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Pathology > Pathology: Musculoskeletal Disorders > Flashcards

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
Q

Malignant - Other - Ewing’s Sarcoma (Primitive Neuroectodermal Tumor)

A
  • Children
  • Diaphysis of long bones and pelvis
  • Small round blue cell tumor
  • Chromosomal translocation
  • Surgery and chemo
26
Q

Metastatic Tumors to Bone

A 
Breast
Lung
Thyroid
Kidney
Prostate
27
Q

Osteoarthritis (Degenerative Joint Disease)

A
  • 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
Q

Rheumatoid Arthritis

A
  • Autoimmune
  • Chronic, proliferative synovitis (lymphocytes and plasma cells)
  • Pannus formation leading to ankylosis
  • Morning stiffness
  • Hands and feet most common
29
Q

Gout

A
  • 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
Q

Infectious Arthritis - Acute Suppurative Arthritis

A

Pyogenic bacterial infection
Fever, malaise, local pain, pus in joint
Gonococci, staph, strep
Antibiotic treatment

31
Q

Lyme Disease

A

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
Q

Ganglion Cyst

A

Small cyst near joint or tendon sheath
Caused - degeneration of fibrous tissue
Wrist most common

33
Q

Villonodular Synovitis

A

Most common neoplasm of joint space
Benign proliferation - villous projections into synovium
One joint affected - knee
Clinical: pain, stiffness, locking

34
Q

Skeletal Muscle Physiology

A

Type 1 - slow twitch

Type 2 - fast twitch

35
Q

Neurogenic Atrophy

A
  • denervation of muscle fiber - nerve disease or trauma
  • affects both types of fibers
  • grouping after renervation
36
Q

Type 2 Myofiber Atrophy

A
  • caused by immobilization or steroids

- type 2 only

37
Q

Myasthenia Gravis

A
  • 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
Q

Muscular Dystrophy

A

Heterogenous - inherited diroders
Begin in childhood - progressive wasting and weakness
Duchenne, Becker

39
Q

Duchenne Muscular Dystrophy

A

X linked inheritance
Progressive weakness, pelvis and shoulder
Death from respiratory failure
Absence of dystrophin

40
Q

Becker Muscular Dystrophy

A

Less common, less severe

Abnormal dystrophin

41
Q

Biologic Behavior of Soft Tissue Tumors

A

Benign - slow growing, limited, excision
Borderline - locally aggressive, infiltrating, wide excision, rare metastasis
Malignant - rapid growing, often metastasize, lungs most common

42
Q

Benign - Adipose - Lipoma

A

Most common soft tissue tumor
Subcutaneous tissue
Histologically same as fat

43
Q

Borderline - Adipose - Well Differentiated Liposarcoma

A

Viscera - deep extremity soft tissue

Myxoid slow growing and local

44
Q

Malignant - Adipose - Round Cell or Pleomorphic Liposarcoma

A

Viscera - deep extremity soft tissue

Capable of metastasis

45
Q

Benign - Fibrous - Nodular Fasciitis

A
  • Reactive proliferation accompanied by inflammation
  • Local excision
  • Associated with trauma
46
Q

Borderline - Fibrous - Fibromatosis

A

Superficial - Palamar Dupuytrens Contracture, Plantar, Penile (Peyronie’s Disease)
Deep (Desmoid) - abdominal wall or viscera, locally aggressive, may secure, wide excision

47
Q

Malignant - Fibrous - Fibrosarcoma

A

Metastasis
Viscera or deep extremity of soft tissue
Herringbone pattern

48
Q

Benign - Fibrohistiocytic - Dermatofibroma

A

Second most common
Small, sometimes pigmented nodule
Simple excision

49
Q

Borderline - Fibrohistiocytic - Dermatofibrosarcoma Protuberans

A

Low malignancy, rare metastasis
Recur locally
Variable size, growing nodule, skin and subcutaneous tissue
Storiform pattern

50
Q

Malignant - Fibrohistiocytic - Unifferentiated Pleomorphic Sarcoma

A

Most common soft tissue sarcoma
Middle age to elderly
Visceral and deep extremity tissues
Metastasize 50%

51
Q

Malignant - Skeletal - Rhabdomyosarcoma

A

Most common in children and adolescents
Head, neck, vagina, retroperitoneum
Embryonal, alveolar, pleomorphic types
“Sarcoma Botryoides” - grape like mass on vagina of infants

52
Q

Benign - Smooth Muscle - Leiomyoma

A

Uterus, Skin, GI

53
Q

Malignant - Smooth Muscle - Leiomyosarcoma

A 
Extremity and Visceral Soft Tissue
Skin
GI Tract
Uterus (uncommon)
Mitotic Activity
54
Q

Malignant - Synovial Sarcoma

A

10% of soft tissue sarcoma
Origin uncertain
Soft-tissue around joints of extremities
Biphasic pattern

Pathology (4 decks)

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