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MSK Part 2 (nlg) > bone pathology > Flashcards

bone pathology Flashcards

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1
Q

What is ESR?

A

erythrocyte sedimentation rate, RBC aggegation causes increased sedimentation (falls faster in test tube)

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2
Q

why does elevated ESR indicate inflammation?

A

inflammatory products (fibrinogen) coat RBC and cause aggregation –> falls faster in test tube

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3
Q

increased ESR in lab could mean…

A 
anemia
infection, inflammation
cancer
pregnancy
autoimmune(SLE)
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4
Q

SLE

A 
systemic lupus erythematous
autoimmune CT disease, chronic
antigen / Ab complex (tyoe 3 hypersensitivity)
malarbutterfly, discoid rash, oral ulcers, arthritis, raynauds , anemia, phenomenon
 childbearing aged women
imitates many diseases!
inflammation 
Not as damaging as RA.
\+ ANA/anti-sdDNA/anti Sm
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5
Q

what disease/gene causes impaired cartilage proliferation in growth plate (short extremities and normal head and chest?

A

achondroplasia

activating mutation –> overexpression of FGFR3

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6
Q

what type of bone formation does achondroplasia affect?

A

endochondral bone formation!

intramembranous is unaffected

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7
Q

what disease gives you normal size head and chest but small extremities?

how are mental function, life span, and fertility

A

achondroplasia

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8
Q

osteogenesis imperfecta

A

congenital defect of bone formation–> weak bone

defect in collagen type 1 synthesis

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9
Q

features of osteogenesis imperfecta

A

weak bone
multiple fractures (can mimic child abuse)
blue sclera - thinning to see choroidal veins
hearing loss - middle ear factures easily

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10
Q

abnormal bone resorption

  • -> abnormal thick heavy bone that fractures easily
  • poor osteoclast [ ]
A

osteopetrosis

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11
Q

what mutation occurs in osteopetrosis?

A

carbonic anhydrase II mutation –>leads to loss of acidic microenvironment and bone cannot be resorbed by osteoclasts

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12
Q

osteopetrosis treatment?

A

marrow transplant

osteoclasts form from monocytes

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13
Q

clinical features of osteopetrosis

A

anemia/thrombocytopenia due to bony replacement of marrow
vision and hearing impaired - cranial nerve impingement
hydrocephalus due to narrowing of foramen magnum
renal tubular acidosis- lack of carbonic anhydrase –>decreased HCO3 resorbtion

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14
Q

osteoblasts –> bone?

A

osteoblasts form osteoid which is then mineralized w calcium and phosphate to form bone

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15
Q

low vit D results in low serum —- & —-?

A

calcium and phosphate

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16
Q

rickets and osteomalacia are diseases that…

A

defective mineralization of osteoid due to low vitamin D

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17
Q

vitaminD sources and activation

A

diet and sunlight;

activated in liver (25 hydroxylation) and proximal tubule cells of kidney (1 alpha hydoxylation)

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18
Q

what does ACTIVATED vit D do?

A

raises serum ca and phosphate by increasing reabsorption in intestine, kidney,and bone

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19
Q

rickets

A

low vit D in children leading to low bone mineralization

arises <1yo, pigeon breast deformity, frontal bossing (osteoid deposit in forehead), rachitic rosary, bowing of legs

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20
Q

osteomalacia

A

low vit D leading to low bone mineralization in adults
weak bone with increased risk of fracture
LAB: decreased serum ca and phosphate and increased PTH and alkaline phosphatase

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21
Q

Lab: decreased serum ca and phosphate, increased PTH and alkaline phosphatase

A

osteomalacia

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22
Q

reduction in trabecular bone mass resulting in porous bone

A

osteoporosis

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23
Q

RANKL - what does it do and what is it a sign of

A

increase osteoclast activity;

osteoporosis

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24
Q

risk of Osteoporosis

A

mostly senile and postmenopausal
rate based on peak bone mass (30 yo) and rate of bone loss after (normally 1% a yr)
bone loss is more rapid with lack of weight bearing exercise, poor diet, and decreased estrogen

