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Bone and CT Flashcards

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1
Q

Bones of the axial and appendicular skeleton + base of the skull are formed via what process?

A

Endochondral ossification

Cartilage model (chondrocytes) → Woven bone (Osteoclasts/blasts)

Later remodel to Lamellar bone

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2
Q

When do you see woven bone in adults?

A

After fx and Pagets disease

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3
Q

What bones are formed by membranous ossification?

A

Calvarium and facial bones - no cartilage model

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4
Q

What do osteoblasts differentiate from?

A

Mesenchymal stem cells - secrete collagen and catalyze mineralization

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5
Q

What do osteoclasts differentiate from?

A

Monocytes/Mφ

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6
Q

Chronic ↑PTH has what effect on bone?

A

Catabolic - osteitis fibrosa cystica

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7
Q

Estrogen has what effect on bone?

A

⊣ apoptosis in osteoblasts

→ apoptosis in osteoclasts

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8
Q

What causes Achondroplasia?

A

Constit active FGFR3 - inhibit chondrocyte proliferation

Sporadic - adv. paternal age

some AD inheritance

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9
Q

S/S of Achondroplasia?

A

Failure of longitudinal long bone growth (endochondral ossification)

Short limbs, large head

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10
Q

How do you diagnose osteoporosis?

A

DEXA ≤ -2.5

Normal bone mineralization and lab values

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11
Q

What are indications of type 1 (post-men) osteoporosis?

A

Femoral neck fx & distal radius fx

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12
Q

How do you treat osteoporosis?

A

Bisphosphonates

PTH - intermittant

SERMs

Denosumab - anti-RANKL

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13
Q

SS of Osteopetrosis?

A

Thickened dense bones prone to fx

Pancytopenia and EM hematopoiesis

Cranial nerve impingement and palsies

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14
Q

What drives the symptoms of osteopetrosis? What can cure it?

A

Mutations in carbonic anhydrase II
Osteoclasts can’t make enough acid

BMT - OC are from monocytes

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15
Q

What effect does vitamin D deficiency have on bone?

A

↓ mineralization/calcification of osteoid

*hyperactivity of osteoblasts - ↑ALP

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16
Q

What is the only lab value that is incresaed in Paget disease of bone?

A

ALP

Ca, PO4 and PTH are nomral

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17
Q

What are other symptoms of Paget disease of bone?

A

↑Hat size and Hearing loss

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18
Q

What isthe most common site for AVN?

A

Femoral head - insufficiency of medial circumflex femoral a.

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19
Q

What causes AVN?

A

Trauma, high-dose corticosteroids, alcoholism, sickle cell

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20
Q

What are the 2 benign primary tumors of bone?

A

Giant Cell tumor

Osteochondroma

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21
Q

A 25 yo man has a tumor in the epiphyseal end of a long bone with a soap bubble appearance on XR - what is it?

A

Giant cell tumor - locally aggressive, benign

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22
Q

Osteochondroma

A

Mature bone w/ cartilaginous cap, rarely transforms

Males < 25

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23
Q

What is the 2nd most common 1˚ malignant tumor of bone? What does imaging show?

A

Osteosarcoma

codman triangle or sunburst on XR

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24
Q

Who gets an osteosarcoma and where does it occur?

