Muscoskeletal Pathology Flashcards

1
Q

Osteoblasts

A

Produce osteoid

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2
Q

Osteocytes

A

Osteoblasts within bone in a lacuna

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3
Q

Osteoclast

A

Multinucleated Resorts bone Reside in Howsips lacunae

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4
Q

Explain signaling for bone resorption

A

RANKL and Macrophage stimulating factor expressed by osteoblasts bind with macrophages to convert them into osteoclasts Osteoprotegrin can block RANKL and prevent osteoclast formation and bone resorption

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5
Q

Name the 6 categories of bone lesions

A

Congenital

Acquired

Fractures

Osteonecrosis

Osteomyelitis

Tumors

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6
Q

Name the 4 Congenital Lesion

A

Osteogenesis Imperfecta

Anchodroplasia

Osteopetrosis

Fibrous Dysplasia

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7
Q

Name the 5 Accquired Lesions

A

Osteoporosis

Paget Disease

Rickets Osteomalacia

Hyperparathyrodism

Scurvy

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8
Q

Name the 2 Osteomyelitis Lesions

A

Pyogenic

Tuberculous

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9
Q

Name the 3 Tumors of the bone

A

Bone-forming

Cartilage forming

Miscellaneous

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10
Q

Osteogenesis Imperfecta

What causes it

2 examples

A
  • Mutations of collagen type 1 (alpha 1 and alpha 2)
    • Autosomal Dominant
  • Multiple fractures
  • Blue Sclera
  • Hearing loss
  • Dentinogenesis Imperfecta
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11
Q

Achondroplasia

A
  • FGFR3 Mutation
    • Chondrocyte proliferation inhibition
    • Growth of normal epiphyseal plates is repressed
    • Autosomal dominant
  • Avg life span
  • Affects all bone that develop via endochondral ossification
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12
Q

Osteopetrosis

A
  • Reduced osteoclast-mediated bone resorption
    • defective bone remodeling
    • abnormally dense but brittle
  • both autosomal recessive and dominant
  • can cause many issues in infants
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13
Q

Fibrous Dysplasia

A
  • Replacement of bone with connective tissue
  • None malignant
  • 3 types
    • Monostotic
    • Polyostotic
    • McCune Albright Syndrome
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14
Q

Osteoporosis

A
  • Reduced bone mass
  • Existing bone has normal mineral content
  • 5 main factors contributing
    • Menopause
    • Aging
    • Nutrition
    • Decreased physical activity
    • Endocrine
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15
Q

Paget Disease

A
  • Random excess bone formation
  • Repetitive episodes of frenzied regional osteoclast activity and resorption
    • Osteolytic Stage
  • Exuberant bone formation
    • Mixed osteoclatic-osteoblastic stage
  • Exhaustion of cellular activity
    • Osteosclerotic stage
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16
Q

Ricketts Osteomalacia

A
  • Vitamin D deficiency
  • Inadequate mineralization of bone
  • Rickets: kids- epiphyseal plates open
  • Osteomalacia:Adults- plates closed
  • Weak tooth enamel, increased caries
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17
Q

What does Parathyroid Hormine increase

A
  • Overall it increases plasma calcium concentration
  • Causes
    • Ca out of kidney tubule
    • Inc Ca release from bones into plasma
    • Stimulates kidney to activate Vit D
    • Lowers plasma phosphate concentration by increasing renal excretion of phosphate- preventing Ca to precipitate back into bone
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18
Q

How is PTH secretion regulated

A
  • Inhibited by calcium concentration
  • Inhibited by active vitamin D
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19
Q

Hyperparathyrodism

A
  • Primary
    • Excess secretion of PTH
  • Secondary
    • Increase in PTH from a chronic disease that causes hypocalcemia
    • Ex Renal Failure
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20
Q

Scurvy

A
  • Deficiency in Vit C
  • Leads to impaired osteoid matrix formation
  • Manifestations
    • Bleeding gums
    • Subperiosteal hemorrhage
    • Osteoporosis
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21
Q

Langerhans Cell Histiocytosis

A
  • A grp of disorders that exhibit histiocyte-like Langerhans cells that cause bone lesions
  • 3 types
    • Letterer-Siwe Disease
    • Hand-Schuller Christian Disease
    • Eosinophilic Granuloma of bone
22
Q

Osteonecrosis

A
  • Ischemia causes loss of bone
    • no infection
  • Result of
    • trauma
    • bone infraction
    • Corticosteroids
23
Q

Bisphosphonate- Associated Osteonecrosis

A
  • Osteonecrosis in patient with history of bisphosphonate use
    • drugs aimed at neutralizing osteoclasts
    • Effects are highest in bones with active remodeling like the jaw
  • BON develops after manipulation of bone, extraction, implant, perio, endo
  • Caution and inform patient over the age of 3
24
Q

