Diseases of the Musculoskeletal System - Diseases (53 & 54) Flashcards Preview

Clinical Pathology > Diseases of the Musculoskeletal System - Diseases (53 & 54) > Flashcards

Flashcards in Diseases of the Musculoskeletal System - Diseases (53 & 54) Deck (89):
1

How many bones?

206

2

What is arthritides?

Pain and stiffness of joint

3

Cause of arthritides

Inflammation of the joint, not a single disease

4

Acute arthritis

Pain, heat, redness and swelling

5

Chronic arthritis commonest types

Osteoarthritis and RA

6

Osteoarthritis

commonest type, degenerative, progressive erosion of articular cartilage

7

What to osteoarthritis result iin

Formation of bony spurs and cysts at margins of joints (subchondral cysts)

8

Secondary OA

Due to wear and tear, frequent use of a joint

9

Causes of OA

Aging, underling systemic disease (diabetes and obesity)

10

Commonest location of OA

Knees and hand in women and hip in men

11

OA pathogenesis

Deterioration and loss of cartilage (protective cushion),

12

Cellular basis of OA

Chondrocytes, produce IL-1 (matrix breakdown)

Prostaglandins derivatives > release of lytic enzymes (prevents matrix synthesis)

13

Primary OA

Abnormal stress in weight bearing joints

14

Where does primary OA affect?

Fingers (Herberden's/Bouchard's nodes), knees and cervical and lumbar spines

15

RA

Chronic systemic disorder, non-suppurative proliferative synovitis - destruction of articular cartilage and ankylosis of joints

16

RA affects..

Skin (rheumatoid nodules), muscles, heart, lung, spleen and blood vessels (Small joints of hands and feet > deformed joint)

17

RA is more common in men or women?

3-5 times more in women than men

18

Pannus (RA)

Inflammatory substances between two bones, sticky erodes into articular cartilage and penetrates subchondral bone and cyst formation > ankylosis of joint space

19

RA clinical features

Malaise, fatigue, generalised musculoskeletal pain, swollen, pain, warm and stiff joints

20

RA disease course

Slow/rapid course, fluctuates over 4-5 years

21

RA pathogenesis

Genetic (HLA-DR4 and DR1), EBV, Viruses, Borrelia, Autoimmune reaction with synovial membranes (CD4 positive T-cells), mediators of joint damage (cytokines), IL-1-6 and TNF-a/B

22

Criteria for diagnosis

1. Morning stiffness
2. Arthritis in 3 or more joint areas
3. Arthritis of hand joints
4. Symmetric arthritis
5. Rheumatoid nodules
6. Serum Rheumatoid factor
(4 of above)

23

Rheumatoid factor

Present in most but not all

24

Analyse synovial fluid

Presence of neutrophils - inflammation

25

Sero-Negative arthritides

Lack RF

26

Examples of Sero-negative arthritis

Ankylosing spondylitis, Reiter's syndrome, Psoriatic arthritis, Eneteropathic arthritis

27

Gout

Hyperuricemia (Uric acid end product of purine metabolism - deficiency of some enzymes involved)

28

Gout clinical features

Acute arthritis, chronic arthritis, tophi in various sites (uric acid crystals in joint spaces) > chronic gouty nephropathy and deposition of masses of rates in joints other sites (Tophi)

29

Pyogenic osteomyelitis clinical features

Systemic illness - fever, malaise, chills, marked pain over affected region

30

Pyogenic OM examinations

X-ray lytic focus of bone destruction surrounded by zone of sclerosis, Blood cultures positive (essential), biopsy (shows neutrophils not cause)

31

Pyogenic OM causes

Bacteria, haematogenous spread, extension from contiguous site, direct implantation

32

Infective arthritis

Acutely painful and swollen joints with restricted movements

33

Infective arthritis clinical presentation

Fever, leucocytosis and elevated ESR

34

Causes of infective arthritis

Bacterial (Staph, Strep, Gonococcus, Mycobacteria), Trauma, IVDU, debilitating illness

35

Osteoporosis

Increased porosity of skeleton, reduction in bone mass, locailised/entire skeleton, primary/secondary

36

Who does osteoporosis effect?

Primary-Age, post menopausal , physical activity, muscle strength, diet, hormonal status

37

Osteoporosis clinical features

Vertebral fractures, kyphosis, scoliosis

38

Secondary osteoporosis caused by

Endocrine disorders (Hyperparathyroidism, Type 1 diabetes), neoplasia (multiple myeloma), malnutrition

39

Osteoclast dysfunction causes

Paget's disease (collage of matrix madness), usually tidy up
1. Osteolytic stage
2. Predominant osteoblastic activity
3. Burnt out ostesclerotic stage
4. Net effect - gain in bone mass
5. Newly formed bone is disordered and architecturally unsound

40

What is osteoclast dysfunction caused by

Paramyxovirus infection

41

Histological hallmark of osteoclast dysfunction

Mosaic pattern

42

Paget's disease affects who?