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25
treatment for osteoporosis
exercise, vit D, calcium, bisphosphonates | not glucocorticoids!!
26
what do bisphosphonates do?
induce apoptosis of osteoclasts
27
Lab for osteoporosis
ca, phosphotase, PTH, and allkaline phosphatase all NORMAL --> rules out osteomalacia **measure bone density using DEXA
28
clinical features of osteoporosis
bone pain and fractures in weightbearing areas - vertebra, hip, distal radius -lost of height from vertebra compression
29
paget disease
imbalance between osteoclast and osteoblast activity, in late adulthood three stages - osteoclastic, mixed, and osteoblastic/sclerotic results in thick, bone with lamellar cement lines (jig saw) that fractures easily due to rushed osteoblasts
30
does paget disease affect entire skeleton?
NO, just one or a few bones | -skull is common
31
clinical features of pagets disease?
``` bone pain (microfractures), increasing hat size, hearing loss (impinged cranial nerve), lion like facies, ```
32
Lab shows all normal except isolated elevated alkaline phosphotase
paget disease
33
treatment of pagets
calcitonin (inhibits osteoclasts) | bisphosphonates (osteoclast apoptosis)
34
two complications of pagets disease
osteosarcoma | AV shunts in bone --> cardiac failure
35
osteomyelitis
infection of marrow and bone, usually bacterial, hematogenous spread kids>adults pain with systemic signs of infection lytic focus (abcess) surrounded by bone sclerosis (sequestrum surrounded by involucrum)
36
where does each form of osteomyelitis seed and in who?
``` transient bacteremia (kids) - metaphysis open wound bacteremia (adults) - epiphysis ```
37
most common cause of osteomyelitis (plus others)
**staph aureus - 90% Ngonorrhoeae - sexually active young adults salmonella - sickle cell pseudomonas - diabetics or IV drug users pasteurella - cat or dog bite mycobacterium tuberculosis - involves vertebra
38
avascular aseptic necrosis vs osteomyelitis
similar presentation except aseptic necrosis is not caused by bactera
39
avascular aseptic necrosis
ischemic necrosis of bone and marrow | caused by trauma, fracture, steroids, sickle cell anemia, and caisson disease (N gas in blood)
40
whats a major complication of avascular necrosis?
osteoarthritis and fracture
41
benign tumor of bone? where do they arise mostly? associated with?
osteoma facial bones gardner syndrome
42
osteoid osteoma
benign tumor of osteoblasts(that produce oteoid) surounded by rim of reactive bone <2cm bony mass in duaphysis cortex (surface) of long bones (femur) with radiolucent core -young adults
43
osteoid osteoma vs osteoblastoma
OO is 2cm, in vertebrae, and does NOT resolve w aspirin
44
osteochondroma
tumor of cone with an overlying cartilage cap; most common benign tumor of bone arises from lateral projection of growth plate (metaphysis) and continuous w marrow *rarely metastasis to osteosarcoma
45
malignant proliferation of osteoblasts, produces osteoid
osteosarcoma
46
demographics of osteosarcoma?
teens>elderly
47
where does osteosarcoma arise?
metaphysis of long bones in knee region (distal femur or proximal tibia)
48
risk factors for osteosarcoma?
familial retinoblastoma, paget disease, radiation exposure
49
three signs of osteosarcoma
bone pain with swelling or pathologic fracture sunburst appearance lifting of the periosteum (codman triangle)
50
codman triangle
lifting of the periosteum as tumor of bone protrudes through cortex
51
only tumor that grows in epiphysis?
giant cell tumor (epiphyses of long bones)
52
giant cell tumor
multinucleate giant cells and stromal cells, "soap bubble" on xray -young adults, knee region, epiphysis -aggressive, can recur -
53
malignant proliferation of poorlydifferentiated cells from neuroectoderm, in diaphysis usually males <15
ewing sarcoma
54
onion skin appearance on xray
ewing sarcoma
55
