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Clinical Pathology > 57 - Diseases of musculoskeletal system > Flashcards

57 - Diseases of musculoskeletal system Flashcards

1
Q

Acute arthritis presentation

A

Pain, heat, redness and swelling

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2
Q

Chronic arthritis presentation

A

Commonest - osteoarthritis & rheumatoid

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3
Q

Osteoarthritis -

A

Commonest type of joint disease aka degenerative

Progressive erosion of articular cartilage resulting in bony spurs and cysts in joint margins

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4
Q

Osteoarthritis (OA) - pathogenesis (mechanical)

A

Deterioration or loss of cartilage

As cartilage is worn away it forms spurs and fluid filled cysts appear in the marrow (subchondral cysts)

Results in pain and limited movements

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5
Q

Osteoarthritis (OA) - pathogenesis (biological)

A

Chrondrocytes produce IL-1 and initiate matrix breakdown.

Prostaglandin derivatives induce the release of lytic enzymes - preventing matrix synthesis.

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6
Q

Osteoarthritis (OA) - primary OA

A

Abnormal stressed in weight bearing joints - fingers, knees, cervical + lumbar spines

Fingers -> Herberden’s or Bouchard’s nodes

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7
Q

Rheumatoid arthritis - what is it?

A

Chronic systemic disorder

Producing non suppurative proliferative synovitis - destruction of articular cartilage and ankylosis of joints

Affects skin, muscles, heart lung and blood vessels (woman 3-5 times more than men)

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8
Q

Rheumatoid arthritis - pathogenesis

A

Polypoid fibrovascular thickening of synovium with hyperplasia, producing pannus that erodes articular cartilage.

Growth penetrates subchondral bone and cysts form .

Joint fills producing ankylosis of joint space

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9
Q

Rheumatoid arthritis - clinical feature

A

Malaise, fatigue + general MSK pain

Involved joints: swollen, warm, painful and stiff in morning or after activity.

Slow or rapid

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10
Q

Rheumatoid arthritis - pathogenesis

A 
Genetic susceptibility 
Primary exogenous arthritogen
Autoimmune
Cytokine problems
IL-1,6 and TNF alpha and beta
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11
Q

Rheumatoid arthritis - diagnosis criteria

A 
morning stiffness
arthritis in 3 or more joint areas
arthritis in hand joints
Symmetric arthritis
Rheumatoid nodules
Serum rheumatoid factors

Radiographic presentation

Rheumatoid factor - present in most

Analysis of synovial fluid - confirms presence of neutrophils (hence inflammatory)

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12
Q

Sero-negative arthritides

A

Lack rheumatoid factor:

  1. ankylosing spondylitis
  2. reiter’s syndrome
  3. psoriatic arthritis
  4. enteropathic arthritis
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13
Q

Gout -

A

hyperuricemia

uric acid is the end produce of purine metabolism

caused by enzyme deficiencies

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14
Q

Gout - clinical features

A

Acute arthritis
Chronic arthritis
Tophi in various sites
Gouty nephropathy

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15
Q

Pyogenic osteomyelitis - clinical presentation

A

Systemic illness - fever, malaise, chills and marked pain over region

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16
Q

Pyogenic osteomyelitis - investigations

A

X ray - lytic focus of bone destruction surrounded by zone of sclerosis

Blood cultures are positive

Biopsy

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17
Q

Pyogenic osteomyelitis - pathogenesis

A

Caused by bacteria

Haematogenous

Extension from a contiguous site

Direct implantation

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18
Q

Infective arthritis -

A

acutely painful and swollen joints with restricted movements

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19
Q

Infective arthritis - clinical presentation

A

fever, leucocytosis and elevated ESR

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20
Q

Infective arthritis - bacterial

A

Staph, strep, gonococcus, mycobacteria

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21
Q

Infective arthritis - predisposing factors

A

Trauma, IV drug abuse, debilitating illness

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22
Q

Osteoporosis -

A

Increased porosity of the skeleton

Reduction in bone mass

Localised or entire skeleton

Primary or secondary

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23
Q

Osteoporosis - risk factors

A

Physical activity
Muscle strength
Diet
hormonal status

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24
Q

Osteoporosis - clinical features

A

Vertebral fractures
Kyphosis
Scoliosis

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25
Q

Secondary Osteoporosis - clinical features

A

Endocrine disorders - hyperparathyroidism, Type 1 diabetes

Neoplasia - multiple myeloma

Malnutrition

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26
Q

Paget’s disease -

A

Disease of collagen matrix

Caused by paramyxovirus

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27
Q

Paget’s disease - problems with which thing

A

Predominant osteoblastic activity with burnt out osteosclerotic phase

Net effect is gain in bone mass

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28
Q

Paget’s disease - epidemiology

A

Begins in 50s

M>F

29
Q

Paget’s disease - clinical presentation

A

pain most common

chalk stick type fractures

30
Q

Paget’s disease - tumours

A

Benign and malignant
Giant cell - benign
Malignant - osteosarcoma, chrondrosarcoma, malignant fibrous histiocytoma

