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Bone Phys/path Flashcards

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0
Q

Inter-medullary callus

A
  • forms new bone from endochonral ossification following hematoma formation
  • soft callus -> hard callus
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1
Q

Vascular response in fracture repair

A
  • Bloodflow increased substantially peaks at two weeks

- Angiogenesis and vasodilation increases

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2
Q

Concave/convex remodeling

A
  • convex: electropositive->osteoclast

- concave: electronegative->osteoblast

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3
Q

Contact vs. gap healing

A
  • contact: allows for direct healing with lamellar bone

- gap: 200-500 nm: fill with woven bone, remodeled to lamellar

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4
Q

TGF in bone repair

A
  • induces the synthesis of cartilage specific proteoglycans and type II collagen
  • stimulates osteoblasts
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5
Q

BMP in bone repair

A
  • 1,2 and 3
  • 1: cleaves carboxy terminus of procallagen I,II and III
  • 2: induces endochonral ossification
  • 3: potent inducer of mesenchymal -> bone tissue
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6
Q

FGF in bone repair

A
  • acidic (FGF-1), basic (FGF-2)
  • proliferation of chondrocytes and osteoblasts
  • FGF2 stims angiogenesis
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7
Q

PDGF in bone repair

A
  • I and II
  • IGF-I induced by GH in liver
  • bone and collagen synthesis, osteoblasts proliferation and inhibits bone collagen degradation
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8
Q

Cytokines in bone repair: IL-1,4,6 and 11, CSF, TNF

A
  • Stimulates bone resorption: IL-1 most potent

- IL-1 and 6 inhibited by estrogen

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9
Q

Prostaglandins in bone healing

A
  • PGEs inhibit osteoclasts and stimulate bone formation

- leukotriens do the opposite

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10
Q

Hormones in bone repair: estrogen, thyroid, glucocorticoids

A
  • estrogen: stimulates fracture healing through IL I inhibitor
  • T3/4: stimulat osteoclast resorption
  • glucocorticoids: inhibits Ca absorption from gut -> increased PTH -> increases osteoclast activity indirectly
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11
Q

PEMF

A
  • Signals in 20 to 30 Hz range

- Shows efficacy in bone healing

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12
Q
  • Bluegray skin and yellow brown microscopic pigment
  • Presents with black urine
  • Associated with severe early-onset arthritis and spine and lower extremity joints
A
  • Alcaptonuria

- Results from homogentistate 1,2 deoxygenase deficiency -> Buildup of homogentisic acid

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13
Q

Anatomic sequelae of osteoarthritis

A
  • Joint space narrowed
  • sclerosis of subchondral
  • cystic degeneration of bone
  • osteophyte lipping
  • chronic pain and debilitation
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14
Q
  • Insidious onset of malaise fatigue and generalized musculoskeletal pain
  • This is followed by polyarticular joint pain in the hands and then the fee
A
  • RA

- Sequela a: destruction of ligaments tendons joint capsules-> deformities

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15
Q

RA immunopathenogenesis

A
  • HLA-DRB1 assoc
  • Activated CD4 stimulates macrophages and B cells
  • b cells contribute autoantibodies
  • TNF/IL1: Stimulates synoviocytes to make inflammatory mediators/mellatoproteases
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16
Q

Synovium and stroma consisting of inflammatory cells granulation tissue and fibroblasts which grow over articular cartilage

A
  • pannus

- sq: fiberous ankylosis, -> bony ankylosis

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17
Q

Fibrinoid necrosis surrounded by palisading rim of macrophages with no microbial infiltrates

A
  • Rheumatoid nodule
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18
Q
  • onset under age 16
  • arthritis present for 6 weeks, spiking fevers, malaise
  • rheumatoid nodules skin usually absent
  • rheumatoid factor usually negative
A

Juvenile idiopathic Rheumatoid arthritis

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19
Q
  • HLA-B27 assoc
  • oligoarthritis and tendinitis
  • immune-mediated disease
A
  • ankylosing spondylitis
  • reactive arthritis
  • psoriatic arthritis
  • arthritis assoc with chronic inflammatory conditions
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20
Q
  • Negatively biferingient crystals
  • hyperuricemia
  • tophi
A
  • gout/gouty arthritis
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21
Q

