Schoenwald - MSK Flashcards
1
Q
metabolic bone diseases (2)
A
osteoporosis
rickets
2
Q
infectious bone disease
A
osteomyelitis
3
Q
non infectious arthritis
A
osteoarthritis
4
Q
osteoporosis is caused by
A
increased bone resorption
5
Q
rickets is a disease of
A
calcium metabolism
6
Q
what do you think when you see, excessive osteoblastic bone formation with abnormal structure and instability
A
paget dz
7
Q
reduced mass of mineralized bone dt imbalance of bone metabolism resulting in increased bone resorption
A
osteoporosis
8
Q
osteoclasts are involved in
A
bone resorption
9
Q
osteoblasts are involved in
A
bone formation
10
Q
what does microscopic pathology show for osteoporosis
A
symmetric thinning of trabecular and cortical bone
11
Q
bisphosphonates stabilize
A
trabecular bone
12
Q
primary osteoarthritis is caused by
A
age, degenerative
13
Q
type 1 primary osteoporosis is called
A
postmenopausal → estrogen loss
14
Q
type 1 primary osteoporosis is characterized by increased
A
osteoclastic activity
15
Q
type 2 osteoporosis is called
A
senile
16
Q
type 2 primary osteoporosis (senile) is characterized by
A
decreased osteoblastic activity
17
Q
mc bones fx’ed in osteoporosis (3)
A
hip
compression of vertebrae
distal radius (FOOSH)
18
Q
rf for osteoporosis (7)
A
aging
(+) fam hx
smoking etohism
decreased estrogen
low BMI
low Ca diet
lack of weight bearing exercise
19
Q
secondary osteoporosis is caused by (6)
A
endocrine-increased parathyroid hormone
DM
Addison’s
GI-manutrition
blood cancers
drugs
20
Q
what drugs are related to osteoporosis (3)
A
long term prednisone
heparin
some chemo agents
21
Q
common presentation of osteoporosis
A
vertebral compression fx
22
Q
osteoporosis causes __ of the spine
A
kyphosis
23
Q
text book osteoporosis pt
A
white
female
long hx smoking
postmenopausal
24
Q
2 parameters of DEXA scan
A
T score
Z score
25
T score compares bone mass to
healthy 30 yo
26
bone density peaks at what age
30
27
nl for T score
+1 to -1 standard deviation from 30 yo
28
Z score compares bone density to
what's normally expected for same age, sex, wt, ethnic/racial origin
29
abnormal Z score
-2 or lower
30
T score interpretation
31
in rickets and osteomalacia, __ is decreased
while __ stays normal
mineralization of osteoid is decreased
bone mass stays normal
32
rickets and osteomalacia are characterized by
bowing of legs
33
what 2 minerals are deficient in rickets/osteomalacia
vit d
phosphate
34
rickets affects what pt population
growing bones of kids
35
in rickets, inadequate mineralization of osteoid matrix leads to
overgrowth and distortion of epiphyseal cartilage
36
ostomalacia affects \_\_
in adults
newly formed bone matrix
37
mc cause of hematogenous spread of osteomyelitis
s.aureus
38
hematogenous spread of osteomyelitis is mc in
kids
39
in kids, osteomyelitis affects __ and spreads from there
epiphyseal plate
40
what is an example of contiguous spread of osteomyelitis
diabetic foot wound
41
contiguous spread of osteomyelitis is mc in
adults
42
\_\_ is common in contiguous spread of osteomyelitis,
but it can also be \_\_
s.aureus
polymicrobial
43
T/F osteomyelitis be chronic or acute
T!
