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YR5 Histopathology > Crash course: Bone and Skin > Flashcards

Crash course: Bone and Skin Flashcards

1
Q

Describe the structure of bones

A

Head: Epiphysis
Neck: Metaphysis (contains growth plate- physis)
Shaft: Diaphysis

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2
Q

Describe the composition of bone

A

Outer: Cortical
Inner: Medullary cavity- site of RBC production

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3
Q

Describe the structure of a joint

A

Articular capsule

Each bone covered in cartilage to prevent rubbing

Synovial cavity containing synovial fluid to lubricate joints on movement

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4
Q

What triad of features characterises McCune Albright syndrome?

A

Cafe-au-lait spots
Precocious puberty
Fibrous dysplasia

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5
Q

What is the most common malignant bone cancer in adults?

A

Osteosarcoma

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6
Q

What are different classifications of fractures?

A

Complete or Incomplete

Closed (Simple): Clean break with intact soft tissue

Comminuted: Splintered bone with intact soft tissue

Compound: Fracture site communicates with skin surface

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7
Q

What are the stages of fracture repair?

A
  1. Formation of haematoma at fracture site (pro-callus)
  2. Deposition of new, immature bone, provides scaffolding (fibrocartilaginous callus)
  3. Mineralisation of immature bone (Important to have Vit D)
  4. Remodelling along weight-bearing lines
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8
Q

What is osteoarthritis?

A

Degeneration of articular cartilage
Mechanical “wear + tear”
Remodelling of adjacent bone + inflammation

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9
Q

What is primary and secondary osteoarthritis?

A

Primary: Age related

Secondary: Any age, previously damaged or congenitally abnormal joint.

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10
Q

What are the 4 x-ray features of osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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11
Q

Where are common sites for osteoarthritis?

A

Vertebrae, HIPS + KNEES

DIPJ/ PIPJ of the hand

Carpometacarpal + metatarsophalangeal joints

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12
Q

Give 3 typical features of OA presentation

A

Pain following use, improves with rest

Unilateral Sx

No systemic upset

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13
Q

What is rheumatoid arthritis?

A

chronic, systemic AI disorder characterized by symmetrical synovitis (inflammation of synovium)

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14
Q

What is the epidemiology of RA?

A

F > M
Any age, peaks 30-40y

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15
Q

List 3 factors increasing genetic predisposition to RA

A

HLA DR4 + HLA DR1
PADI 2+4: increase citrullination of proteins
PTPN2 LoF: (usually suppresses T cell activation)

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16
Q

Describe the pathogenesis of RA (5)

A
  1. Rheumatoid factor + anti-CCP binds to receptors on synoviocytes
  2. Leads to T + B cell proliferation + angiogenesis
  3. Release of inflammatory markers
  4. Pannus formation
  5. Cartilage + bone destruction
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17
Q

Give 3 x-ray findings in RA

A

Joint subluxation
Soft tissue swelling
Erosions at joint margins

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18
Q

Proliferation of which cell occurs in RA?

A

Synoviocytes

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19
Q

Give 5 key histological features of RA

A

Synovitis

Proliferation of synoviocytes

Thickening of synovial membranes

Inflammatory cell infiltrates esp. T cells

Fibrin deposition- leads to scarring around joint

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20
Q

What are differentiating features between RhA and OA?

A

RhA:
Symmetrical

Small joints, hands + feet, sparing DIPJ

Wrists, elbows, ankles + knees

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21
Q

What are 4 characteristic sites for rheumatoid arthritis?

A

Radial deviation of wrist

Ulnar deviation of fingers

‘Swan neck’ + ‘Boutonniere’ deformity of fingers

‘Z’ shaped thumb

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22
Q

Give 3 symptoms of RA

A

Early morning stiffness >30 mins (may improve with activity)

Fatigue

Systemic Sx: low fever, weight loss, malaise

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23
Q

What is osteomyelitis?

A

Infection of bone

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24
Q

What are the 2 types of osteomyelitis?