Mechanism for hyperuricemia

A
  • 90% due to decreased excretion of uric acid (upregulation of URAT1->increased resorption
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22
Q

HGPRTase deficiency

A
  • overproduction of uric acid due to lacking purine salvage pathway
  • Lesch-Nyhan syndrome
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23
Q

Mechanism for acute gouty arthritis

A
  • hyperuricemic conditions addressed by neutrophils which phag the crystals. They aren’t broken down and destroy the neutrophils releasing inflammatory cytokines.
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24
Positive biferingient rhomboid crystals and assoc mutation
- pseudo gout: Calcium pyrophosphate accumulation | - associated with AD mutation of ANKH gene
25
Infectious arthritis: epidemiology
- H. flu: under age 2 - S. aureus: older kids and adults - N. gonorrhea: late adolescence and younger adults - salmonella: sickle cell
26
-Insidious onset of worsening pain resulting from caseating granulomatous inflammation often times within the spinal column
- osteomyelitis from infectious TB - Potts disease - hips>knees>ankles
27
Arthritis associated with cross reactive Borrelia antigens
- infectious arthritis | - silver stain positive in only 25%
28
Ganglion cyst
- 1-2 centimeter translucent cyst not communicating with the joint space and has no cellular lining - excision is curative
29
``` Lipoma/liposarcoma Fibromatoses/fibrosarcoma Rhabdomyoma/rhabdomyosarcoma Leiomyoma/leiomyosarcoma Hemangioma/angiosarcoma ```
- Benign/malignant adipose tumor - Benign/malignant fibrous tissue tumor - Benign/malignant skeletal muscle tumor - Benign/malignant smooth muscle tumor - Benign/malignant vessel tumor
30
Lipoma versus angiolipoma
Lipoma: more common, painless, Subcubitus extremities and trunk - Well differentiated circumscribed adipocytes Angiolipoma: Male predominance subcutaneous often painful - Well differentiated adipocytes and capillary sized vessels with thrombi
31
MDM2 amplification, lack of p53 inhibition TLS-CHOP Pleomorphic - lipoblasts (lipid vacuoles, scalloping nucleus) with atypical lymphocytes
- MDM2: Well differentiated, best prognosis for liposarcoma - myxoid morphology - pleomorphic: Liposarcoma with poorest prognosis
32
- Rapidly expanding subcubitus mass muscle of forearm or trunk - Immature tissue culture would fibroblasts and myofibroblasts high cellularity
- Nodular fasciitis
33
Aggravating deforming fibrous lesion in 3 superficial location - Fascicles of mature myofibroblasts with dense collagen
- Palmer (dupuytrens contracture), - plantar (ledderhose disease), - penile (peyronie disease)
34
Locally aggressive infiltrating disfiguring mass Associated with deep proximal structures Long fascicles of bland fibroblasts infiltrating surrounding tissue Associated with the B-catenin/APC gene
- Desmoid tumor (deep fibromatosis) | - abdominal (anterior wall) extra abdominal, intra abdominal
35
Infiltrated fleshy masses with hemorrhaging and necrosis | Herringbone pattern of fascicles of malignant spindle cells
- Fibrosarcoma
36
The most common sarcoma in kids - Cluster of grapes - t2;13, PAX3-FOXO1A - Atypical bizarre tumor cells
Rhabdomyosarcoma - botryoid and embryonal (best prognosis) bladder, vagina, nasopharynx - alveolar in extremities, adolescents (worst prognosis) - pleomorphic
37
HOXD-13 mutation
- sympolydactyly
38
FGFR 3 mutation
- achondroplasia | - thanatotropic dwarfism
39
COL1A1 mutation
Osteogenesis Imperfecta
40
Synpolydactyly
- HOXD-13 mutation - Extra third digit and fuse third and fourth - homeobox genes associated with absent/extra bones and acrodactyly
41
Decrease of normal chondrocyte proliferation at growth plate
Achondroplastic dwarfism
42
Osteogenesis Imperfecta types