44
clinical findings of osteomyelitis
pain
warmth of area affected
+/- fever → *often absent*
45
lab findings for osteomyelitis (3)
**elevated:**
ESR
CRP
platelets
46
radiographic findings of osteomyelitis (2)
destruction of bone
periosteal edema
47
what type of culture is not reliable in osteomyelitis
superficial → ex sinus tracks
48
dx of osteomyelitis (2)
blood cultures
bone bx
49
tx for osteomyelitis
long term IV abx targeted to organism → at least 6 weeks
+/- surgical debridement
50
in osteomyelitis, infxn lifts \_\_,
which impairs blood flow and results in __ of the bone
periosteum
ischemia
51
what is sequestrum
dead bone fragment
52
what is involucrum
new bone growth around sequestrum
53
what is brodie's abscess
residual abscess surrounded by bone growth
54
in osteomyelitis, the infection creates __ through bone, which can drain to the outside
sinus tracks
55
what is this xray showing
osteomyelitis
56
what test differentiates infectious vs inflammatory arthritis
synovial fluid analysis
57
normal synovial fluid analysis
appearance: clear
WBC: \<200
%PMNs: \<25
glucose % serum level: 95-100
crystals under polarized light: none
58
what arthritis conditions will show have turbid appearance of synovial fluid
acute gout
pseudogout
septic arthritis
inflammatory (RA)
59
in septic arthritis, synovial fluid may appear (2)
turbulent/purulent
60
what 2 arthritis conditions will show WBC 5,000-50,000 on synovial fluid analysis
pseudogout
inflammatory (RA)
61
in septic arthritis WBC count will be \>
50,000
62
in acute gout, WBC will be
2,000-5,000
63
in non inflammatory arthritis (DJD/OA) WBC will be \<
400
64
% PMNs will be \>75 in all arthritic conditions except for (2)
non inflammatory (OA)
RA
65
which arthritic conditions will show hypoglycemia (\<50)
septic arthritis
66
in pseudogout, bg can be what range
80-1000
67
which 2 arthritic conditions will show crystals under polarized light
gout
pseudogout
68
negative birefringent needle like crystals
acute gout
69
positive birefringent rhomboid crystals
pseudogout
70
mc degenerative joint dz in \>65 yo
OA
71
mc cause of OA
wear and tear
72
OA causes progressive loss of cartilage at joint spaces of
wt bearing bones
73
what do you think when you see microscopic findings including, loss of cartilaginous staining, loss of proteoglycans, loss of chondrocytes
OA
74
in OA, fibrillation and splitting of cartilage surface allows for \_\_
and causes \_\_
synovial fluid infiltration
inflammation
75
on OA, \_\_
and __ replace cartilage, which causes
erosion of
granulation tissue and fibrosis
open bony surface
76
what causes decreased ROM in OA
osteophyte formation
77
what bony outgrowths are associated w. OA
heberden nodes
bouchard nodes
78
clinical findings of OA (4)
morning stiffness worsening throughout the day
unilateral joint pain
crepitus
pain and tenderness
79
joint pain in OA is usually
unilateral
80
imaging for OA will show (3)
joint space narrowing
subchondral sclerosis and cysts
osteophytes
81
in OA, synovial fluid leaks into
defects in cartilage
82
t/f infectious arthritis can be acute or chronic
T!
83
infectious arthritis is caused by \_\_,
which leads to \_\_
direct seeding of bacteria
edematous and neutrophilic infiltration of synovial space and fluid
84
4 pathogens associated w. infectious arthritis
staph
neisseria gonorrhea
chlamydia
strep pneumo
85
what is reiter's syndrome
reactive arthritis that affects joints, eyes, urethra
86
what arthritic condition do you think of when you see chlamydia
Reiter's syndrome - reactive arthritis
87
dx of reactive arthritis
clinical exam
synovial fluid analysis and culture
88
tx for reactive arthritis
abx directed at causative organism
89
RA is a __ disease (3)
chronic
progressive
inflammatory
90
what do you think when you see, collagen vascular disorder
RA
91
what genes are associated w. RA
HLA-DR4
HLA-DR1
92
OA is caused by \_\_,
whereas RA is \_\_
wear and tear
autoimmune
93
OA is characterized by stiffness \_\_,
whereas RA is characterized by \_\_
throughout the day
morning stiffness \> 30 min
94
clinical features of RA (5)
morning stiffness \> 1 hr
3 or more affected joints
symmetric
fever, wt loss, fatigue
warm tender joints
95
joint pain in OA is \_\_,
while joint pain in RA is \_\_
unilateral
symmetric
96
how many joints are usually affected in RA
3 or more
97
what 3 deformities are associated w. RA
swan neck
dupuytren's contracture
boutonniere
98
triad of RA
leukopenia
splenomegaly
felty syndrome
99
swan neck is DIP \_\_
and PIP \_\_
DIP flexion
PIP hyperextension
100
boutonniere deformity is __ DIP
and __ PIP
extended DIP
flexed PIP
101
what do you think when you see microscopic findings of, progressive villous hypertrophy of synovalis 2/2 to fibrinous swelling