A

Haematogenous: more common in kids
Non-haematogenous: more common in adults

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25
What are common sites of osteomyelitis?
Adults: Vertebrae Jaw (2º to dental abscess) Toe (2º to diabetic skin ulcer) (>3mm) Children: Long bones (usually metaphysis)
26
Which is the most common implicated organism in osteomyelitis?
Staphylococcus aureus
27
Which is the most common organism implicated in osteomyelitis in sickle cell patients?
Salmonella
28
What is the imaging modality of choice for osteomyelitis?
MRI
29
Give risk factors for haematogenous and non haematogenous osteomyelitis?
H: SCA, IVDU, immunosuppression, HIV, infective endocarditis NH: DM + foot ulcers, peripheral arterial disease
30
Which organism may be implicated in osteomyelitis in IVDU?
Pseudomonas aeruginosa
31
What is seen on x-ray if osteomyelitis goes untreated?
1w: Irregular sub-periosteal new bone formation (involucrum) 1-2w: Irregular lytic destruction (osteolysis) 3-6w: Detachment of necrotic cortex (sequestra)
32
What is the association between TB and osteomyelitis?
Rare cause of OM More destructive + resistant to control. Spinal disease (50%) may result in psoas abscess + severe skeletal deformity (Pott’s disease).
33
What is gout?
rapid onset crystal-induced arthritis Most common form of inflammatory arthritis.
34
Which joint is typically affected in acute gout?
1st Metatarsalphalangeal joint of the great toe
35
What causes gout?
prolonged hyperuricaemia due to purine breakdown Results in accumulation of monosodium urate (MSU) crystals in the joint.
36
Give 5 risk factors for gout
Alcohol Obesity Metabolic syndrome African American origin FH
37
What is the gold standard investigation for gout?
Synovial fluid aspiration (FNA) Examination under polarised light NEGATIVELY birefringent NEEDLE shaped crystals composed of monosodium urate YELLOW when parallel to compensator ray
38
What is seen on X-ray in gout?
Rat bite erosions
39
What is the pathognomic lesion in gout?
Tophus
40
What is pseudogout?
microcrystal synovitis caused by deposition of calcium pyrophosphate dihydrate crystals (CPPD) in synovium
41
Which joints are most commonly affected in pseudogout?
Knees Wrists Shoulders
42
What is seen on examination under polarised light in psuedogout?
RHOMBOID shaped POSITIVELY birefringent crystals BLUE when parallel to compensator ray
43
What is seen on X-ray in pseudogout?
White lines of chondrocalcinosis (calcium deposition in joint space)
44
Give 4 features of benign bone tumours
No periosteal reaction Thick endosteal reaction Regular bone formation Intraosseous + regular calcification
45
Give 5 features of malignant bone tumours
Acute periosteal reaction Distinct border between normal + malignant bone Irregular bone formation Extraosseous + irregular calcifiation Extremely PAINFUL
46
Describe the epidemiology of osteosarcoma
Adolescence V rare
47
Which bone is commonly affected in osteosarcoma?
Knee (60%) (Tibia + Femur)
48
Give 3 histological features (buzzwords) for osteosarcoma
Malignant mesenchymal cells ALP +ve Replacement of BM with trabecular bone
49
Give 3 features on X-ray in osteosarcoma
Elevated periosteum Codman's triangle Sunburst appearance
50
Describe the epidemiology of Chondrosarcoma
>40s
51
Which bones are commonly affected in Chondrosarcoma?
Axial skeleton Femur Tibia Pelvis
52
Give 3 histological features (buzzwords) for Chondrosarcoma
Malignant CHONDROCYTES (proliferation of cartilage)
53
Give 2 features on X-ray in Chondrosarcoma
Lytic lesion Fluffy calcification
54
Describe the epidemiology of Ewing's sarcoma
<20y HIGHLY MALIGNANT
55
Which bones are commonly affected in Ewing's sarcoma?
Long bones Pelvis
56
Give a histological feature (buzzword) for Ewing's sarcoma
Sheets of small round cells
57
Give a feature on X-ray in Ewing's sarcoma
Onion skinning of periosteum
58
Describe the epidemiology of giant cell (borderline malignancy)
20-40 F > M
59
Which bone is commonly affected in giant cell? (borderline malignancy)
Knee- ephiphysis
60
Give 3 histological features (buzzwords) for giant cell (borderline malignancy)