Defective synthesis of type I collagen: too little bone density - type I mild: normal lifespan - type II: non-survivable - type III/IV: moderate severity, deforming
43
Osteogenesis imperfecta morphology
- commonly shin deformations and scoliosis
44
Deficiency of lysosomal acid hydrolase enzymes that degrade mucopolysaccharides - progressive accumulation in cells
- hurlers: type I MPS, deficiency of a-L induronidase - hunters: type II MPS, deficiency of iduronate-2-sulfatase; XL recessive
45
Long bones lacking normal medullary cavity filled with persistent primary spongiosa - Fractures pancytopenia and cranial nerve deficits
- osteopetrosis "marble bone" disease - very heaped but very brittle bones - type II Carbonic anhydrase deficiency - May also have renal tubular acidosis
46
Mosaic pattern of lamellar bone in axial skeleton/femur Increased ALPase Increased osteoblast/osteoclast Predominantly whites
- Paget's disease - sqstm1 mutation in 50% - abnormal bone architecture
47
Osteoclast signaling
- RANK binds and MCSF is released with osteoprotegrin from stromal cell/osteoblasts - causes release of NFKB in monocyte osteoclast precursor - OPG binds and inhibits RANK
48
A specific and sensitive marker for osteoblast activity
- osteocalcin
49
Osteogenesis imperfecta
- AD (primarily) - type I collagen defect (COL1A) - type I (mild) type II (lethal) type III/IV (moderate to severe, deforming)
50
- Short stature, chest wall abnormalities, bone malformations - a-L induronidase - indurate-a-sulfatase
- hunters and hurlers | - mucopolysaccharide accumulation
51
- dense, brittle bones - concurrent renal tubular acidosis - pancytopenia -> Extra medullary hematopoiesis
- carbonic anhydrase II deficiency -> osteopetrosis (marble bone disease) - decreased osteoclast activity
52
Genetic factors and developing osteoporosis
Estrogen receptor, vitamin D receptor and LRP 5
53
Severe complications of Paget's disease
- Giant cell tumors, sarcoma (osteosarcoma/Fibrosarcoma) | - 5-10% in people with polyostoic disease
54
Vitamin D deficiency in kids | Deformed bones
Ricketts, | In adults it's osteomalacia
55
Severe cortical bone defect: increased bone resorption Dissecting trabeculae on X-ray Brown tumor
- hyperparathyroidism - can result in osteitis Fibrosis cystica if untreated - brown tumor not actually tumor: microinfarcts and 2nd hemorrhages
56
- Increased bone resorption - delayed matrix mineralization - growth retardation - osteoporosis - metabolic acidosis
Renal osteodystrophy - Phosphate retention due to renal failure results and secondary hyperparathyroidism (phosphate is a secondary regulator of PTH: PTH blocks resorption of phosphate in tubules normally leading to excretion, so with increased phosphate more PTH is needed to induce -> too much resorb) - decreased vitamin D conversion
57
Wedge shaped infarcts in medullary bone
- subchondral infarcts | - cortical bone not usually affected by infarcts due to the periosteal collateral circulation
58
Pyogenic osteomyelitis
- H. Fu: kids under 2 - S. aureus: kids and adults - N. gonnoreae: adolescents and young adults - salmonella: HbS Typically hematogenous spread: ots. Tuberculosis increasing
59
Osteomyelitis clinical course
- a necrotic center known as a sequestrum forms inside of the involucrum - may form a communicating nidus to drain through the soft tissue
60
Osteomyelitis localized to the jaw
- sclerosing osteomyelitis of Garre
61
- HLA B27 to susceptibility - Destruction of sacroiliac and apophysial joints - ANA seronegative
Ankylosing spondylitis
62
- B 27 Cw6 susceptibility | - Psoriatic condition associated with axial joints and enthesis
Psoriatic arthritis
63
Finkelstine test
- adduction of wrist with thumb adducted causes pain over radial styloid process - DeQuervains tenosynovitis
64
Yergasons sign
Bicipital tendinitis: Anterior shoulder pain
65