31
Q

Osteomalacia -

A

Defects in matrix mineralisation
Lack of vit D
Decreased bone density and too little bone - osteopenia

32
Q

Hyperparathyroidism - pathogenesis

A

Excessive secretion of PTH

Increases bone resorption and Ca mobilisation from the skeleton

Increaces renal tubular reabsorption and retention of calcium

=== hypercalcaemia

Causing osteitis fibrosa cystica - loss of bone mineral with osteoporosis

33
Q

Renal osteodystrophy -

A 
Skeletal changes of chronic renal disease:
Increased osteoclastic bone resorption
Delayed matrix mineralisation 
Osteosclerosis
Growth retardation
Osteoporosis
34
Q

Lipomas are

A

fat tissue

35
Q

fibromas are

A

fibrous tissue

36
Q

leiomyomas

A

smooth muscle

37
Q

heamangiomas

A

blood vessel

38
Q

lymphangiomas

A

lymphatics

39
Q

neuromas

A

peripheral nerves

40
Q

soft tissue tumour syndrome

A

neurofibromatosis type one - neurofibroma

gardner syndrome - fibromatosis

carney syndrome - myxoma, melanotic schwannoma

turner syndrome - cystic hygroma

41
Q

Soft tissue tumour diagnosis

A

US guided core biopsy
Wide excision
Cytogenetics - culture of fresh tissue and karyotypic analysis
Molecular genetics - FISH, PCR and RT-PCR

42
Q

Bone tumours

A

from bone and cartilage

43
Q

benign bone tumours

A

osteomas, osteoblastomas

44
Q

benign cartilage

A

chrondromas

45
Q

mixed

A

osteochondromas

46
Q

malignant bone tumours

A

osteosarcoma

young age group - around knee

47
Q

other bone tumours

A

chondrosarcomas
Ewing’s sarcoma
Giant cell tumours

48
Q

Where do bones met to?

A

Thyroid, prostate, kidney, breast, GI tract

49
Q

Systemic lupus erythematosus -

A

Complex multi system disease

Predominantly cutaneous
F>M

50
Q

Systemic lupus erythematosus - clinical presentation

A

Cutaneous - butterfly rash - typically affecting bridge of nose and the cheeks

Cardiac - cardiomegaly, endocarditis

CNS - convulsions, hemiplegia

Renal - 45% of patients, nephrotic syndrome and glomerulonephritis

51
Q

Systemic sclerosis - pathogenesis

A

complex and poorly understood

52
Q

Systemic sclerosis - what is it?

A

vessel damage, inflam response and cytokines

53
Q

Systemic sclerosis - clinical presentation

A

Diffuse-widespread cutaneous lesions

Renal, cardioresp and GI tract

Osteoarticular involvement - artharlgia and arthritis

54
Q

Systemic sclerosis - prognosis

A

poor

55
Q

Systemic sclerosis - localised variant

A

Limited cutaneous involvement, oesophageal involvement and SI malabsorption

CREST syndrome

56
Q

CREST syndrome stands for

A 
Calcinosis
Reynaud's
Oesopageal dysfunction
Sclerodactyly
Telangiectasia
57
Q

Polymyalgia rheumatica - clinical presentation

A

stiffness, weakness, aching and pain in neck, limb girdles and upper limbs

associated with giant cell arteritis - occipital and facial arteries. Causing pyrexia, headache and severe scalp pain.

58
Q

Polymyalgia rheumatica - pathogenesis

A

immunological mechanism

59
Q

Myopathy definition

A

muscle disease unrelated to any disorder of innervation or neuromuscular junction

60
Q

Myositis definition

A

muscle fibres and overlying skin are inflamed and damaged resulting in muscle weakness

61
Q

Muscular dystrophy - what is it?

A

heterogenous group
inherited
progressively severe muscle weakness and wasting
begins in childhood

62
Q

Malignant hyperthermia - what is it?

A

inherited

fast rise in body temperature and severe muscle contraction when the affected person general anaesthesia

63
Q

rhabdomyolysis - what is it?

A

destruction of skeletal muscle releasing muscle fibre content into blood e.g. myoglobin

64
Q

rhabdomyolysis - urine

A

myoglobin filtered through kidney and enters urine - myoglobinuria - brown urine

65
Q

rhabdomyolysis - causes

A 
trauma, crush injuries
drugs - cocaine, amphetamine
extreme temp
severe exertion (marathon)
length surgery
severe dehydration
66
Q

rhabdomyolysis - complications

A

acute renal failure

67
Q

metabolic myopathies

A

glycogen synthesis and degradation

disorders of mitochondrial metabolism

68
Q

malignant hyperthermia - signs and symptoms

A 
bleeding
dark brown urine
muscle rigidity
quick rise in body temp to 105 deg F
discovered during anaesthesia
may have FH

Clinical Pathology (65 decks)

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