A

Bimodal - 10-20 and >65

Metaphysis of long bones, often around knee

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25
What predisposes to osteosarcoma?
Pagets disease of bone Bone infarcts Radiation Familial retinoblastoma Li-Fraumeni syndrome
26
Who gets Ewing Sarcoma? Where does it occur?
Boys \< 15 **Diaphysis** of long bones, pelvis, scapula, and ribs
27
Ewing Sarcoma
Small blue malignant tumor Onion skin appearance of bone t(11;22)
28
Where do chondrosarcomas occur? Who get them?
Pelvis, spine, scapula, humerus, tibia, or femur (diaphysis) Men 30-60 yo
29
An expansive glistening mass within the medullary cavity is a description of what?
Chondrosarcoma
30
How do you distinguish between osteoarthritis and RA?
OA: Pain after use or at end of day RA: Morning stiffness \> 30min, improve w/ use
31
What is RA mediated by?
Type III and IV hypersensitivity Cytokines
32
What antibodies can be seen in RA? What predisposes to it?
**⊕ rheumatoid factor** (IgG) **Anti-cyclic citrullinated peptide Ab** = more specific **HLA-DR4**
33
What are examples of disease modifying agents used to treat RA?
MTX Sulfasalazine TNF-α inhibitors
34
S/S of Sjogren syndrome
**Xerophthalmia** = ↓ tear producition → corneal damage **Xerostomia** = ↓ saliva prodcution → dental caries **Bilateral parotid enlargement**
35
What might a unilateral parotid enlargement in a patient with Sjogren syndrome suggest?
MALT-oma
36
What antibodies are seen in Sjogren? (2)
**Antinuclear antibodies** SS-A = anti-Ro SS-B = anti-La
37
What is the most common cause of gout?
**Underexcretion of uric acid - 90%** EtOH consumption - metabolites compete w/ uric acid for excretion
38
Gout
Precipitation of **monosodium urate crystals** **Needle-shaped ⊖birefringent** (yellow under parallel) Red, swollen, painful joint **Tophus** in external ear, olecranon bursa, achilles tendon
39
How do you treat an acute gout attack? Chronic?
**Acute** = NSAID, glucocorticoids, colchicine **Chornic =** allopurinol, febuxostat
40
What types of crystals are seen in pseudogout?
**Calcium pyrophosphate** Basophilic rhomboid, weakly ⊕ birefringent (blue when parallel)
41
What diseases might be associated with pseudogout?
Hemochromatosis HyperPTH and Hypo PTH
42
What are the 3 most common causes of infectious arthritis? In sexually active people?
**S. aureus, Streptococcus, N. gonorrhoeae** **N. gonorrhoeae**
43
What are the 4 seronegative spondyloarthropaties - what are they associated with?
**PAIR - HLA-B27** **P**soriatic arthritis **A**nkylosing spondylitis **I**BD - w/ ankylosing spondylitis or peripheral arthritis **R**eactive Arthritis
44
Psoriatic Arthritis
Dactyitis (sausage fingers) Pencil in cup
45
Ankylosing Spondylitis
CID of spine and sacroiliac joints **Ankylosis** - stiff spine - bamboo spine **Uveitis** **Aortic Regurgitation**
46
Reactive Arthritis (Reiter syndrome)
**Conjunctivis, urethritis, arthritis** Post GI - Shigella, Salmonella, Yersinia Post Chlamydia
47
What is the classic presentation of Lupus (SLE)
Rash, joint pain, and fever in a female of reproductive age and African descent.
48
What antibodies are sensitive for SLE? Drug-induced lupus?
**ANA** - sensitive not specific **Antihistone** = drug induced
49
What antibody is both specific for SLE and associated with poor prognosis?
**Anti-dsDNA** Poor prognosis associated with renal disease
50
Anti-Smith antibodies
Specific for SLE against snRNPs
51
Lupus nephritis (type III) can cause which 2 diseases?
Nephritic: **Diffuse proliferative glomerulonephritis** Nephrotic: **Membranous glomerulonephritis**
52
What do you use to treat SLE?
NSAIDs, steroids, immunosuppressants, hydroxychloroquine
53
Widespread noncaseating granulomas in a black female is indicative of what?
Sarcoidosis
54
What 2 enzymes are elevated in Sardoidosis?
**ACE** **1α-hydroxylase (Mφ)**
55
Polymyalgia rheumatica
**Pain/stiffness in hips/shoulders** + fever, malaise, and weight loss **↑ESR, CRP, normal CK** Responds to low-dose **corticosteroids**
56
How do you treat fibromyalgia?
Regular exercise Antidepressants - TCA, SNRI Anticonvulsant
57
What is polymyalgia rhematica associated with?
Temporal (giant cell) arteritis
58
Endomysial inflammation with CD8 T cells is characterisitic of what?
**Polymyositis: progressive symmetrical proximal weakness** \*\*shoulders\*\*
59
Perimysial inflammation and atrophy with CD4 Tcells?
**Dermatomyositis**: Malar rash, "shawl and face" rash, heliotrope rash, Gottron papules, mechanic's hands ↑ risk of occult malignancy
60
↑CK, ⊕ANA, ⊕anti-Jo-1, ⊕anti-SRP, and ⊕anti-Mi- antibodies are indicative of what?
Polymyositis/Dermatomyositis
61
How can you differentiate **Mysathenia Gravis** and **Lambert-Eatin myasthenic syndrome**?
**MG = worsens w/ use, improves with AChE inhibitor** Lambert-Eaton = improves with use, no response to AChEi
62
Myasthenia Gravis
Auto-Antibody to postsynaptic ACh receptor Ptosis, diplopia, weakness Associated w/ thymoma, thymic hyperplasia
63
Lambert-Eaton myasthenic syndrome
**Auto-antibodies to presynaptic Ca channel → ↓ACh release** Proximal muscle weakness, autonomic symptoms (dry mouth, impotence) **Small cell lung CA**
64
Myositis ossificans
Metaplasia of sk. muscle to bone following trauma
65
Scleroderma
Excessive fibrosis and collagen deposition throughout body
66
Diffuse Scleroderma
Widespread skin involvement, rapid progression, early visceral involvement **Anti-Scl-70 antibody** - DNA-topo I
67
Limited scleroderma
**Limited skin - fingers and face only** **CREST - antiCentromere antibody** **C**alcinosis **R**aynaud phenomenon **E**sophageal dysmotility **S**clerodactyly **T**elangiectasia

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