Males > females

43

What age does Paget's disease effect?

5th decade

44

What's mainly involved in Paget's disease?

Axial skeleton and proximal skeleton

45

What's most common symptom of Paget's disease?

Pain

46

Complications of Paget's disease

- Chalk stick type fractures
- Tumours (Benign - giant cell, malignant - osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma)

47

Osteomalacia

Defects in matrix mineralisation, lack of Vit d, decreased bone density (osteopenia), skeletal deformities not seen

48

Hyperparathyroidism increases

- Bone resorption and calcium metabolism from skeleton
- Renal tubular reabsorption and retention of calcium

49

Hyperpararthyoridism complications

Hypercalecemia, osteitis fibrosa cystica (loss of bone mineral with osteoporosis)

50

Real osteodystrophy

Skeletal changes of CKD
- Increased osteoclastic bone resorption
- Delayed matrix mineralisation
- Osteosclerosis
- Growth retardation
- Osteoporosis

51

Soft tissue

Non-epithelial extraskeletal structures exclusive of supportive tissue of organs and lymphoid/hematopoietic tissue

52

Embryological origin of soft tissue

Mesodermal

53

Are benign soft tissue tumours common or rare?

Common

54

Sarcomas

Malignant soft tissue tumours, rare and lymph node involvement is uncommon

55

Neurofibromatosis Type 1

Neurofibroma

56

Gardner syndrome

Fibromatosis

57

Carney syndrome

Myxoma, melanotic schwannoma

58

Turner syndrome

Cystic hygroma

59

Diagnosis of soft tissue tumour

- Ultrasound guided core biopsy
- Cytogenetics (fresh tissue and karyotype)
- Molecular genetics (FISH, PCR and RT-PCR)

60

Benign bone tumours

Osteomas, Osteoblastomas

61

Benign cartilage tumours

Chondromas

62

Mixed benign tumours

Osteochondromas

63

Malignant bone tumours

Osteosarcoma

64

What age group does malignant bone tumours effect?

Young

65

Where is commonest site for malignant bone tumours?

Knee (60%)

66

Other bone tumours

Chrondosarcomas, Ewing's sarcoma, Giant cell tumours

67

Metastatic bone tumours

Thyroid, prostate, kidney, breast, GI tract

68

SLE

Complex multi-system disease, predominantly cutaneous

69

Is SLE more common in males or females?

Females

70

Clinical presentation of SLE

Butterfly rash, cardiomegaly, endocarditis, CNS (convulsions, hemiplegia), 45% patients nephron syndrome and glomerulonephritis

71

Pathogenesis of systemic sclerosis

Vessel damage, inflammatory response, cytokines, diffuse - widespread cutaneous lesions

72

Which systems does systemic sclerosis effect?

Renal, Cardiorespiratory, GIT, osteoarticular involvement (arthralgia, arthritis)

73

What is prognosis for systemic sclerosis?

Poor

74

Localised variant of systemic sclerosis

Limited cutaneous and oesophageal involvement, SI malabsorption, CREST syndrome

75

CREST syndrome

Calcinosis, Raynaud's phenomenon, Oesophageal dysfunction, Sclerodactyly, Telangiectasia

76

Symptoms of Polymyalgia Rheumatica

Stiffness, weakness, aching and pain in muscles of neck, limb girdles and upper limbs

77

Polymylagia Rheumatica associated with

Giant cell arteritis

78

Giant cell arteritis affects what

Occipital or facial arteries

79

Giant cell arteritis symptoms

Pyrexia, headache and severe scalp pain

80

Myopathy

Muscle disease unrelated to any disorder of innervation/neuromuscular junction

81

Myositis

Muscle fibres and overlying skin are inflamed and damaged resulting in muscle weakness

82

Muscular dystrophy

Heterogenous group, inherited, progressively severe muscle weakness and wasting

83

When'd does muscular dystrophy start

Childhood

84

Malignant hyperthermia

(Inherited) Fast rise in body temperature and severe muscle contraction

85

When does malignant hyperthermia occur?

When affected person gets general anaesthesia

86

Rhabdomyolysis

Destruction of skeletal muscle, release of muscle fibre content into blood, myoglobin is released into blood, filtered through kidneys > myoglobinuria (brown urine)

87

Causes of rhabdomyolsis

Trauma, crush injuries, drugs (cocaine, amphetamine), extreme temp, severe exertion, lengthy surgery, severe dehydration, complication (acute renal failure)

88

Metabolic myopathies

Glycogen synthesis and degradation, disorders of mitochondrial metabolism

89

Symptoms of malignant hyperthermia

Bleeding, dark brown urine, muscle rigidity, quick rise in body temp 40 degrees and higher

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