptor
  • Prevention: estrogen supplementation, bisphosphonates, physical activity, Ca in diet
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10
Q

Rickets/Osteomalacia

A

Defect in bone mineralization due to vitamin D deficiency (Rickets - kids, Osteomalacia - adults)

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11
Q

Hyperparathyroid Bone Disease

A

PTH - regulates calcium and phosphorus metabolism
Primary - tumors or hyperplasia
Secondary - chronic renal disease
Principal effect - increase in osteoclast - osteoporosis, fibrosis, fractures with hemorrhage and fibrosis - brown tumor

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12
Q

Renal Osteodystrophy

A

Skeletal manifestation of chronic renal disease
Hyperparathyroid effects - increase osteoclast activity, osteoporosis
Osteomalacia like effects - defect in bone mineralization

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13
Q

Osteomyelitis

A

Infection of Bone
Pyogenic: staph aureus, Klebsiella, Pseudomonas, E Coli, Hemophilus, Strep, Salmonella
Pathogenesis: hematogenous spread, direct spread or traumatic implantation
Clinical: pain, fever, malaise, leukocytosis
Treatment: aggressive, prolonged antibiotic treatment

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14
Q

Tuberculous Osteomyelitis

A

Mycobacterium Tuberculosis
Hematogenous spread
Destructive and difficult to treat
Locations: long bones, knees, hips, Pott’s disease

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15
Q

Paget’s Disease “Osteitis Deformans”

A 
Unknown etiology
Pathogenesis:
-Osteolytic: increased osteoclast
-Mixed: osteoclastic/osteoblastic stage
-Sclerotic: mosaic pattern
Sites: pelvis, hips, vertebrae, skull
Symptoms: headache, visual and hearing loss, back pain, bowing legs
-Complications: fractures, osteoarthritis, malignant transformation
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16
Q

Avascular Necrosis

A

Bone infarct - fracture, steroid therapy, radiation damage, idiopathic
Most common site - head of femur
Complications - osteoarthritis, fractures

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17
Q

Benign - Bone Tumor - Osteoma

A

Bump in head an neck
Removed for cosmetic or mechanical reasons
Do not undergo malignant transformation

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18
Q

Benign - Bone Tumor - Osteoid Osteoma

A

Osteoid Osteoma - long bones, painful, distinct x-ray, reactive/sclerotic bone tumor
Osteoblastoma - vertebra, dull pain
Surgical excision
Malignancy rare

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19
Q

Malignant - Bone Tumor - Osteosarcoma

A

Produces osteoid
Large bulky tumor - destroys bone
Metastasis common - lungs
Clinical types:
conventional osteosarcoma (70%)
–knee, proximal arm - metaphysis
–enlarging painful mass, pathlogic fracture
secondary (20%)
–arises in diseased bone - radiation, Paget’s
–worse prognosis, harder to resect, pain delays diagnosis, resistant to chemo

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20
Q

Benign - Cartilage Tumor - Encondroma

A
  • Mature cartilage
  • Medullary cavity of long bone, hands or feet
  • Solitary
  • Multiple: Ollier’s, Maffucci
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21
Q

Benign - Cartilage Tumor - Osteochondroma (Exostosis)

A
  • Bony tumor with cartilaginous cap - sessile or pedunculated
  • Arise near growth plate
  • Solitary
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22
Q

Malignant - Cartilage Tumor - Chondrosarcoma

A
  • Older adults
  • Common sites: proximal extremities, pelvis, ribs
  • Prognosis: based on grade, respectability
  • Aggressive, destroy bone, metastasize to lungs
23
Q

Benign - Other - Giant Cell Tumor

A

Epiphyses of long bones
Pain, simulates arthritis
Can reoccur if not completely resected