Osteoclasts + stromal cells "SOAP BUBBLE appearance" "GIANT MULTI-NUCLEATE OSTEOCLASTs"
61
Give a feature on X-ray in giant cell (borderline malignancy)
Lytic/ lucent lesions right up to articular surface
62
What is fibrous dysplasia?
Bone replaced by fibrous tissue
63
What histological feature characterises fibrous dysplasia?
"Chinese letters" + Trabecular Bone parenchyma infiltrated with fibrous tissue (bone not so dense)
64
Give 2 features of fibrous dysplasia on X-ray
Soap bubble osteolysis Shepherd's crook deformity: bowing of metaphysis
65
What are the layers of epidermis from superficial to deep?
Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum basale (come lets get some beers)
66
What are the 2 types of skin lesion?
Inflammatory: eczema + psoriasis, bullous disease Cancer: BCC, SCC, Melanoma
67
What are the 2 theories of aetiology of eczema?
Inside out: bodies own reaction to internal IgE (AI IgE sensitisation) leads to skin barrier dysfunction Outside in: body reacts to external allergen exposure leading to IgE sensitisation
68
What mutation causes eczema?
Mutations in filaggrin gene
69
What are the 2 types of reaction driving eczema?
T1 hypersensitivity: classic- atopic dermatitis T4 hypersensitivity: contact dermatitis e.g. jewellery, watches, occupational
70
What are 4 histological features of eczema?
Thickening of epidermis Spongiosis: fluid collection in dermis Eosinophil infiltrate in dermis Dilated dermal capillaries
71
What is the pathophysiology of psoriasis?
1. T4 T-cell hypersensitivity reaction within the epidermis 2. T-cell recruitment + release of inflammatory cytokines e.g. TNF-a 3. Keratinocyte hyperproliferation 4. Epidermal thickening
72
What inflammatory cell is involved in psoriasis? What does this cause?
MUNRO’s MICROABSCESSES form, from recruitment of neutrophils
73
What buzzword is associated with psoriasis?
Parakeratosis (abnormal retention of keratinocyte nuclei in stratum corneum) (release of lots of keratin + proliferation of keratinocytes)
74
What sign may be seen in psoriasis? What causes this?
Auspitz sign Rubbing skin causes bleeding
75
What is the most common type of psoriasis? Which sites are usually affected?
Chronic plaque psoriasis Extensor surfaces
76
List 5 types of psoriasis
Chronic plaque Flexural Guttate Erthrodermic/ pustular Koebner phenomenon
77
Give 2 features of guttate psoriasis
"Rain drop" lesions on back + torso 2w after Group A Streptococcal infection
78
Psoriasis is associated with what nail changes?
POSH Pitting Onycholysis Subungual Hyperkeratosis
79
Which form of psoriasis is an emergency?
Erythrodermic/ pustular
80
What is Koebner phenomenon?
New skin lesions of a pre-existing dermatosis at sites of trauma in otherwise healthy skin
81
Which population is affected by Bullous pemphigoid? Which areas?
Elderly population Flexural surfaces
82
Describe the pathophysiology of bullous pemphigoid
1. IgG antibodies + C3 bind to hemidesmosomes (adhesion molecules) in BM of epidermis 2. Epidermis lifts off 3. Fluid accumulates in space a.k.a. sub-epidermal bulla
83
Give 2 histological features of bullous pemphigoid
Eosinophilia Linear deposition of IgG along basement membrane
84
Compare the bulla in bullous pemphigoid and pemphigus vulgaris
BP: Strong, difficult to burst PV: Weak, easily broken/ ruptured + ripped apart
85
Describe onset of Pemphigus vulgaris
Blisters start in mouth before spreading to other parts of the body
86
What is the pathophysiology of pemphigus vulgaris?
IgG to desmoglein 1 + 3 (adhesion molecules) between keratinocytes in stratum spinosum Acantholysis aka intra-epidermal bulla
87
Which population is affected by pemphigus follaceus?
Elderly
88
What is the pathophysiology of Pemphigus follaceus?
IgG against desmoglein in stratum corneum Detachment of superficial keratinocytes
89
Describe the epidemiology of skin cancers
BCC: 70% SCC: 20% Melanoma: 10%
90
What is the most important prognostic feature in melanomas?
Breslow thickness
91
What is the most common melanoma?
Superficial spreading (90%)

YR5 Histopathology (27 decks)

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