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Pathophys II - Exam 2 > Schoenwald - MSK > Flashcards

Schoenwald - MSK Flashcards

1
Q

metabolic bone diseases (2)

A

osteoporosis

rickets

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2
Q

infectious bone disease

A

osteomyelitis

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3
Q

non infectious arthritis

A

osteoarthritis

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4
Q

osteoporosis is caused by

A

increased bone resorption

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5
Q

rickets is a disease of

A

calcium metabolism

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6
Q

what do you think when you see, excessive osteoblastic bone formation with abnormal structure and instability

A

paget dz

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7
Q

reduced mass of mineralized bone dt imbalance of bone metabolism resulting in increased bone resorption

A

osteoporosis

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8
Q

osteoclasts are involved in

A

bone resorption

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9
Q

osteoblasts are involved in

A

bone formation

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10
Q

what does microscopic pathology show for osteoporosis

A

symmetric thinning of trabecular and cortical bone

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11
Q

bisphosphonates stabilize

A

trabecular bone

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12
Q

primary osteoarthritis is caused by

A

age, degenerative

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13
Q

type 1 primary osteoporosis is called

A

postmenopausal → estrogen loss

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14
Q

type 1 primary osteoporosis is characterized by increased

A

osteoclastic activity

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15
Q

type 2 osteoporosis is called

A

senile

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16
Q

type 2 primary osteoporosis (senile) is characterized by

A

decreased osteoblastic activity

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17
Q

mc bones fx’ed in osteoporosis (3)

A

hip

compression of vertebrae

distal radius (FOOSH)

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18
Q

rf for osteoporosis (7)

A

aging

(+) fam hx

smoking etohism

decreased estrogen

low BMI

low Ca diet

lack of weight bearing exercise

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19
Q

secondary osteoporosis is caused by (6)

A

endocrine-increased parathyroid hormone

DM

Addison’s

GI-manutrition

blood cancers

drugs

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20
Q

what drugs are related to osteoporosis (3)

A

long term prednisone

heparin

some chemo agents

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21
Q

common presentation of osteoporosis

A

vertebral compression fx

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22
Q

osteoporosis causes __ of the spine

A

kyphosis

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23
Q

text book osteoporosis pt

A

white

female

long hx smoking

postmenopausal

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24
Q

2 parameters of DEXA scan

A

T score

Z score

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25
Q

T score compares bone mass to

A

healthy 30 yo

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26
Q

bone density peaks at what age

A

30

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27
Q

nl for T score

A

+1 to -1 standard deviation from 30 yo

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28
Q

Z score compares bone density to

A

what’s normally expected for same age, sex, wt, ethnic/racial origin

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29
Q

abnormal Z score

A

-2 or lower

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30
Q

T score interpretation

A
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31
Q

in rickets and osteomalacia, __ is decreased

while __ stays normal

A

mineralization of osteoid is decreased

bone mass stays normal

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32
Q

rickets and osteomalacia are characterized by

A

bowing of legs

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33
Q

what 2 minerals are deficient in rickets/osteomalacia

A

vit d

phosphate

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34
Q

rickets affects what pt population

A

growing bones of kids

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35
Q

in rickets, inadequate mineralization of osteoid matrix leads to

A

overgrowth and distortion of epiphyseal cartilage

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36
Q

ostomalacia affects __

in adults

A

newly formed bone matrix

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37
Q

mc cause of hematogenous spread of osteomyelitis

A

s.aureus

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38
Q

hematogenous spread of osteomyelitis is mc in

A

kids

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39
Q

in kids, osteomyelitis affects __ and spreads from there

A

epiphyseal plate

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40
Q

what is an example of contiguous spread of osteomyelitis

A

diabetic foot wound

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41
Q

contiguous spread of osteomyelitis is mc in

A

adults

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42
Q

__ is common in contiguous spread of osteomyelitis,

but it can also be __

A

s.aureus

polymicrobial

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43
Q

T/F osteomyelitis be chronic or acute

A

T!

