Bones, Joints, and Tumors Flashcards

Question

Pott's Disease (associated wwith tuberculous arthritis)

Answer 1

- Extrusion of disc after collapse of vertebra - Tuberculous pus and granuloma with lysis and collapse of bone - Anterior extrusion of pus to form psoas abscess - Posterior extrusion of pus into dura - Bamboo spine

Answer 2

- Reactive Arthritis (ReA) - Psoriatic Arthritis (PsA) - Ulcerative colitis - Crohn disease

Answer 3

- Vertebrae - Sacro – iIio – lumbar and areas (prominent region of tendon and ligament insertions) - Enthesis (point of tendon, ligament or muscle insertion into bone)

Answer 4

- Inflammation at tendon/ligament/muscle insertion sites

Answer 5

- Chronic inflammatory joint disease | - Sacroiliac infiltration (CD4 and CD8+ T cells, macrophages and high [TNF-α])

Answer 6

- Usually 2nd and 3rd decades of life - Men 2-3x > frequently than woman - 80 - 90% of individuals are HLA-B27 positive - No specific lab test

Answer 7

- Enthesopathy (inflammation) - Mononuclear cell infiltrate - PMN - Tumor Necrosis Factor (high levels) - CD4+ T cells - CD8+ T cells - Macrophages

Answer 8

- Chronic synovitis - Destruction of articular cartilage - Bony ankylosis - Tendinoligamentous inflammation and ossification - Bony outgrowths (syndesmophytes) --> severe spinal immobility

Answer 9

- Osseous excrescence attached to a ligament - Bamboo Spine - Feature of AS

Answer 10

- Chronic progressive - Low back pain - Peripheral joints (hips, knees, and shoulders)

Answer 11

- Fracture of the spine - Uveitis - Aortitis

Answer 12

- Genitourinary (Chlamydia) - Gastrointestinal tract infections (Shigella, Salmonella, Yersinia, Campylobacter) - Symptoms emerge 2-3 wks after infection - 80% + HLA-B27

Answer 13

- Arthritis - Urethritis / Cervicitis - Conjunctivitis

Answer 14

- Organisms associated with enteric Infections | - Immunologic responses against lipopolysaccharide components

Answer 15

- Enthesitis | - Macrophage infiltration of fibrocartilage

Answer 16

- Arthritic symptoms (painful) - Develop within weeks of urethritis or diarrhea - Joint stiffness and low back pain - Asymmetrical (additiveknee/ankle) - Synovitis - Ossifications - Severe

Answer 17

- Ankylosing spondylitis

Answer 18

- Circinate Balanitis - Keratoderma blenorrhagica - Plaques / erosions of tongue - Painful erosions on hands / fingers - Conjunctivitis - Cardiac conduction abnormalities - Aortic regurgitation

Answer 19

- Serpiginous ring-shaped dermatitis of the glans penis - One of the most common cutaneous manifestations of reactive arthritis - However, balanitis circinata can also occur independently

Answer 20

- Skin lesions commonly found on the palms and soles in reactive arthritis - May spread to the scrotum, scalp and trunk - Lesions may resemble psoriasis

Answer 21

- Self-limiting (resolution 3-12 months) | - Arthritis waxes and wanes (several weeks to months)

Answer 22

- Recurrent arthritis - Tendonitis - Fasciitis - Lumbosacral back pain

Answer 23

- Deposition of calcium pyrophosphate crystals within joint space - Occurs in patients > 50 years old; both sexes affected equally - Knee most commonly affected joint

Answer 24

- Chondrocalcinosis (cartilage calcification) on x-ray | - Crystals are rhomboid and weakly ⊕ birefringent under polarized light (blue when parallel to light)

Answer 25

- Acute treatment: NSAIDs, colchicine, glucocorticoids | - Prophylaxis: colchicine

Answer 26

- Caused by precipitation of monosodium urate crystals in joints

Answer 27

- Male sex - Hypertension - Obesity - Diabetes - Dyslipidemia - Hyperuricemia (strongest risk factor)