where does ewing sarcoma develop?
diaphysis of long bone, usually in male kids <15 | often metastasizes
56
biopsy of ewing sarcoma shows? | what genetic defect causes it?
small round blue cells that resemple lymphocytes | t(11,22) translocation
57
chondroma
benign tumor of cartilage | medulla of hands and feet
58
chondrosarcoma
malignant cartilage forming tumor | medulla of pelvis or central skeleton
59
metastatic tumors
more common than primary tumors --> result in osteolytic (punched out) lesions BUT prostatic carcinoma results in osteoblastic lesions
60
osteoarthritis
progressive loss of articular cartilage due to wear and tear | stiffness in the morning that WORSENS during day
61
most common arthritis
osteoarthritis
62
risk factors for osteoarthritis
old age, obesity, trauma
63
osteoarthritis affects what joints?
hips, lumbar, knees, DIP AND PIP
64
what nodes develop at DIP and what at PIP?
DIP -> heberden nodes | PIP -> bouchard nodes
65
pathologic findings of osteoarthtritis?
``` disruption of articular surface (joint mice) eburnation (polishing) ofsubchondral bone after it is exposed osteophyte formation (reactive bony outgrowths) in DIP and PIP (heberden and bouchards) ```
66
osteophyte
reactive bony outgrowth | happens in osteoarthritis
67
rheumatoid arthritis
chronic, systemic, autoimmune late bearing aged women morning stiffness that IMROVES with activity
68
morning stiffness - gets worse in day or better....2 conditions?
worse --> osteoarthritis | better --> rheumatoid arthritis
69
disease associated with HLA-DR4?
rheumatoid arthritis
70
synovitis leading to pannus (inflamed granulation tissue)?
rheumatoid arthritis
71
what leads to joint space narrowing, loss of cartilage and destruction of joint, fusion (ankylosis)
rheumatoid arthritis
72
what is usually spared in RA?
DIP
73
symmetric involvement of PIP, wrists, elbows, ankles, and knees
Rheumatoid arthritis
74
clinical features of RA
rheumatoid nodules vasculitis baker cyst pleural effusions
75
Lab findings of RA
IgM autoantibodies against FC portion of IGG | high neutrophils and high protein in synovial fluid
76
IgM autoantibodies against Fc portion of IgG
Rheumatoid arthritis
77
lack of rheumatoid factor axial skeleton involvement HLA-B27
seronegative spondyloarthropathies
78
HLA-B27 association
seronegative spondyloarthropathies
79
disease of vertebral column
seronegative spondyloarthropathies
80
ankylosing spondyloarthritis
involvement of sacroiliac joints and spine --> leads to fusion of vertebrae young adults usually males presents with low back pain
81
what can associate with uveitis and aoritis?
anklosing spondyloarthritis
82
reiter syndrome
arthritis, urethritis, and conjunctivitis | arises in young male adult weeks after GI infection
83
DIP of hands and feet are commonly affected (sausage fingers and toes)
psoriatic arthritis
84
psoriatic arthritis due to?
N gonorrhoeae - sexually active young adults | staph aureus - older children
85
usually involves a single joint, mostly knee | warm, erythematous limited ROM
psoriatic arthritis
86
gout
deposition of MSU crystals in tissues, especially the joints | due to hyperuricemia
87
hyperurimia and deposition of MSU crystals causes
gout
88
leukemia and MPDs lesch nyhan syndrome renal insufficiency
secondary gout
89
podagra
arthritis of big toe (acute gout)
90
chronic gout
tophi- uric acid crystals in soft tissue or joints | renal failure - uric acid deposition in tubules
91
yellow needle shaped crystals with negative birefringence under polarized light
chronic gout
92
pseudogout
resembles gout deposition of calcium pyrophosphate rhomboid shaped crystals with weak positive birefringence
93
gout vs pseudogout under polarized light
g- needle shaped, yellow, negative birefringence | ps- rhomboid, blue, positive birefringence

MSK Part 2 (nlg) (9 decks)

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