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44
Q

clinical findings of osteomyelitis

A

pain

warmth of area affected

+/- fever → often absent

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45
Q

lab findings for osteomyelitis (3)

A

elevated:

ESR

CRP

platelets

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46
Q

radiographic findings of osteomyelitis (2)

A

destruction of bone

periosteal edema

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47
Q

what type of culture is not reliable in osteomyelitis

A

superficial → ex sinus tracks

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48
Q

dx of osteomyelitis (2)

A

blood cultures

bone bx

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49
Q

tx for osteomyelitis

A

long term IV abx targeted to organism → at least 6 weeks

+/- surgical debridement

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50
Q

in osteomyelitis, infxn lifts __,

which impairs blood flow and results in __ of the bone

A

periosteum

ischemia

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51
Q

what is sequestrum

A

dead bone fragment

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52
Q

what is involucrum

A

new bone growth around sequestrum

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53
Q

what is brodie’s abscess

A

residual abscess surrounded by bone growth

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54
Q

in osteomyelitis, the infection creates __ through bone, which can drain to the outside

A

sinus tracks

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55
Q

what is this xray showing

A

osteomyelitis

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56
Q

what test differentiates infectious vs inflammatory arthritis

A

synovial fluid analysis

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57
Q

normal synovial fluid analysis

A

appearance: clear

WBC: <200

%PMNs: <25

glucose % serum level: 95-100

crystals under polarized light: none

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58
Q

what arthritis conditions will show have turbid appearance of synovial fluid

A

acute gout

pseudogout

septic arthritis

inflammatory (RA)

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59
Q

in septic arthritis, synovial fluid may appear (2)

A

turbulent/purulent

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60
Q

what 2 arthritis conditions will show WBC 5,000-50,000 on synovial fluid analysis

A

pseudogout

inflammatory (RA)

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61
Q

in septic arthritis WBC count will be >

A

50,000

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62
Q

in acute gout, WBC will be

A

2,000-5,000

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63
Q

in non inflammatory arthritis (DJD/OA) WBC will be <

A

400

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64
Q

% PMNs will be >75 in all arthritic conditions except for (2)

A

non inflammatory (OA)

RA

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65
Q

which arthritic conditions will show hypoglycemia (<50)

A

septic arthritis

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66
Q

in pseudogout, bg can be what range

A

80-1000

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67
Q

which 2 arthritic conditions will show crystals under polarized light

A

gout

pseudogout

68
Q

negative birefringent needle like crystals

A

acute gout

69
Q

positive birefringent rhomboid crystals

A

pseudogout

70
Q

mc degenerative joint dz in >65 yo

A

OA

71
Q

mc cause of OA

A

wear and tear

72
Q

OA causes progressive loss of cartilage at joint spaces of

A

wt bearing bones

73
Q

what do you think when you see microscopic findings including, loss of cartilaginous staining, loss of proteoglycans, loss of chondrocytes

A

OA

74
Q

in OA, fibrillation and splitting of cartilage surface allows for __

and causes __

A

synovial fluid infiltration

inflammation

75
Q

on OA, __

and __ replace cartilage, which causes

erosion of

A

granulation tissue and fibrosis

open bony surface

76
Q

what causes decreased ROM in OA

A

osteophyte formation

77
Q

what bony outgrowths are associated w. OA

A

heberden nodes

bouchard nodes

78
Q

clinical findings of OA (4)

A

morning stiffness worsening throughout the day

unilateral joint pain

crepitus

pain and tenderness

79
Q

joint pain in OA is usually

A

unilateral

80
Q

imaging for OA will show (3)

A

joint space narrowing

subchondral sclerosis and cysts

osteophytes

81
Q

in OA, synovial fluid leaks into

A

defects in cartilage

82
Q

t/f infectious arthritis can be acute or chronic

A

T!