Shoulder pain with full range of motion
- Olecranon bursitis not involving the joint itself
66
Capsulitis arthrogram
- Reduced uptake of die on MRI
67
Pain in shoulder with abduction of arm from 60-120°
- Rotator cuff tendinitis: Most commonly weakness of the supraspinatus tendon -> Impingement of supraspinatus between humeral head and acromion process
68
Typically healthy young person with inability to abduct the arm at all
- Supraspinatus tendon tear
69
Morphological changes in osteoarthritis
- thickened joint capsule, synovial hypertrophy - sclerosed subchondral bone - cyst formation
70
Bouchards and heberdens nodes
- B before H in osteoarthritis - B=proxymal - H= distal
71
Gullwing deformity on X-ray
- Indicative of osteoarthritis
72
RA vs OA in hand
- OA spares MCP joints, RA does not | - RA is disfiguring, not just inflammatory
73
Boutonnière and swan neck deformities
- Both due to contracture of muscle groups in the hands in rheumatoid arthritis
74
Extra-articular features of rheumatoid arthritis
- pleuritis - pulmonary nodules - interstitial lung disease - Caplans syndrome ~ lung nodules ~ pneumoconiosis ~ RA
75
RA, splenomegaly, granulocytopenia
Feltys syndrome
76
Scleromalacia perforans
- complication from RA | - thinning of sclera result in extrusion of intra occular contents
77
Caplans syndrome
~ lung nodules ~ pneumoconiosis ~ RA
78
Jaccouds vs. SLE arthropathy
Both are symmetrical and nonerosive but SLE is nondeforming unlike jaccouds
79
SLE trt
- avoidance of the sun - hydroxychloroquine - steroids - cyclophosphamide/mycophenolate mofetil
80
SSA Ro/La
ANA sp to sjorgens syndrome
81
Calcinosis, Raynaud's phenomenon p, esophageal dysmotility, sclerodactyly, telangiectasia
- crest syndrome assoc with scleroderma (limited cutaneous)
82
Can't see, can't pee, can't tree
- conjunctivitis, urethritis, arthritis - triad of reactive arthritis - typically oligoarthritis
83
Treatment for reactive arthritis
Abx if infection is still present NSAIDs Corticosteroids DMARDs: sulfalazine, methotrexate, anti-TNFa
84
Keratoderma blenorrhagica
- identical to pustular psoriasis | - variable prognosis
85
Enteropathic arthropathy trt
- NSAIDs are a problem - sulfasalazine - TNFa inhibitors
86
Hyperuricemia levels
- M: 7.1mg/dl | - F: 6.0 Mg/dl
87
Precipitants of gout and gouty arthritis
- drugs: Diuretics, heparin, cyclosporine - trauma - EtOH
88
Disease states associated with CPPD crystals
- Hypothyroidism, Hyperparathyroidism,hypophosphatasia, hemochromatosis, hypomagnesemia
89
Vasculitis affecting large and medium blood vessels
- giant cell arteritis - takayasu's arteritis - angiitis of CNS
90
Vasculitis affecting predominantly medium and small blood vessels
- polyarteritis nodosa - microscopic angiitis - Wegeners syndrome - Churg-straus syndrome
91
Vasculitis affecting predominantly small blood vessels
- Henoch-schonlein purpura - HSN vasculitis - mixed cryoglobinemia
92
- medium/small vessels | - Identified by recent history of severe asthma, eosinophilia, sinusitis, pulmonary infiltrates, G.I. ischemia
Churg straus vasculitis
93
- Small/medium vessels - ischemia involving ~ renal, GI mesentery, peripheral nerves, CNS - livedo reticularis (doily rash)
Polyarthritis nodosa
94
Angiogram demonstrating aneurysmal dilation tapering a blood vessel
Diagnostic for polyarteritis nodosa
95
- Headache, scalp tenderness, fever, weight loss, night sweats, visual disturbance, blindness - Vasculitis involving cranial arteries and large branches aorta
- Giant cell arteritis (temporal arteritis) | - trt with high dose steroids
96
Wegeners syndrome
- Radiographically identical to metastatic carcinoma of the lung - get a biopsy - saddle nose deformity
97
Henoch schonlein purpura
- classic triad: ~ lower extremity rash ~ abdominal pain ~ hematuria

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