Osteomyelitis- Pyogenic

A
  • Inflammation of bone and marrow
  • Most are caused by bacteria (S. aureus)
    • Hematogenous dissemination ( spread via blood)
    • Contigous infection spread (back to back infections)
    • Traumatic implantation (fractures)
25
Q

Osteomyelitis- Tuberculous

A
  • Mycobacterial infection of the bone
  • Bone infections accompany 1-3% of pulmonary tuberculosis
  • Long bones and vertebrae are favored
26
Q

Bone forming tumors Benign

A
  • Osteoma
  • Osteoid Osteoma
  • Osteoblastoma
27
Q

Bone forming Tumors, Malignant

A
  • Primary Osteosarcoma
  • Secondary Osteosarcoma
28
Q

Cartilage forming bone tumors, Benign 2

A

Osteochondroma

Enchondroma

29
Q

Cartilage forming bone tumrs, Malignant 1

A

Chondrosarcoma

30
Q

Miscellaneous bone tumors

A

Giant Cell Tumor of bone

Ewing Sarcoma

31
Q

List the 6 types of joint arthritis

A
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Juvenile theumatoid arthritis
  • Seronegative spondyloarthropathies
  • Gout
  • Pseudogout
  • Infectious arthritis
32
Q

List the 2 joint tumors

A

Ganglion and synovial cysts

Tenosynovial gian cell tumor

33
Q

Osteoarthritis

A
  • Most common joint disorder
  • Common in 65+
  • Degeneration of the articular cartilage
34
Q

Osteoarthritis Primary and Secondary

A
  • Primary
    • Appears gradually with age
    • No apparent Cause
  • Secondary
    • Common in youth
    • Caused by trauma, deformity, diseases
35
Q

Evolution of Osteoarthritis

A

Thinning of cartilage

Cartilage remnant

Destruction of cartilage

36
Q

Rheumatoid Arthritis

A
  • Systemic, chronic inflammatory autoimmune disease
  • Rare, common in women
  • Occurs bilaterally
  • Likely combination of genetics and enviroment
37
Q

Progression of Rheumatoid Arthritis

A
  • Initiating event–> Synovitis and Pannus
  • CD4 helper T cells lead to
    • Pain and stiffness
    • Joint space narrowing and joint erosions
38
Q

Atlanto-axial dislocation

A

Form of RA

Instability at joint btw C1-C2

Due to laxity of ligaments and cartilage destruction with RA

39
Q

Juvenile RA

A

Similar to RA but in youth

Strong genetic component (HLA and PTPN22)

40
Q

Seronegative Spondyloarthropathies

A
  • Used to be considered RA
  • Pathologic changes that originate in the ligamentous attachment (not synovium)
  • No rheumatoid factor
  • HLA associated
41
Q

Gout

A

Uric acid accural in tissues

Monosodium urate crystals precipitate from supersaturated body fluids

Induce inflammation

42
Q

Hyperuricemia

A
  1. Precipitation of urate crystals in joints
  2. Complement activation
  3. Phagocytosis of crystals
  4. Lysis and activation of neutrophils
  5. Release of crystals
  6. Release of lysosomal enzymes
  • Precipitation of urate crystals in joints
  • Phagocytosis by monocytes
  • Release of cytokines
43
Q

Primary and Secondary Gout

A
  • Primary
    • Hyperuricemia in the abscence of other disease
      • enzyme defects
    • altered high or low uric acid renal secretion
  • Secondary
    • Known cause of hyperuricemia
      • Leukemia
      • Renal disease
      • Metabolic defects
  • Symptoms
    • joint pain, renal failure, urate stones
44
Q

Pseudogout

A
  • Chondrocalcinosis
  • Calcium pyrophosphate crystal deposition
  • 50+ years
  • Crystal deposits in joint and triggger inflammation (similar to gout)
45
Q

Infectious arthritis

A
  • Bacteria lodge in joints during hematogenous dissemination
  • 2 types
    • Suppurative arthritis
    • Lyme arthritis
46
Q

Supporative Arthritis

A

H. influenzae in kids

S aureaus and N gonorrhea in adults

Those with deficient complement are more susceptible

Joint aspiration yields purulent fluid

47
Q

Lyme arthritis

A

Infection B burgdorferi

Advances in stages

  • Tick passes spirochetes
  • Spirochetes spread
  • 2-3 years later symptoms appear as arthritis
48
Q

Ganglion Tumors of joints

A

Small tendon cyst (fluid filled)

Often near wrist

Bible therapy

49
Q

Synovial cyst tumors of joints

A

Herniation of synovium thru joint capsule

50
Q

Tenosynovial giant cell tumor

A

Catchall term for several benign neoplasms of synovium

51
Q

Name the 6 types of tumors in soft tissues

A

Adipose

Fibrous

Fibrohistiocytic

Skeletal Muscle

Smooth muscle

Synovial

52
Q

Name the 3 types of Skeletal muscle disorders

A

Inherited

Acquired

Autoimmune