83
Q

infectious arthritis is caused by __,

which leads to __

A

direct seeding of bacteria

edematous and neutrophilic infiltration of synovial space and fluid

84
Q

4 pathogens associated w. infectious arthritis

A

staph

neisseria gonorrhea

chlamydia

strep pneumo

85
Q

what is reiter’s syndrome

A

reactive arthritis that affects joints, eyes, urethra

86
Q

what arthritic condition do you think of when you see chlamydia

A

Reiter’s syndrome - reactive arthritis

87
Q

dx of reactive arthritis

A

clinical exam

synovial fluid analysis and culture

88
Q

tx for reactive arthritis

A

abx directed at causative organism

89
Q

RA is a __ disease (3)

A

chronic

progressive

inflammatory

90
Q

what do you think when you see, collagen vascular disorder

A

RA

91
Q

what genes are associated w. RA

A

HLA-DR4

HLA-DR1

92
Q

OA is caused by __,

whereas RA is __

A

wear and tear

autoimmune

93
Q

OA is characterized by stiffness __,

whereas RA is characterized by __

A

throughout the day

morning stiffness > 30 min

94
Q

clinical features of RA (5)

A

morning stiffness > 1 hr

3 or more affected joints

symmetric

fever, wt loss, fatigue

warm tender joints

95
Q

joint pain in OA is __,

while joint pain in RA is __

A

unilateral

symmetric

96
Q

how many joints are usually affected in RA

A

3 or more

97
Q

what 3 deformities are associated w. RA

A

swan neck

dupuytren’s contracture

boutonniere

98
Q

triad of RA

A

leukopenia

splenomegaly

felty syndrome

99
Q

swan neck is DIP __

and PIP __

A

DIP flexion

PIP hyperextension

100
Q

boutonniere deformity is __ DIP

and __ PIP

A

extended DIP

flexed PIP

101
Q

what do you think when you see microscopic findings of, progressive villous hypertrophy of synovalis 2/2 to fibrinous swelling

A

RA

102
Q

acute inflammation in RA causes __,

which erodes __ of joints

A

fibrosis

cartilaginous surface

103
Q

what does xray show for RA (2)

A

osteopenia

narrowing of joint space

104
Q

joints affected in OA (4)

A

wt bearing:

hips

knees

PIP

DIP

105
Q

joints affected in RA

A

MCP

PIP

ankles

elbows

knees

106
Q

what joint is rarely affected in RA

A

DIP

107
Q

symptoms w. OA are __ with rest,

whereas RA symptoms are __ with rest

A

better

worse

108
Q

what do you think when you see radial deviation of wrist, ulnar deviation of phalanges

A

RA

109
Q

ankylosing spondylitis is also called

A

seronegative spondyyloarthropathy

110
Q

90% of ankylosing spondylitis pt’s are

A

HLA B27 positive

111
Q

ankylosing spondylitis mc affects (2)

A

vertebral column

SI joints

112
Q

ankylosing spondylitis mc affects what age group

A

2nd and 3rd decade of life

113
Q

clinical presentation of ankylosing spondylitis (2)

A

gradual onset of back pain

loss of mobility

114
Q

90% of gout cases are primary and result from (2)

A

increased production of uric acid

decreased excretion of uric acid

115
Q

secondary gout is caused by (2)

A

cell turnover from leukemia

chronic renal dz

116
Q

rf for gout (3)

A

etoh

obesity

thiazide diuretics

117
Q

in gout, urate crystals precipitate in

A

synovium

118
Q

what are urate crystals chemotactic for

A

neutrophils/activate complement

119
Q

gout can cause __

due to neutrophilic infiltrate w. uric acid crystals in joint

A

acute arthritis

120
Q

topi are aggregates of urates rimmed w. (3)

A

macrophages

lymphoctes

giant cells

121
Q

50% of first gout attacks occur at

A

first metatarsophalangeal joint

122
Q

pseudogout occurs in pt’s w. __

and mimics __

A

djd

OA

123
Q

crystals in pseudogout are made of __

and are __ shaped

A

calcium pyrophosphate

rhomboid

124
Q

paget dz is also called

A

osteitis deformans

125
Q

what do you think when you see, excessive osteoblastic bone formation w. abnormal structure and impaired stability