Answer 28

- Underexcretion of uric acid (90% of patients) | - Overproduction of uric acid (10% of patients)

Answer 29

- Idiopathic - Potentiated by renal failure - Exacerbated by certain medications (eg, thiazide diuretics)

Answer 30

- Lesch-Nyhan syndrome - Increased cell turnover (eg, tumor lysis syndrome) - von Gierke disease

Answer 31

- Needle shaped and ⊝ birefringent under polarized light | - Yellow under parallel light, blue under perpendicular light

Answer 32

- Degeneration of cartilage | - Structural and functional failure of synovial joints

Answer 33

1. Chondrocyte injury 2. Early OA 3. Late OA

Answer 34

- Genetic | - Biomechanical factors

Answer 35

- Chondrocyte proliferation - Secrete inflammatory mediators - Remodeling of cartilaginous matrix - Initiation secondary inflammatory changes in the synovium and subchondral bone

Answer 36

- Repetitive injury and chronic inflammation - Chondrocyte drop out - Marked loss of cartilage - Extensive subchondral bone changes

Answer 37

- Fissures and clefts at the articular surface occur - Chondrocytes die - Full-thickness portions of the cartilage are sloughed - Dislodged pieces of cartilage and subchondral bone tumble into the joint, forming loose bodies (joint mice)

Answer 38

- Exposed subchondral bone plate becomes the new articular surface - Bone eburnation - Fracture gaps force synovial fluid into the subchondral - Fibrous-walled cysts develop - Bony outgrowths develop at the margins

Answer 39

- Insidious disease | - Asymptomatic until 50s

Answer 40

- Deep, achy pain that worsens with use, morning stiffness , 20min - Crepitus, limitation ROM - Only one or a few joints are involved (asymmetrical)

Answer 41

- Hips, Knees, lower lumbar, cervical vertebrae - Proximal and distal interphalangeal joints of the fingers - First carpometacarpal joints, first tarsometatarsal joints

Answer 42

- Prominent osteophytes at the DIP joints (common in women) | - Feature of OA

Answer 43

- Results in cervical and lumbar nerve root compression - Radicular pain - Muscle spasms - Muscle atrophy - Neurologic deficits

Answer 44

- Chronic inflammatory disorder of autoimmune origin - Affect many tissues and organs - Principally attacks the joints

Answer 45

- Non-suppurative proliferative and inflammatory synovitis

Answer 46

- Mediated by antibodies against self-antigens - Cytokine-mediated inflammation (secreted by CD4+ T-cells) - Autoantibodies generated specific for citrullinated peptides (CCPs)

Answer 47

- Arginine residues are post-translationally converted to citrulline - Antigen-antibody complexes containing citrullinated fibrinogen, type II collagen, α-enolase and vimentin deposit in the joints

Answer 48

- Symmetric arthritis - Small joints of the hand and feet - Synovium

Answer 49

- Edematous - Thickened, hyperplastic - Dense inflammatory infiltrates - Lymphoid follicles - Increased vascularity - Fibrinopurulent exudate on the synovial and joint surfaces

Answer 50

- Periarticular erosions and subchondral cysts - Pannus formation - Pannus bridges the apposing bones to form a fibrous ankylosis - Ossification and fusion of bone = bony ankylosis

Answer 51

- Most common cutaneous lesions of RA | - Approximately 25% of individuals with severe disease

Answer 52

- Ulnar aspect of the forearm - Elbows - Occiput - Lumbosacral area

Answer 53

- Acute necrotizing vasculitis (small and large arteries) - Obliterating endarteritis (peripheral neuropathy, ulcers, gangrene) - Leukocytoclastic vasculitis (purpura, cutaneous ulcers, nail bed infection) - Ocular changes (such as uveitis and keratoconjunctivitis)

Answer 54

- Symptoms usually develop in the hands (MCP, PIP) - Feet, followed by the wrists, ankles, elbows, and knees - Progressive joint enlargement - Decreased range of motion - Ankylosis