RA
102
acute inflammation in RA causes \_\_,
which erodes __ of joints
fibrosis
cartilaginous surface
103
what does xray show for RA (2)
osteopenia
narrowing of joint space
104
joints affected in OA (4)
**wt bearing:**
hips
knees
PIP
DIP
105
joints affected in RA
MCP
PIP
ankles
elbows
knees
106
what joint is rarely affected in RA
DIP
107
symptoms w. OA are __ with rest,
whereas RA symptoms are __ with rest
better
worse
108
what do you think when you see radial deviation of wrist, ulnar deviation of phalanges
RA
109
ankylosing spondylitis is also called
seronegative spondyyloarthropathy
110
90% of ankylosing spondylitis pt's are
HLA B27 positive
111
ankylosing spondylitis mc affects (2)
vertebral column
SI joints
112
ankylosing spondylitis mc affects what age group
2nd and 3rd decade of life
113
clinical presentation of ankylosing spondylitis (2)
gradual onset of back pain
loss of mobility
114
90% of gout cases are primary and result from (2)
increased production of uric acid
decreased excretion of uric acid
115
secondary gout is caused by (2)
cell turnover from leukemia
chronic renal dz
116
rf for gout (3)
etoh
obesity
thiazide diuretics
117
in gout, urate crystals precipitate in
synovium
118
what are urate crystals chemotactic for
neutrophils/activate complement
119
gout can cause \_\_
due to neutrophilic infiltrate w. uric acid crystals in joint
acute arthritis
120
topi are aggregates of urates rimmed w. (3)
macrophages
lymphoctes
giant cells
121
50% of first gout attacks occur at
first metatarsophalangeal joint
122
pseudogout occurs in pt's w. \_\_
and mimics \_\_
djd
OA
123
crystals in pseudogout are made of \_\_
and are __ shaped
calcium pyrophosphate
rhomboid
124
paget dz is also called
osteitis deformans
125
what do you think when you see, excessive osteoblastic bone formation w. abnormal structure and impaired stability
paget dz
126
paget dz risk increases in what age group
older than 40
127
rf for paget dz (2)
caucasian
male
128
early phases of paget dz are
asymptomatic
129
clinical features of paget dz
macrocephaly
HA
deafness
visual disturbances
deformation/tenderness of long bones
130
radiographic findings of paget dz
thick coarse cortex of bone
131
what do you think when you see chalkstick fx/cross fx of long bones
paget dz
132
lab findings of paget dz
elevated serum alkaline phosphatase
133
malignant primary tumors of bone (3)
osteosarcoma
ewing sarcoma
chondrosarcoma
134
mc tumor arising w.in bone
multiple myeloma
135
benign bone tumors are __ mc than malignant
100x
136
mc malignant bone tumor
osteosarcoma
137
osteosarcoma usually occurs in \_\_
and \_\_
children
adolescents
138
common sites for osteosarcoma
areas adjacent to knee and shoulder
139
what do you think when you see, localized lytic or osteoblastic lesions w. fuzzy borers and prominent subperiosteal reactive bone formation
osteosarcoma
140
what do you think when you see codman triangle
osteosarcoma
141
what do you think when you see, osteoblastic lesion w. lacy osteoid deposition
osteosarcoma
142
where does osteosarcoma commonly metastasize
lungs
143
what is this xray showing
codman triangle → osteosarcoma
144
2nd mc tumor in kids
ewing sarcoma
145
common presentation of ewing sarcoma
fever and pain mimicking inflammatory response
146
ewing sarcoma is commonly misdiagnosed as
osteomyelitis
147
dx of ewing sarcoma is confirmed w.
bx
148
mc affected bones in ewing sarcoma
long bones → humerus, tibia, femur
149
ewing sarcoma commonly metastasizes to (3)
lungs
brain
skull
150
what is this xray showing
ewing sarcoma
151
chondrosarcoma arises from \_\_
and is NOT a __ tumor
cartilage
childhood
152
chondrosarcoma is mc found in
central portions of skeleton → shoulder, pelvis, proximal femur, ribs
153
what do you think when you see, bulky osteodestructive lesion w. calcification popcorn
chondrosarcoma
154
chondrosarcoma commonly metastasizes to the
lungs
155
what is this xray showing
calcification popcorn → chondrosarcoma
156
what are the 5 types of malignant soft tissue tumors
malignant fibrous histiocytomas
liposarcomas
rhabdomyosarcomas
leiomyosarcomas
neurofibrosarcomas
157
malignant soft tissue tumors are at type of
sarcoma
158
how do soft tissue tumors spread
hematogenous
159
soft tissue sarcomas are classified by
tissue derivation
160
mc malignant soft tissue tumor
malignant fibrous histiocytoma
161
malignant fibrous histiocytomas are found in (3)
deep fascia
skeletal muscle
retroperitoneal space
162
deep subq tissue of thighs, abdomen, and retroperitoneum in age \>50
liposarcoma
163
rhabdomyosarcoma is mc in \_\_
and affects \_\_
kids/adolescent
skeletal m
164
leiomyosarcomas affect \_\_
of \_\_
and \_\_
smooth muscle
uterus
GI
165
neurofibrosarcoma affects
peripheral n