A

paget dz

126
Q

paget dz risk increases in what age group

A

older than 40

127
Q

rf for paget dz (2)

A

caucasian

male

128
Q

early phases of paget dz are

A

asymptomatic

129
Q

clinical features of paget dz

A

macrocephaly

HA

deafness

visual disturbances

deformation/tenderness of long bones

130
Q

radiographic findings of paget dz

A

thick coarse cortex of bone

131
Q

what do you think when you see chalkstick fx/cross fx of long bones

A

paget dz

132
Q

lab findings of paget dz

A

elevated serum alkaline phosphatase

133
Q

malignant primary tumors of bone (3)

A

osteosarcoma

ewing sarcoma

chondrosarcoma

134
Q

mc tumor arising w.in bone

A

multiple myeloma

135
Q

benign bone tumors are __ mc than malignant

A

100x

136
Q

mc malignant bone tumor

A

osteosarcoma

137
Q

osteosarcoma usually occurs in __

and __

A

children

adolescents

138
Q

common sites for osteosarcoma

A

areas adjacent to knee and shoulder

139
Q

what do you think when you see, localized lytic or osteoblastic lesions w. fuzzy borers and prominent subperiosteal reactive bone formation

A

osteosarcoma

140
Q

what do you think when you see codman triangle

A

osteosarcoma

141
Q

what do you think when you see, osteoblastic lesion w. lacy osteoid deposition

A

osteosarcoma

142
Q

where does osteosarcoma commonly metastasize

A

lungs

143
Q

what is this xray showing

A

codman triangle → osteosarcoma

144
Q

2nd mc tumor in kids

A

ewing sarcoma

145
Q

common presentation of ewing sarcoma

A

fever and pain mimicking inflammatory response

146
Q

ewing sarcoma is commonly misdiagnosed as

A

osteomyelitis

147
Q

dx of ewing sarcoma is confirmed w.

A

bx

148
Q

mc affected bones in ewing sarcoma

A

long bones → humerus, tibia, femur

149
Q

ewing sarcoma commonly metastasizes to (3)

A

lungs

brain

skull

150
Q

what is this xray showing

A

ewing sarcoma

151
Q

chondrosarcoma arises from __

and is NOT a __ tumor

A

cartilage

childhood

152
Q

chondrosarcoma is mc found in

A

central portions of skeleton → shoulder, pelvis, proximal femur, ribs

153
Q

what do you think when you see, bulky osteodestructive lesion w. calcification popcorn

A

chondrosarcoma

154
Q

chondrosarcoma commonly metastasizes to the

A

lungs

155
Q

what is this xray showing

A

calcification popcorn → chondrosarcoma

156
Q

what are the 5 types of malignant soft tissue tumors

A

malignant fibrous histiocytomas

liposarcomas

rhabdomyosarcomas

leiomyosarcomas

neurofibrosarcomas

157
Q

malignant soft tissue tumors are at type of

A

sarcoma

158
Q

how do soft tissue tumors spread

A

hematogenous

159
Q

soft tissue sarcomas are classified by

A

tissue derivation

160
Q

mc malignant soft tissue tumor

A

malignant fibrous histiocytoma

161
Q

malignant fibrous histiocytomas are found in (3)

A

deep fascia

skeletal muscle

retroperitoneal space

162
Q

deep subq tissue of thighs, abdomen, and retroperitoneum in age >50

A

liposarcoma

163
Q

rhabdomyosarcoma is mc in __

and affects __

A

kids/adolescent

skeletal m

164
Q

leiomyosarcomas affect __

of __

and __

A

smooth muscle

uterus

GI

165
Q

neurofibrosarcoma affects

A

peripheral n

Pathophys II - Exam 2 (4 decks)

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