24
Q

Benign - Other - Fibrous Dysplasia

A
  • Replacement of bone by combination of fibrous tissue and malformed bone
  • Monostotic (70%) - adolescence, ribs, long bones of legs, skull, jaws
  • Polyostotic (20%) - children, craniofacial involvement, fractures, deformitites
25
Malignant - Other - Ewing's Sarcoma (Primitive Neuroectodermal Tumor)
- Children - Diaphysis of long bones and pelvis - Small round blue cell tumor - Chromosomal translocation - Surgery and chemo
26
Metastatic Tumors to Bone
``` Breast Lung Thyroid Kidney Prostate ```
27
Osteoarthritis (Degenerative Joint Disease)
- Degeneration of Articular Cartilage - Risk factors: age, mechanical stress - Splitting and fissuring - Erosion - sclerosis and polishing (eburnation), joint mice; Fissuring - bone cysts; Reactive synovial inflammation - Gradual onset - Common Joints - knees, hips, vertebrae, fingers - Symptoms: dull pain, morning stiffness, decreased ROM
28
Rheumatoid Arthritis
- Autoimmune - Chronic, proliferative synovitis (lymphocytes and plasma cells) - Pannus formation leading to ankylosis - Morning stiffness - Hands and feet most common
29
Gout
- Systemic disease - precipitation of uric acid - End product of purine metabolism - Primary accumulation - enzyme deficiency - Secondary accumulation - increased cell turnover, decreased excretion - Uric acid crystals in synovial fluid - birefringent - Gouty tophus - chalky white accumulations - Gouty nephropathy - precipitation in renal tubules - Acute: sudden, painful, swelling and redness, usually big toe - urate crystals in synovial fluid - Chronic: result of multiple attacks
30
Infectious Arthritis - Acute Suppurative Arthritis
Pyogenic bacterial infection Fever, malaise, local pain, pus in joint Gonococci, staph, strep Antibiotic treatment
31
Lyme Disease
Chronic infectious disease involving skin and joint Arthropod-borne disease - vector: deer tick Acute Stage: redness, induration at site of tick bite Secondary Stage: skin lesions distant, cardiac symptoms, meningitis Late Stage: arthritis, knees, shoulders, elbows
32
Ganglion Cyst
Small cyst near joint or tendon sheath Caused - degeneration of fibrous tissue Wrist most common
33
Villonodular Synovitis
Most common neoplasm of joint space Benign proliferation - villous projections into synovium One joint affected - knee Clinical: pain, stiffness, locking
34
Skeletal Muscle Physiology
Type 1 - slow twitch | Type 2 - fast twitch
35
Neurogenic Atrophy
- denervation of muscle fiber - nerve disease or trauma - affects both types of fibers - grouping after renervation
36
Type 2 Myofiber Atrophy
- caused by immobilization or steroids | - type 2 only
37
Myasthenia Gravis
- autoimmune - against acetylcholine receptor - neuromuscular junction - associated with thymoma - muscle weakness (eyelids, double vision, can lead to respiratory failure) and fatigue - thymectomy, anticholinesterase drugs
38
Muscular Dystrophy
Heterogenous - inherited diroders Begin in childhood - progressive wasting and weakness Duchenne, Becker
39
Duchenne Muscular Dystrophy
X linked inheritance Progressive weakness, pelvis and shoulder Death from respiratory failure Absence of dystrophin
40
Becker Muscular Dystrophy
Less common, less severe | Abnormal dystrophin
41
Biologic Behavior of Soft Tissue Tumors
Benign - slow growing, limited, excision Borderline - locally aggressive, infiltrating, wide excision, rare metastasis Malignant - rapid growing, often metastasize, lungs most common
42
Benign - Adipose - Lipoma
Most common soft tissue tumor Subcutaneous tissue Histologically same as fat
43
Borderline - Adipose - Well Differentiated Liposarcoma
Viscera - deep extremity soft tissue | Myxoid slow growing and local
44
Malignant - Adipose - Round Cell or Pleomorphic Liposarcoma
Viscera - deep extremity soft tissue | Capable of metastasis
45
Benign - Fibrous - Nodular Fasciitis
- Reactive proliferation accompanied by inflammation - Local excision - Associated with trauma
46
Borderline - Fibrous - Fibromatosis
Superficial - Palamar Dupuytrens Contracture, Plantar, Penile (Peyronie's Disease) Deep (Desmoid) - abdominal wall or viscera, locally aggressive, may secure, wide excision
47
Malignant - Fibrous - Fibrosarcoma
Metastasis Viscera or deep extremity of soft tissue Herringbone pattern
48
Benign - Fibrohistiocytic - Dermatofibroma
Second most common Small, sometimes pigmented nodule Simple excision
49
Borderline - Fibrohistiocytic - Dermatofibrosarcoma Protuberans
Low malignancy, rare metastasis Recur locally Variable size, growing nodule, skin and subcutaneous tissue Storiform pattern
50
Malignant - Fibrohistiocytic - Unifferentiated Pleomorphic Sarcoma
Most common soft tissue sarcoma Middle age to elderly Visceral and deep extremity tissues Metastasize 50%
51
Malignant - Skeletal - Rhabdomyosarcoma
Most common in children and adolescents Head, neck, vagina, retroperitoneum Embryonal, alveolar, pleomorphic types "Sarcoma Botryoides" - grape like mass on vagina of infants
52
Benign - Smooth Muscle - Leiomyoma
Uterus, Skin, GI
53
Malignant - Smooth Muscle - Leiomyosarcoma
``` Extremity and Visceral Soft Tissue Skin GI Tract Uterus (uncommon) Mitotic Activity ```
54
Malignant - Synovial Sarcoma
10% of soft tissue sarcoma Origin uncertain Soft-tissue around joints of extremities Biphasic pattern

Pathology (4 decks)

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