Answer 55

- Characteristic radiographic finding - Sterile, turbid synovial fluid - Combination of rheumatoid factor and anti-CCP antibody (80% of patients)

Answer 56

- Reactive (2° trauma or degenerative processes) - Neoplastic (cytogenetic studies reveal consistent chromosomal aberrations) - Benign neoplasms

Answer 57

- 20–40 years old - Epiphysis of long bones (often in knee region) - Locally aggressive benign tumor - Significant bone destruction, local recurrence, and occasionally metastasis

Answer 58

- Express high levels of RANKL | - Promotes proliferation of reactive multinucleated giant (osteoclast-like) cells

Answer 59

- Feedback between osteoblasts and osteoclasts is absent - “Osteoclastoma” - “Soap bubble” appearance on x-ray

Answer 60

- Destroy the overlying cortex - Large, red-brown masses - Cystic degeneration

Answer 61

- Sheets of uniform oval mononuclear cells - Numerous osteoclast-type giant cells - Necrosis and mitotic activity prominent

Answer 62

- Common localized form of GCTs - GCT of the tendon sheath - Often found in the hands and feet

Answer 63

- Discrete nodule on a tendon sheath (wrist, fingers) - Arise in the 20s – 40s - Affect the sexes equally

Answer 64

- Solitary - Slow-growing - Painless mass - Cortical erosion - Often recurs locally - Surgery

Answer 65

- Localized | - Well circumscribed (walnut shaped)

Answer 66

- Polyhedral - Histiocytes - Multinucleated Giant Cells - Resemble synoviocytes

Answer 67

- Tumors that show evidence of Schwann cell differentiation - Schwannomas (Neurilemmoma) - Neurofibromas - Malignant Peripheral Nerve Sheath Tumors - Neurofibromatosis Type 1 Type 2

Answer 68

- Arise directly from peripheral nerves - Benign - Encapsulated

Answer 69

- Schwannomas | - Neurofibromas

Answer 70

- Most common in boys (< 15 years old) - Anaplastic small blue cells (neuroectodermal origin) - “Onion skin” periosteal reaction in bone - Aggressive with early metastases - Responsive to chemotherapy

Answer 71

- Diaphysis of long bones (especially femur) | - Pelvic flat bones

Answer 72

- Conditions with similar morphology | - Lymphoma, chronic osteomyelitis

Answer 73

- T (11;22) (fusion protein EWS-FLI1)

Answer 74

- 70% have acquired genetic abnormalities - RB - TP53 - INK4a - MDM2 and CDK4

Answer 75

- Painful (particularly pain with activity) - Progressively enlarging masses - Sudden fracture of the bone is the first symptom

Answer 76

- Mixed lytic and blastic mass with infiltrative margins - Tumor breaks through the cortex and lifts the periosteum - Codman triangle

Answer 77

- Shadow between the cortex and raised ends of periosteum

Answer 78

- All age groups - Bimodal age distribution - 75% in persons younger than 20 - Second peak occurs in older adults (Paget disease, bone infarcts, prior radiation) - Men affected more than women (1.6 : 1)

Answer 79

- Metaphysis of long bones (often in knee region) | - Pleomorphic osteoid-producing cells (malignant osteoblasts)

Answer 80

- Arises in the metaphysis of long bones - Destroy the surrounding cortices and produce soft tissue masses - Spread extensively in the medullary canal, infiltrating and replacing hematopoietic marrow

Answer 81

- Bulky tumors that are gritty, gray-white - Often contain areas of hemorrhage and cystic degeneration - Tumor cells vary in size and shape and frequently have large hyperchromatic nuclei - Bizarre tumor giant cells are common, as are abnormal mitoses - Vascular invasion is usually conspicuous

Answer 82

- Osteosarcoma

Answer 83

- X-ray | - Biopsy

Answer 84

- Spread hematogenously to the lungs - Approximately 10% to 20% have pulmonary metastases at diagnosis - Outcome for patients with metastases, recurrent disease or secondary osteosarcoma is poor (<20% 5-year survival rate)

Bones, Joints, and Tumors Flashcards

(108 cards)